Tummy Tuck Scar is Not As Promised by my Physician, What Should I Do?

Question

I went to a board certified PS. I did my homework, im 55, i weigh 140 lbs, i'm 5'7", no scars, my first surgery. The most i've ever been overweight is roughly 40 lbs. At the consultation and postop the doctor was very clear that i would have a transverse scar and bellybutton scar. I awoke with a T shaped scar and was devastated. I cried in recovery and told him he had no right to do this. I'm one month post op and not sure the best way to handle this, he hasnt ever mentioned it.

Kelly Gallego, MD, FACS · Answer

It is true that after a tummy tuck most patients will only have a belly button scar, as well as a long transverse scar which is concealed by clothing. When there is only a moderate amount of upper abdominal skin excess, it is sometimes impossible to completely remove the old belly button site, necessitating the placement of a small vertical scar in between the belly button and the horizontal scar. Without photos or a pre-operative exam it is impossible to know why exactly a vertical incision was made in your case. What I can say is that four weeks is still very early. It is much too early to make any final judgements about your results. It takes up to a year for scars to take on their permanent appearance. Some scars that initially look horrible and are worrisome, fade over time and become a non-issue. It is important for you to honestly discuss your concerns with your plastic surgeon. In the event that you remain concerned with your scar, and that something can be done to improve it's appearance, most plastic surgeons will revise the scar at no extra cost if they performed the initial surgery.

John J. Corey, MD · Answer

Many of us do have situtations where we need to leave a small vertical scar where the old belly button used to be. You can't always tell before surgery. But it should be small and it really does heal well with time, usually better than the rest! Give it time. And had your doctor tried to pull as hard as he could to get it out, you may have ended up with dead skin at the bottom of your tummy...and really have a problem then..

Steve Laverson, MD, FACS · Answer

Relax, and let the wound heal. The scar often melts away, and becomes invisible to casual observation. Patients with a short distance from xiphoid to umbilicus and long distance from umbilicus to pubic symphysis offer plastic surgeons a choice during tummy tuck: Option #1: Close with a high transverse scar that will be visible above panties and swimsuits. Option #2: Float the belly button and lower it to keep the transverse scar low. Option #3: Add a small vertical midline lower abdominal component to the scar to keep the much longer and potentially visible transverse scar low and concealed beneath most swimsuit and intimate wear. In my opinion and experience, option #3 is nearly always the best choice, and it sounds like this is what your surgeon decided was best for you. The alternative would likely be a long transverse scar high above your pubis running across the middle of your belly... YUCK! Thank your surgeon for sparing you this permanent and difficult to correct problem.

Remus Repta, MD · Answer

Hello,

	The vertical part of the your inverted "T" incision is in large part the result of not being able to remove the location of the belly button.  It should have been discussed as a possibility.  During your surgery, your plastic surgeon, once he partially performed your tummy tuck, did not have much of a choice to prevent the vertical incision.  Down the road it may be possible to revise your tummy tuck and remove the vertical incision.  I would discuss this with your plastic surgeon and give it some time for healing to occur.

	All the best,

	Dr Repta

John P. Di Saia, MD · Answer

Hello,

	 

	There are reasons to do what your surgeon did (rare reasons,) but the possibility should have been discussed before surgery. The term for this type of tummy tuck is Inverted T or Fleur-de-lis.

	 

	Best Regards,

	 

	Dr D

C. Bob Basu, MD, MPH, FACS · Answer

As my colleagues have suggested, there are some scenarios where a limited lower midline scar may be needed.   In most cases, the surgeon is striving to place the larger transverse scar as low as possible.  But because of a patient's anatomy (where preoperatively,  the distance between the belly button and bikini crease is  longer than usual), a limited lower midline scar is needed to minimize the tension at your transverse incision.  In these cases, if a lower midline scar is not placed, this could lead to excessive tension at your transverse tummy tuck scar line.   This tension could precipitate disastrous consequences including scar widening, skin edge separation, skin necrosis/complex wound.

	During my initial consultation, I evaluate every patient's anatomy including the distance between their belly button and bikini crease.  If this distance is long, I will inform my patient  for the need of a possible lower midline scar (measuring about 1 inch in height).   This is something I usually can identify during the preoperative assessment/exam. In my experience these scars heal very well and fade.

	But do not worry.  Please talk with your plastic surgeon about scar massage and treatment options.   And if you are not happy with your scarring, you may be a candidate for a scar revision procedure (a much smaller procedure than your initial tummy tuck).

	Best of luck.

	Dr. Basu

Vincent P. Marin, MD, FACS · Answer

Unfortunately, there are circumstances where a surgeon needs to employ the use of a vertical component to the tummy tuck scar to prevent more significant consequences. This isn't always possible to predict. If too much skin is removed to avoid this possibility in the wrong circumstances, the consequences can be disastrous. If at some point in the future, this continues to be a problem, it might be re-excised once your skin has relaxed from the original procedure. Communication is the key to success with cosmetic surgery, but occasionally you are faced with tough decisions in the operating room that couldn't be anticipated.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Sometimes, especially for patients with a relatively short torso and/or minimal redundant abdominal wall skin,  a short vertical scar is necessary ( in addition to the usual transverse tummy tuck scar).  This vertical scar results from closure of the previous umbilical opening  and prevents excessive tension upon closer in the midline of the tummy tuck incision line. If  this vertical incision is not used,  patients may end up with wound healing problems and much wider scars.

	Sometimes these vertical scars can be revised/ removed ( usually one year or more after the tummy tuck surgery).

	I'm sure your plastic surgeon did what was necessary to achieve the best results possible in the safest manner possible.

	I hope this helps.

Wendell Perry, MD · Answer

If your skin is very tight sometimes the bellybutton scar has to be closed as a T  in order to close your wound.

	If you take off too much skin your wound be too tight and would open postoperatively which would leave A horrible scar. I've had to do the same thing on some of my patients. Most of the time I can tell before surgery which patient may need an inverted T scar.

	The best thing you can do now is to wait and try not to worry. In my experience the T usually heals very well and most patients are not bothered by its appearance. If the scar bothers you you may be able to excise the T at a later date. 6 months or more after tummy Tuck the skin will stretch be much looser than it is now at that time it may be possible to excise T scar. At the time of surgery your doctor may not have had a choice of excising extra skin. If the excise too much skin the would would open and event chances for infection and other problems.

	Time is your friend and try not to worry if you're not happy something can probably be done in time.

James McMahan, MD (retired) · Answer

Melartgirl;

	I'm with you on this one. I have performed over 800 tummy tucks and have never had the situation where I put a 'T' shaped scar on a patients abdomen. It's a matter of knowing when to do a full tuck, when to do a mini-tuck, when to perform an extended mini-tuck with umbilical float and when not to operate because you  know that the patient will not like where the scar is. I think that the 'T' scar is a bad look. I would definitely mention it at your next visit.

Tummy Tuck Scar is Not As Promised by my Physician, What Should I Do?

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