I'm 58, and according to the surgeon, in good shape with an hour glass figure. My plastic surgeon says I need a T-incision Tummy Tuck to address excess fat above the belly button, but I can't find where anyone else has had it done that way. Do I really need this? I'm not sure why a T-incision below the belly button would be helpful in removing fat above it.
T-incision Tummy Tuck?
Doctor Answers 26
Detail regarding abdominoplasty skin patterns
Forgive the poor drawings below - but hopefully this will give you some insight.
Typically "inverted T" pattern incisions for abdominoplasty are used to address excess skin above the umbilicus. And in my practice the skin excess usually has to be fairly dramatic (typical of massive weight loss patients who have successfully undergone gastric bypass surgery). The ability to remove excess skin above the umbilicus comes at a cost of additional scar as well increasing the risk of poor healing (as Dr. Di Sai mentions).
Typical abdominoplasty excision pattern - note that the skin is pulled downward to improve the abdominal contour.
This is the typical post-op result with a transverse scar low along the abdomen and a scar around the umbilicus.
A inverted T abdominoplasty (as pictured below).
You can see that this skin excision pattern allows for the skin to be pulled downward and also from side to side. This additional direction of skin pull can be useful for patients that have a significant amount of extra skin above the umbilicus and where that downward pull alone may not provide enough of an improvement.
Here's a picture of the typical end result.
I hope this helps. In my practice the traditional abdominoplasty incision for patients that have not lost significant (more than 100 lbs) amounts of weight is usually all I need to get a great result.
Steven Williams, MD
Many options now in tummy tucks
A few years ago, the only common options for patients were a mini tuck or a full tummy tuck.
Now, there are options for almost every anatomy and every problem.
The "T" tummy tuck is a lesser tummy tuck than a full tummy tuck, and is usually used for patients who want to have a low incision but don't have enough excess skin and fat to do a full tummy tuck without having a high incision. The "T" represents where the old belly button hole was. Sometimes it comes down to whether the patient would prefer a "T" incision with a very low incision, or a higher incision with no "T".
Other options include a reverse abdominoplasty done through breast lift incisions, endoscopic tummy tucks, a hybrid abdominoplasty (short incision, full tightening of the fascia), and several different mini-tucks, all depending on the nature and location of the excess skin and fascia.
T-incision or Fleur de Lis Tummy Tuck
The Fleur de Lis (French for Lilly Flower, the symbol of the French monarchy from its earliest days) is a fanciful way to describe a inverted T scar patterned abdominoplasty.
By removing skin and fat both inferiorly and centrally, this operation can better contour the trunk in cases of extreme skin laxity without necessarily having to do a lower body lift and liposuction. However - the cost is not minimal. You are left with a scar BOTH from hip to hip but also with another from where the ribs meet in the midline to the pubis.
Personally, I think a Tummy Tuck is a wonderful operation. But it has a huge stumbling block stopping a lot of women from having it - the scar from hip to hip.
As surgeons we can only exchange tummy tightness for this permanent scar. Even tough this scar can be designed to be hidden by most conventional underwear a lot of women prefer to remain flabby than have this single scar. When it comes to adding another, much more visible and harder to conceal scar, we should think about it carefully. Yes, it can bring about nice results but the permanent cost are 2 lengthy permanent scars which a lot more people would find very unappealing.
If the patient ALREADY has a vertical abdominal scar. If the patient has a huge amount of laxity. If the patient insists over and over again that he / she does not care about the scars along as all the flab is gone - I would perform this procedure very comfortably.
But - I would not offer it to people who would get equivalent results with a standard Abdominoplasty or a Lockwood High Lateral Tension Abdominoplasty.
