Reverse abdominoplasty with hernia repair plus breast fat transfer? (Photo)

Thank you for your question and photos. I do see why it is hard to find or convince board certified plastic surgeons to go along with your plan. You not only have loose muscles and plus hernia in the upper abdomen, but you also have looseness in the lower abdomen below the belly button. A reverse abdominoplasty will not give you good or reliable results for your problem. If you were my patient, as a Total Definer surgeon, I would do a full abdominoplasty with a low pubic bone level incision. You most likely will end up with a short vertical scar in the midline, perpendicular to the horizontal abdominoplasty scar. You do not have significant fat on your body (what I can see) which would make a difference in your breast size. Reviewed your previous results and they show modest and nice increase in size, but fat grafting does not address the sagginess of the breasts. Having a breast lift done in your situation would involve only a vertical incision besides the circumareolar incision. You were probably thinking that most surgeons do an anchor type of lift, and the scar would help reshape the breasts and also serve as the upper abdominal incision. That will not be the case. BTW, the hernia can be repaired as easily from below, without making an upper abdominal incision. Good luck in your search.

Great question. Reverse tummy tucks (RTT) are usually not commonly talked about, however in certain patients i is the most appropriate procedure to achieve the best results. The incision for a reverse tummy tuck is in the breast folds which is the same incision that is used for breast lift procedures. So RTT is often done at the same time as a breast lift as they use similar incisions. Epigastric hernias can be repaired through a RTT as well depending on their size and location.
Its best that you consult a Plastic surgeon with experience in RTTs to get an opinion if this is the right procedure to get the best results in your circumstances.

Dear Straightforward194722,

Based on your description and concerns, a reverse tummy tuck (abdominoplasty) may not provide you with the optimal results you are seeking. The muscle weakness you've described, along with the presence of hernias, suggests that a standard tummy tuck would be a more effective solution for your needs.

A standard tummy tuck focuses on repairing the muscle weakness across the entire abdomen and can concurrently address hernia repairs. This procedure involves an incision made low above the pubic region, extending from hip to hip, which allows for comprehensive access to the abdominal wall for muscle repair and the removal of excess skin and fat. This approach ensures a more pronounced and overall improvement in abdominal contour and can also address the lower abdomen and pubic region, areas that a reverse tummy tuck does not affect significantly.

Considering a breast fat transfer and potentially a mastopexy (breast lift) at the same time is indeed possible and can be done safely within the same surgical session, assuming you are in good health and your surgeon assesses you as a good candidate for combined procedures. This approach can offer the advantage of a single recovery period for multiple enhancements.

It's crucial to consult with a board-certified plastic surgeon who has extensive experience in body contouring and breast surgery to discuss your options. They will evaluate your specific case, including your anatomy and surgical goals, to recommend the most suitable procedures for achieving the best possible outcome.

In summary, a standard tummy tuck, possibly combined with hernia repair and your desired breast procedures, seems to align more closely with your goals, offering a comprehensive approach to address your concerns effectively.

Sincerely,

Dr. Katzen
Plastic Surgeon

I would recommend a standard abdominoplasty. Reverse tummy tucks are reserved for rare and specific cases. You will have a nice result possibly a vertical scar, but I would not hesitate to proceed. For your breasts, I doubt you have enough fat as a donor, but a small implant will suffice and no need for a mastopexy. Thanks.

When faced with the prospect of inframammary scars from a breast lift, a reverse tummy tuck begins to make some sense in selected individuals. For you though, a reverse tummy tuck will only be appropriate if you know that muscle tightening will not be possible; limited access to the abdominal wall around the belly button will not allow it. If that's ok, then you could proceed knowing that skin can be tightened in the upper abdomen and the ventral hernia can be repaired easily. In my estimation though, your abdominal wall laxity and protuberance is the most prominent feature that should be corrected, making a traditional abdominoplasty the correct choice.

The technique I recommend is a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique uses inframammary incisions which can be connected across the midline to perform a reverse tummy tuck. The upper abdomen will be dissected and elevated higher. The upper hernia can be repaired as well at the same time.

Best Wishes,

Gary Horndeski, M.D.

Hello; there is a sagging issue on your breasts. Breast lifting method is required to you. Fat injection is not suitable. Since your belly button is quite low, it will be very difficult to perform a reverse Tummy Tuck procedure. It would be appropriate for you; to undergo hernia repair and breast lift along with Lipoabdominoplasty.

I am not sure what you have been reading, but the standard tummy tuck would be much more helpful. I would suggest the breast lift as well. Once lifted, fat could be added later. If you just add fat, you will be some bigger and still sagging. Adding volume does not correct sagging. Reverse tummy tucks are usually not good procedures long term for they often just gradually pull the breasts down even lower. Also, the reverse tuck does not address the lower abdomen. If you do have a hernia, have that repaired first and insurance will probably cover that procedure.

From the submitted photos it appears you would benefit from a standard abdominoplasty versus a reverse tummy tuck. The hernia repair can often be addressed at the same time. I encourage you to consider implants rather than fat transfer to the breast as the latter can form microcalcifications that can interfere with breast imaging. Seek a double board certified plastic surgeon who may be able to correct the hernia as well as address the cosmetic procedures.

Hello, thank you for your question, we suggest doing reverse tummy tuck + hernia repair with general surgery + breast lifting with implant, we don't recommend fat injection to breast.
We can offer you a virtual consultation for a better evaluation, please send us your full name and phone number on our email: hi@estherianclinic.com. We will contact you as soon as possible.

Hope it helped!