Full or Reverse Tummy Tuck? (photo)

  Due to the fact that you probably already have the IMF scars from the breast reduction and you do have upper abdominal problems, you may be good candidate for reverse tummy tuck.  However, this can be a tricky procedure if the IMF is not strong enough to oppose the tension from the tummy flap.  This sometimes has to be reinforced to prevent IMF migration.  Find a plastic surgeon with ELITE credentials who performs breast lifts and tummy tucks hundreds of times a year.  Kenneth Hughes, MD Los Angeles, CA

When the lower abdominal skin is good but there is looseness in the upper part, a reverse tummy tuck might be an option. Since you already have a scar along the bottom of the breasts from the reduction, it would not add much of a new scar. It would have to be anchored to prevent the scar from pulling down.

The true reverse abdominoplasty is seldom done any more. The scar is simply too long and covers the center of the chest, where a low cut dress or swimwear might reveal the incision.

The reverse abdominoplasty done through the existing breast incisions is a weak, but occasionally helpful, technique.

Your pictures show looseness in the upper and lower abdomen, so it would be best to perform a full abdominoplasty or a modified full abdominoplasty, depending on existing incisions, umbilicus to pubis distance etc. that could be determined at the time of consultation.

I am not a huge fan of the reverse tummy tuck. I do not like a scar over the upper abdomen. If skin is truly your issue then just go for the traditional tummy tuck and I think you will be very happy with your result. The reverse tummy tuck is much more rare. I have only done that in patients who have prior scars in those areas from previous surgery. That is just my personal preference.

Hello 'lucygooseynomore', thanks for your question.  There are significant risks and very few indications for a reverse tummy tuck, where the incision is under your breasts and the soft tissue is elevated superiorly rather than pulled inferiorly.  For one, this pull acts against gravity, leading to a higher recurrence rate.  In addition, the results are more unpredictable, and can lead to a hypertrophic and noticeable scar between the breasts when wearing a swimsuit.  The reverse tummy tuck also does not do a good job of addressing soft tissue laxity or muscle stretch below the umbilicus, and can lead to devascularization and necrosis of soft tissue in patients who have had prior abdominal surgeries with lower scars.  The only time that I think a reverse tummy tuck would be of benefit is in a patient with predominantly upper abdominal laxity who has no prior lower abdominal surgical scars and does not mind having a potential scar in the cleavage region.  Based on your photo, I would recommend a traditional tummy tuck where the scar can at least be hidden by your pants or a bikini bottom.  Be sure to consult with a board-certified plastic surgeon who should be able to further discuss your options with you.  Good luck!

-Dr.92660