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Fleur-de-lis tummy tuck
The Fleur-de-lis tummy tuck is a well know operation, but it has limited indications. Most patients will get an excellent result with one of the "standard" horizontal scar abdominoplasty, and they will not have a visible scar across their abdomen. Because the ribcage margin is an inverted V, the area above the belly button will have more laxity than the skin below the belly button, but the amount of laxity is generally acceptable. In my mind, it is only reasonable to consider this operation in patients who have excessive amounts of skin (very massive weight loss), or a pre existing midline scar that starts at the base of the breast bone. The decision for this operation has to balance the benefit of the additional tightening with 1) the visible scar, 2) the increased risk of complications (wound healing complications are significantly higher with this version of tummy tucks.)
A 'T' incision can be used in multiple instances...
A 'T' incision may be used in several instances. One is in the massive weight loss patient in which there is too much skin laxity in both the vertical and horizontal dimensions.
Another instance where a 'T' incision may be indicated is in the thin patient with some skin excess (too much for a mini-abdominoplasty). The reason to add this additional 'T' closure of vertical closure in the midline is to close the original belly button skin opening that has now been pulled down lower.
There are two situations in which a T is needed
If a patient already has a vertical scar on the abdomen, it might as well be used to get more skin off in a tummy tuck along with the horizontal scar in the lower abdomen. This is often the case after "open" gastric bypass surgeries followed by massive weight loss.
There are also some rare patients who have a long narrow torso where much more skin wants to come off side to side with a vertical scar than up and down with a horizontal scar. If they don't already have a vertical scar, I usually just do the horizontal incision but tell them that I won't get all the skin off. Most patients would be much happier without the vertical scar if at all possible.
T pattern Abdominoplasty: Massive Weight Loss and Choosing a Tummy Tuck Procedure. Fleur de Lis
Massive weight loss patients have excessive skin after they reach their weight plateau. In some patients, a typical lower incision abdominoplasty would not tighten the waistline so an alternative procedure can be performed in experienced hands. The surgery is named after the French Fleur de Lis, or triflower. This entails a vertical incision and a horizontal incision in order to tighten the waistline and reduce the abdominal bulge.
This can also be performed selectively in patients that have a midline incision from a previous surgery such as a gastric bypass. There are a lot of alternatives to tummy tucks and experience really counts in choosing the right incision with your plastic surgeon.
T-Incision or Anchor Pattern Tummy Tuck
If the concern is excess skin above the belly button, an anchor pattern abdominoplasty may be avoided and instead, a reverse upper abdominoplasty , often in conjunction with a mini lower abdominoplasty may be performed.
The nature of the tummy tuck surgery that will best suit each patient is determined during the consultation and is based on the physical examination. For all patients, I draw the proposed incisions on their body with a skin marker (it washes off easily) so that it is clear what the nature of the resulting surgical scars will be. I also outline liposuction areas if that is part of the surgical plan.
A T incision may be used if there is a lot of laxity requiring excision in two dimensions.
A T - incision may be used when there is a lot of laxity such as in patients who have lost extreme amounts of weight ( generally over 100 lbs) to remove skin both in the vertical and the horizontal direction. In these cases the horizontal incision goes from hip bone to hip bone along the lower abdomen and the vertical insion goes from the pubic area up to the breast bone. A small T incision can also be used when there is very little laxity in the abdominal skin. In these cases there is not enough laxity to take all the skin off up to above the belly button and so a small vertical incision is necessary to close the skin where the belly button used to come thru.
T-Incision may describe someone on the verge
In my practice, I will evaluate the excess skin both above and below the belly button to decide what is the most appropriate treatment.
When there is excess skin below the belly button, but not above it, I will suggest a mini-tummy tuck.
When there is a large amount of skin above and below the belly button I will suggest a full tummy tuck.
When there is a large amount of skin below the belly button and moderate amount of excess skin above the belly button, I may not be able to pull the skin tight enough to get the umbilical incision out in the removal of skin through a low horizontal incision.
In this case, we may leave a small inverted T. This is a much better option then pulling the skin too tight and suffering with wide ugly scars and possible separation.
Some doctors will allow the transverse scar to ride up higher on the abdomen to avoid the "T", but I prefer to have the horizontal scar within the bikini line at all times.