Would you deny a tummy tuck procedure because a patient is "too skinny?" (Photo)

Question

I am currently 5'7, 115lbs however I still have a small "pooch" w/nominal stretch marks from 2 pregnancies. During a mommy makeover consultation, the PS said most other PS wouldn't agree to preform the tummy tuck b/c I don't have a large amount of excess skin/fat to excise. (however he feels confident he can give me good results). If I proceed with this PS, are there possible adverse results from a tummy tuck pulled too tight?

Brent Moelleken, MD · Answer

We were taught in our residencies that there were two types of tummy tuck, mini tucks and full tummy tucks.  However the mini tuck is a poor operation for most post-pregnancy patients as it does nothing for the fascia in the upper abdomen.There are in fact many more types of tummy tucks, especially well suited for thinner patients or patients who had a limited weight gain during pregnancy.Because you have a bulge in your fascia (also known as separation of the muscles, or diastasis recti), it is advisable to tighten these muscles.  Liposuction by any technique will not do the trick as the fascia will not respond to tightening unless sutures are placed.You would most likely be best served by a lower abdominal incision, with full tightening of the abdominal fascia.Much of our practice is geared to the 'in-between' tummy tucks.It would be a shame to make a hip to hip incision relatively high on the abdomen just to access the upper abdominal fascia, when, with special instrumentation, it can be accessed from a C-section type incision.

Ira H. Rex III, MD · Answer

Each operation is tailored to the patients presentation and her needs and expectations. If you have loose muscles from having a baby, these can be tightened just enough to give you your flat tummy back, without changing your overall figure. Usually, tightening has to be from your rib cage to your pubis. The amount of extra skin you have will determines the length of your scar.
You might consider getting a second opinion from a board-certified plastic surgeon and see if there are any other ideas he can put on the table.

George Marosan, MD · Answer

Being "too skinny" is not a contraindication for a tummy tuck. Although I can't appreciate the skin laxity in the lower abdomen, you could have a tummy tuck via a small suprapubic incision with VASER liposuction to better define the waist line for you. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Richard Baxter, MD · Answer

The ideal patient for a tummy tuck is one who has done their part with diet and exercise so that they know what they can accomplish on their own and what the tummy tuck does. When there is loose skin and a degree of muscle separation after pregnancy, then a tummy tuck is the way to go. What version of a tummy tuck depends on an in-person exam to assess.

Bryson G. Richards, MD · Answer

Based on your pictures, history of two pregnancies, and current height/weight, you would be a great candidate for a tummy tuck operation. Glad to hear that your plastic surgeon is confident enough to do a tummy tuck, because you would look great after having one. There is usually enough skin and tissue laxity after having children to perform a tummy tuck.I hope this helps.- Dr. Bryson G. Richards, MD

Shim Ching, MD · Answer

Based on your description and photos, you are a great candidate for a mini tummy tuck.  Patients with minimal skin excess, but primarily abdominal wall laxity, do very well with this procedure.  If the surgery is planned and executed correctly, there should be no risk of being too tight.

Daniel A. Medalie, MD · Answer

HI,It looks like you may be a candidate for a "mini" or lower tummy tuck. This is where less skin is removed and the main point of the operation is to tighten the underlying muscle. You are not too skinny for this procedure and should get a good result. I hope this helps.Regards,Daniel A. Medalie, MD

Eric Desman, MD · Answer

I personally hate the common terms used for tummy tuck - full vs. mini. The operation needs to be tailored to the specific problem at hand. I would agree to do a procedure to tighten the muscles & remove some excess skin. The secondary question you asked is whether there are possible adverse results from a tummy tuck pulled too tight? The answer is yes. If the skin is pulled too tight, the skin can lose its blood supply and die off. The repair can be so tight that the scar is more inclined to spread after surgery. The abdominal wall can be tightened too much as well in certain circumstances. These risks hopefully can be mitigated by having an experienced board certified plastic surgeon perform your procedure. Good luck.

Erik Hoy, MD · Answer

You have loose skin in the lower abdomen and would be a good candidate for a mini-abdominoplasty since there isn't much loose skin in the area of the upper abdomen.  However, if on exam you also have splaying of the rectus muscles to the sides, then a conventional abdominoplasty with muscle tightening would be more appropriate.  If the skin is pulled too tight, you could have problems with wound healing due to poor blood flow, or could have widening of the scar.  If you choose a board-certified plastic surgeon with experience with this procedure, he or she should be able to set this tension without making the closure too tight.  See your plastic surgeon for further discussion of these questions prior to your procedure.  Good luck!--Erik Hoy, M.D.

Robert Singer, MD · Answer

There are a variety of
surgical procedures or combinations that can produce good
results in patients with only mild abdominal laxity, depending on multiple factors
including their anatomy and degree of desired improvement: A mini tummy tuck,
an umbilical float modified tummy tuck, a full abdominoplasty. Each of these
can be performed  with or without abdominal
 muscle repair. They produce different degrees of improvement.

Following the advice of anyone who would presume to tell
you what to do based on two dimensional photos without taking a full medical
history, examining you, feeling and assessing your tissue tone, discussing your
desired outcome and fully informing you about the pros and cons of each option
would not be in your best interest.Your plastic surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD  FACS

La Jolla, California

Would you deny a tummy tuck procedure because a patient is "too skinny?" (Photo)

Answers (19)

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