Reverse Tummy Tuck. What are your thoughts on this procedure?

Question

HI have upper abdominal skin laxity. I don't have any issues with below my bbutton. I have a good amount of skin laxity above my belly button that really bothers me. My lower abs are in good shape with no skin issues. It seems very few surgeons perform reverse tummy tuck. I know it can create quite a scar. What are your thoughts on the procedure? I am 45 years old, 5'5 and weigh 125. I am very physically fit. I am having a hard time finding information on this procedure.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about what to do with excess abdominal skin laxity. You did not include pictures, so it’s a little difficult to answer your question. However, based on your description of the problem, I would suggest that, yes, indeed, a reverse tummy tuck would be your best option. I perform this procedure quite frequently. The scar is underneath the breast, so this scar usually is very well hidden. If you have significant excess skin, the spot may need to extend slightly around the side of the breast.
Nonetheless, it’s an excellent and perhaps the best procedure for excess skin of the upper abdomen. Therefore I would highly suggest that if you have upper abdominal skin laxity, your best procedure could be a reverse tummy tuck. Please seek an experienced board-certified plastic surgeon who has performed many reverse tummy tucks.
Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Alan Gonzalez, MD, FACS · Answer

Hello @OCblonde thank you for your question. It is an appropriate technique to improve laxity above the navel, taking into account several factors. Among others, that in this technique only the skin is fractionated, there is no muscle tie and the scar is just below the breasts. These are factors that should be analyzed by the patient. Best wishes! Alan Gonzalez MD, FACS.

Finny George, MD · Answer

Hi, thank you for sharing your question. This can be an ideal procedure for what you’ve described. Without a photo or a physical exam, it’s hard to know for certain. Isolated upper abdominal skin laxity can be very effectively treated this way. You may have other options such as liposuction as well. Discuss these with your plastic surgeon.

Kristopher Day, MD, FACS · Answer

I would imagine your difficulty finding information on reverse tummy tuck is reflective of the frequency with which this procedure is perfumed. Back in training, I asked my professors about their experiences with reverse abdominoplasty, and most said that had never done it and one said he had: once. So, in some cases this procedure can be more powerful and focused on the specific areas of concern in the upper abdomen, but it's rare that a traditional tummy tuck, which is often combined with rectus muscle plication and judicious liposuction, does not impact the upper abdomen as well. And then your scar is under the belt line instead of under the breast, which is much less noticeable. I would advise talking about these pros and cons with a surgeon that is well-versed in all forms of abdominal rejuvenation so that you get a plan that gets your best result and confidence from an individualized goals-based discussion.

Daniel Barrett, MD · Answer

Dear OCblonde,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Timothy M. Bradley, MD · Answer

A reverse tummy tuck is the procedure of choice for rejuvenation the area of the abdomen above the belly button. Proper diagnosis of the problem is key to selecting the proper , and best procedure to correct upper abdominal skin laxity.Many surgeons mistakenly think the redundant/ lax upper abdominal skin can be addressed with a formal Abdominoplasty, but I have had patients in which I have done both a formal Abdominoplasty and the later I performed a reverse Abdominoplasty to fully address the upper abdominal skin excess . This is especially true in patients who are good candidates for the mini Abdominoplasty procedure which does not violate the belly button, but they have excess skin and “hooding” of the bellybutton.The incisional scar of a mini Abdominoplasty is placed with in the skin fold underneath the breasts (within the inframammary fold) so that it is well hidden. The scar does not necessarily have to cross the mid line between the breasts if the amount of upper abdominal skin elevation is not excessive, and this is determined by physical examination. Not crossing the midline makes for a more challenging incision closure in order to avoid “dog ear” deformities, but the extra work is worth the enhanced aesthetic outcome in my opinion. The reverse Abdominoplasty procedure, although seemingly a “lesser” procedure, can be every bit as challenging as a formal Abdominoplasty depending on the patient & the amount of skin excision required. If a patient has a lot of excess skin which needs to be addressed, then the larger, more visible post op scar is inevitable & must be accepted by the patient.

Connie Hiers, MD, FACS · Answer

The problem with the reverse tuck is that in trying to pull up the skin tightly, it tends to pulls down on the breasts and can change the shape of the breasts.  In most women, this does not work well.  What actually works better is the full tummy tuck and pull everything down as one unit.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

A reverse tummy tuck removes upper abdominal excess skin and can tighten the muscles in the upper abdomen.  The resultant scar lies in the fold beneath both breasts and joins in the midline.

It is not a common procedure for a few reasons: 
There are not many individuals for whom it is suitable.  (in most cases, there is lower abdominal muscle separation that requires tightening as well) 
The scar that crosses the midline of the chest is not acceptable to many individuals.  Although I have seen this this scar may fade very well, it is well documented that scars in this part of the body can become hypertrophic and many individuals do not want to risk this.

There are some office laser based technologies that have helped my patients in your situation, however an in person assessment is required to determine if this is suitable for you. 
Posting a photo will be helpful for you.  An in person consultation will also provide you with advice specific to your situation. 
All the best to you,
Dr. Nancy de Kleer

Camille Cash, MD · Answer

You are correct in your statement that the reverse tummy tuck is not performed nearly as often as a standard tuck.  You will need to visit with a board certified plastic surgeon for an evaluation to determine if you are a good candidate for this procedure.  If you are, you can certainly consider it.  One of the things to keep in mind with this approach is that the scar can sometimes be problematic and pulled lower by the body over time, making it difficult to conceal.

Richard R. Orr, MD · Answer

I've been in practice 31 years. I have done one reverse tummy tuck, and swore I would not do another one. It very effectively gets rid of the upper abdominal excess. But with a significant scar that runs from lateral to your breast, along the breast fold, across the midline and to the other side. I have done several traditional tummy tucks on patients with primarily upper abdominal skin excess and gotten very good results with far better scars!Look at photos and talk with your surgeon. I would encourage a traditional tummy tuck.

Reverse Tummy Tuck. What are your thoughts on this procedure?

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