Full or Reverse Tummy Tuck for Upper Abdomen Laxity?

I had a mini Tummy Tuck 2 years ago, and now I'm unhappy with my upper abdomen area (above the belly button). I want a more smoother, tighter look. To correct this, my surgeon has recommended a reverse Tummy Tuck. I'm scared to death of how the scar is going to look since my breasts are set far apart (I had breast implants in 2000 as well). That's my main concern.

He also said he would recut from my mini Tummy Tuck and perform a full Tummy Tuck, but the results wouldn't be as accomplished this way as it would be from a reverse tuck. I'm really torn here and need some advice. I fully trust my surgeon, I'm just wanting to make sure that I make the right choice in which direction to pull my skin. I'm leaning towards the recut.

Doctor Answers 12

Traditional Tummy Tuck vs. Inverse Abdominoplasty

Upper abdominal laxity can usually be successfully improved even with a "full' tummy tuck (abdominoplasty), but in some severe cases (usually after massive weight loss) a reverse tummy tuck may be suggested by the surgeon. However, it is very important to note that the scars from a reverse tummy tuck might not be advantageous, (they will run straight across the inframammary fold), and so I personally am very hesitant to suggest this procedure.


Toledo Plastic Surgeon
5.0 out of 5 stars 7 reviews

I'm not a big fan of the reverse tummy tuck

If you want the home run result, I think you will get it with liposuction or VASER of your whole torso, and convert to a full tummy tuck. Your torso seems the area where you carry your extra weight, so really thinning this area out will have a big effect on your overall look, including the sides and love handles. As for reverse tummy tuck, I find the scar is rarely acceptable and since gravity is always pulling downwards, the result is always half of what you want it to be. Pulling upward on your abdomen with your hands looks fabulous and like it would work great, but in real life it just isn't as powerful.

Lisa B. Cassileth, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 12 reviews

Reverse Tummy Tuck not advisable for your case

Scrappy,

I would strongly advise against the reverse tummy tuck in your case. You're absolutely right about the scar in the middle - it is very obvious - connecting both breasts. Don't add an extra, visible and long scar if you don't have to.

I think you are a good candidate for a full tummy tuck. I would excise the mini-tummy tuck scar, lower the scar to the pubic hair line and recruit all that extra skin down again. You would need to have your umbilicus (belly button) pulled through a new opening in the upper skin, but this scar heals well and usually looks great.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 28 reviews

Full Tummy Tuck Likely Your Answer

When patients have loose saggy upper abdominal skin following mini-abdominoplasty correction usually always requires conversion to a full abdominoplasty. This procedure involves raising a flap to the level of the ribcage. The skin is then advanced in a downward direction and the excess skin is removed at the level of the lower abdominal incision.An umbilical transposition is an important part of this procedure.
Your picture suggests redundant upper abdominal wall loose skin.A full abdominoplasty can remove excess upper abdominal skin and tightens the abdominal wall muscles.It avoids additional incisions that potentially compromise the blood supply to the abdominal wall and decreases the potential for skin necrosis.
If you’re considering abdominoplasty revision, consultation with a board certified plastic surgeon is appropriate.This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Full or Reverse Tummy Tuck for Upper Abdomen Laxity?

The reverse abdominoplasty is quite popular in South America but has not gained the same popularity in America. To me, this is reminiscent of vertical(lollipop) breast lifts and reductions as opposed to the inverted "T"(anchor) scars still commonly employed in the United States.

As with the vertical breast scar procedure, there is a significant learning curve associated with the reverseabdominoplasty procedure.
Sub-optimal quality scars were visible in the lower cleavage and scars migrated from the breast crease caudally(downward). However, these issues have been solved with some important surgical modifications.

With the reverse abdominoplasty, the umbilicus(belly button) is elevated into a more youthful position and vertical configuration, the torso is elongated, and the waist is thinned via a full 180 degrees of the lower abdominal skin elevation.
The scar can be continued around the back as a back/bra strap excision, smoothing the back rolls from hip to shoulder blades.
This procedure will not remove lower abdominal skin excess and muscle tightening of the lower abdomen requires another but small(C-section size) scar.
Residual lower abdominal skin excess may be amenable to Ultherapy.

Upper abdominal skin removed using conventional abdominoplasty(in my experience) requires not only a periumbillical(belly button) scar but a large amount of lower abdominal skin removal increasing the horizontal scar length to the hips, potentially widening the scar quality due to increased tension and perhaps a traction deformity of the mons, while giving the abdomen a shorter wider appearance.

Once the issues of the upper abdominal scar were solved, reverse abdominoplasty has become the procedure of choice for abdominal rejuvenation, when appropriate.
The combination of no periumbllical(belly button) scar, elongation of the waist and tapering of the skin from the hips speaks for itself.

The cost ranges from $7000 to $8500 including abdominal and anterior hip lipoplasty.

Andrew Kornstein, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

Caution:Full Tummy Tuck after Mini could be a problem.

If you had a mini tummy tuck usually the belly button base is cut and this takes away the blood supply form below.  When a full tummy tuck is done the belly button is cut all the way around form the skin and surrounding tissue.  The belly button could easily die.  This is the issue in your case.  The surgeon who you like very much can look at the op note and answer this question.  I have never like the reverse tummy tuck results and scar.  Your upper abdomen does not warrant that procedure.

Miguel Delgado, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 57 reviews

Reverse or Full tummy tuck after Mini Tummy Tuck

In my opinion, given the limited information here in your photograph. I believe you would get an improvement with a full tummy tuck. You still may have some residual laxity in the upper most abdomen but I believe that is preferable to the results or risks of a reverse abdominoplasty.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 69 reviews

Standard tummy tuck would work best in this situation

Tummy tucks are a very popular and effective way to contour the abdomen. Like no two patients are the same, in our practice note to tummy tucks are equal. We spent a great deal of time evaluating the patient before the surgery to assess their physical condition and to understand their aesthetic goals. We then create a surgical plan that will help meet these goals. It is possible in your case to perform any revision to me to to correct the laxity in the upper abdomen. I would not consider a reverse tummy tuck for this area as it would add unnecessary scar onto your abdomen and could impair the blood supply to your abdominal skin.

To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 77 reviews

Reverse Tummy Tuck can correct your upper tummy fullness

Scrappy,

An upper tummy tuck or reverse tummy tuck through incisions placed beneath your breasts is the best solution for excess skin of the upper abdomen following a mini lower tummy tuck. The results can be excellent as long as you are healthy with good blood supply. I would not use this approach if you are a smoker, have vasculitis, or poor circulation.

Another option is laser liposuction. I have had good results with fat removal and skin tightening using SlimLipo laser liposuction.

See before and after pictures of SlimLipo of upper abdominal laxity and mini tummy tuck of lower abdomen.

Explanation of Reverse Upper Abdominoplasty Look at Photos - There is NO Scar Between Breasts

A reverse Upper Tummy Tuck involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts.  THERE IS NO INCISION MADE BETWEEN THE BREASTS. The photos in my gallery (below) show results and show close ups of the scars undeneath the breasts that are completely hiden unless a wonan actually liifts her breasts up.

In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.
A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.
Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.
A reverse upper abdominoplasty can be a good option for some patients. be sure to view many before and after photos and look at incision sites and scars which are camoflaged under the breasts and not across the chest between the breasts.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 98 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.