Tummy Tuck Through Incision Under the Breasts?

I have no stretch marks and I have fairly tight skin. I have very severe diastasis. I'll be having a breast augmentation, and was wondering, is it possible to also have a Tummy Tuck done with the incision under the breasts, not from one side of the hip to the other?

Doctor Answers 22

No Do-Over's: A Scar is Forever

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If you are concerned about an incision across the pelvic brim, which should be hidden by your underwear and most swimwear, you should ask the surgeon if he (or she) would, in good conscience, place the proposed incision on his wife or sister's chest. I'd be willing to bet the answer would be NO, approximately 999 times out of 1000.

First, there is nothing inherently wrong with placing breast implants through the inframammary fold, with the exception that this incision is sometimes visible in certain clothing, and certainly can be seen when naked. However, the reverse abdominoplasty involves joining the breast incisions across the lower chest. This over-simplified approach to two problems (small breasts and diastasis without skin laxity) not only makes the total length of the incision almost identical to a pelvic brim incision (or longer), it has the disadvantage of placing the long in a very visible location. Unless you wear a "granny" bra with very wide straps in the fold, this incision is likely to be seen in clothing, and will certainly be visible and unsightly when you are naked. Rather than being an elegant approach to solving two problems through one incision, this violates the principal of minimizing the visibility of the scar(s) while achieving cosmetic improvement (for both areas).

The circumstances that call for a "Reverse Abdominoplasty" are very limited, and wide diastasis would not be a good indication for this procedure, especially in a patient with minimal skin laxity.

Instead of "killing two birds with one stone", ask your surgeon if it really makes sense to have beautiful breasts and a tighter tummy, if you must also have a horrible scar, albeit a "single" one? There are no do-overs, so think carefully, or you may regret the decision for the rest of your life.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

Consider a though the belly button abdominal wall tightening procedure!

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As you'll notice above, there is general disagreement about the procedure you're considering. If skin is not an issue on your abdomen, you should consider having an abdominal wall tightening (rectus diastasis repair) through an incision placed only in the belly button. You do not need additional scars in the pubic area or underneath the breasts. The procedure takes about 60-90 minutes and can accomplish the same thing from an abdominal wall tightening perspective that a full abdominoplasty can! It can provide the exact same corsette type effect. It can be done with a endoscopic assistance or simply with an adequate lighted retractor.

Your breast implants can be placed throught the same incision (although I personally am not a fan of the transumbilical breast augmentation (TUBA).

Good luck in your research process!

Dr. Kaufman

Don't try this

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This would be an ill advised procedure in my opinion.  It is possible however to do a rectus diastasis repair from a small lower abdominal incision. Some surgeons even do this endoscopically.

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Reverse tummy tuck

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Patients who have loose deep fascia may want to get this tightened. This can be done through minimal incisions (endoscopic tummy tuck or hybrid tummy tuck). It is no longer necessary to get a hip to hip incision to tighten the entire deep fascia.

It is possible to remove a small to moderate amount of upper only abdominal skin through a breast lift incision, not through a breast augmentation incision. It can actually be a very satisfying procedure for a fit woman without a lot of loose skin who is undergoing a breast lift and hybrid tummy tuck (short C-section type incision, full abdominal fascial tightening, including above the belly button) to have some skin removed through the breast lift incisions.

This is one of the many newer options in tummy tuck surgery.

For women with a great deal of extra skin, the combination of hybrid tummy tuck plus breast lift / reverse abdominoplasty would not be a good option, since there is too much skin for the procedure to achieve optimal results.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

I would avoid this in most cases

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This technique (a reverse abdominoplasty) is helpful only in certain cases, and the two biggest problems with it are the presence of the scar and the inability to adequately contour the abdomen. A traditional tummy tuck works very well and the scar is not only hidden but will usually fade quite a bit with time.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Reverse abdominoplasty

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You're describing a technique called a reverse abdominoplasty. You are correct that the incision changes from being from hip to hip to being across the entire chest at the level of the inframammary fold. This can be an effective technique for patients with significant amounts of excess skin above the umbilicus.

Here are the things that are important to consider:

1. Even though the majority of the scar is hidden within the breast fold, the scar typically also continues between the breasts.

2. This technique usually makes it more difficult to deal with excess skin and fat below the umbilicus because it is unusual to continue the dissection below the umbilicus meaning that the area you're improving is really just above the umbilicus.

3. This technique usually does not allow for plication of your abdominal muscles below the umbilicus. Plicating the abdominal muscles helps to improve the contour of your abdomen.

4. This technique is not used as often meaning that your surgeon may not have as much experience with it. In my San Francisco area practice, I've done hundreds of abdominoplasties but only a handful of reverse abdominoplasties (all with good results!).

These limitations are the reason that in people looking for purely cosmetic improvement typically wind up choosing a more traditional technique. There have also been several articles regarding improving excess upper back skin by placing incisions in the inframammary folds as well. I hope this helps.

Steven Williams, MD

About the Mommy Makeover Procedure

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A Mommy Makeover is a combination of procedures to bring a woman’s body back to the way she looked prior to pregnancy. Most commonly some variation of a #TummyTuck and #BreastSurgery are performed. Additional procedures can include liposuction, umbilical hernia repair.  The most common #breastprocedures include #mastopexy or #breastlift, #breastaugmentation, or #breastreduction.   #Combined operations are often performed with our #Gynecology colleagues. Tubal ligation is a common post pregnancy procedure which is done at the time of many of the surgeries included with a #MommyMakeover. If you require a gynecologic operation or study (laparoscopy) and are considering a plastic surgery procedure, discuss these issues with your physician and board-certified plastic surgeon. Also, combining these #procedures may decrease anesthetics, costs, and recovery time. Your procedures should be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Minimizing CombinationTummy Tuck and BA Scars

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Because you have tight skin rather than using the smaller breast scars to correct the diastasis recti (typically a bit worse below your belly button than above it, I would recommend using the tummy tuck scar as access to insert your breast implants thereby having no scars on your breasts. 

A tummy tuck is rarely performed through an incision under the breasts.

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The scars of this type of operation are usually unacceptable.  It is occasionaly done in massive weight loss patients as a secondary procedure to an extended abdominoplasty.  I personally have never used the approach in any other patients.

Diastasis Repair

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I would not recommend a "reverse" tummy tuck when having a breast augmentation. A reverse tummy tuck places the incision in the upper chest rather than at the lower abdomen. This is particularly useful for women with excessive skin in the upper abdomen rather than the lower abdomen. Often, this is performed after massive weight loss and can be combined with a breast reduction or lift.

For issues related only to a diastasis or separation of the rectus muscles, I recommend a trans-umbilical approach. This hides the incision within the belly button, but allows for plication (tightening) of the rectus muscles and resolution of the diastasis.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 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.