What Are The Different Types of Tummy Tuck? What Is Best For My Case After Massive Weight Loss?

I have heard the tummy tuck called extended, anchor cut, fleur de lis and full abdominalplasty. Can you explain the difference in these, when they are use and if there is a cost difference between them. Can any of them be used when having a lower body lift? I had open RNY bypass surgery six years ago and lost 150 lbs. I am now considering plastics to finish what I started. Tess

Doctor Answers 12

A Full Tummy Tuck is usually required after Masive Weight Loss

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After Massive Weight Loss there is usually a large amount of loose skin lefft on the abdomen. A Full Tummy Tuck which ioncludes reconstruction of the Umbilicus or Belly Button is usually required for the best result. THe Mini Tummy Tuck will not remove enough skin.

See my photos of Full Tummy Tuck and check the link below for a review of the different types of Tummy Tuck Procedures.

What are the Different Techniques of Tummy Tucks used for Body Contouring after Large Weight Losses?

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Hi Tess,

Congratulations on your large weight loss! 

Whenever people lose large amount of weight they usually end up with somewhat different appearances. The amount and width of skin sag determine the procedure needed to take in and contour the skin.

FULL TUMMY TUCK - an incision is placed in the transverse groin / abdominal crease (which is covered by most underwear fashions) from onterior hip to the other anterior hip. Through this incision / future scar the muscles are tightened and excess tummy skin is removed. After the upper tummy skin is fulled down, the belly button is exited through its old position through skin which used to be positioned higher.  

EXTENDED TUMMY TUCK - as above but the incision is carried further along the sides to remove a wider amount of loose skin and fat.

FLEUR DE LIS (Lilly Flower) / INVERTED T / ANCHOR TUMMY TUCK (Abdominoplasty) - refer to the scar pattern where in addition to the transverse scar seen with the above tummy tucks, we add a vertical scar. This is done in people whose weight loss left them with a significant amount of loose, hanging skin above the belly button. In such cases, the other tummy tucks would not entirely flatten the abdomen. To remove a wide span of excess  upper abdominal skin an additional vertical scar limb needs to be added to the Full Tummy Tuck resulting in the Anchor / Inverted T or Lilly Flower pattern. 

To learn what may best be done in your case you should look for experienced Plastic surgeons in your  area and see him / her in consultation.

The Best of Luck.

Peter A. Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

The different varieties of tummy tuck

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Yes, there are many types of tummy tuck. Yes, the tummy tuck can be incorporated with and is part of a circumferential lower body lift.  This is yet another type of tummy tuck called the belt circumferential abdominoplasty where the scar goes all the way around, front and back. Sometime a vertical component can be added to the front, sometimes referred to as a fleur de lis.

Giving it a name is not as important as picking the right procedure(s) for you to give you the right contour that looks good for your body. When the procedure is customized and tailored to your needs, the surgeon will usually adjust the price to reflect the actual amount of surgical time it is going to take to complete the procedure.

To help determine what might be best for you, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

Abdominoplasty after massive weight loss

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Various techniques in abdominal contouring are categorized by resulting pattern of scars, extent of dissection, or placement of tension. I prefer not to think within these categories since the categories are basically the organization of an infinite number of variations. These names should be the result of your planning, not the determinant of the surgery. That is, the surgery you will need to undergo is a product of the anatomy your have (i.e. intra-abdominal contents, muscle quality, skin and fat distribution, and general body type) and the goal you set for yourself with your surgeon. How to get from A to B will be your surgical blueprint and may, or may not, fit into these various named categories. In other words, customize the procedure to fit your individual situation. 

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Different types of tummy tuck procedures

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You are absolutely correct.  There are many ways of performing a tummy tuck.  Massive weight loss typically results in a lot of extra abdominal skin and this is frequently more severe than our standard mom with three kids.  A physical exam helps us to determine what technique suites your personal needs most.  In patients who have a circumferential excess of skin at their trunk and want improvement in the abdomen, hips, and buttock region, a lower body lift (or you may see the words extended tummy tuck or circumferential tummy tuck/belt lipectomy) may serve the patient best.  It can helps with the extra skin all the way around the body.  This prolongs the time of procedure, cost, and some of the risks such as wound healing problems.  But, it can result in a powerful improvement.  Other patients are more concerned with the abdomen itself with most of the redundant skin being there.  If the extra skin is modest to moderate, a standard tummy tuck (removing a wedge of lower abdominal skin, repairing the underlying muscle, and bringing the upper skin down like a window shade) resulting in a low lying scar reaching from hip to hip may serve the patient well.  The fleur di lis (may also be referred to as an anchor shaped or upside down T shaped scar) is also a powerful manuver when patients want to avoid the circumferential surgery but have a lot of excess skin such that they need a vertically oriented excision and a horizontally oriented excision in order to remove the skin and bring the abdomen in to reach that pleasing and flat contour.  This winds up giving you a central, vertical (up and down) scar combined with the lower horizontal scar of a standard tummy tuck.  The belly button ends up being placed within that vertical scar line. 

I suggest a consult with a board certified plastic surgeon to determine your best option for your particular skin issues.  Tummy tucks are initially tough on the patient for a week or two but offer such a nice, dramatic effect in weight loss patients with extra skin that it is well worth it.  Good luck! 

Various Tummy Tuck Incisions to Meet Your Goals

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Hi Tess,
Generally the amount of sagging skin left behind after weight-loss surgery determines the appropriate tummy tuck technique. The three terms you refer to – extended, anchor and fleur de lis – refer to three types of incisions. I'd suggest scheduling a consultation with one or more board-certified plastic surgeons to discuss how these three incision options apply to your situation.

Abdominoplasty can certainly be incorporated into a lower body lift; to do so is fairly standard. After gastric bypass surgery and weight loss, a large amount of hanging, excess skin is normal. A tummy tuck is often a very effective way to remove extra skin permanently. An extended incision reaches around the flanks to remove more hanging skin than a standard tummy tuck. Similarly, the anchor or fleur de lis incision may be suggested for a significant amount of hanging skin, but it leaves a vertical scar extending from your tummy upward. Each plastic surgeon may have different fees for the tummy tuck techniques they offer.

A consultation with a board-certified plastic surgeon is the best way to find out which surgical technique can achieve your goals and meet your expectations. Instead of trying to choose a technique first, you may be better served by learning about which options fit the final results you want to see.

Body Contouring After Massive Weight Loss

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As you can see, several physicans have noted that body contouring after massive weight loss is quite a bit different than plastic surgery after pregnancy.  This is because your skin has most likely withstood multiple weight gain-loss cycles and thus has more damage.  With your a00+ lb weight loss, there is also often a circferential excess of skin/ Weight loss patients who have had a RNY also have unique nutritional needs that must be addressed to ensure proper healing.

Many plastic surgeons specialize in baritaric plastic surgery, and books such as "Total Body Lift" or "Bariatric Plastic Surgery" may be helpful resources.

Many Options Exist for Weight Loss Patients

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Hi there-

You are correct that many options exist for improvement in your body contour, and while (considering your excellent success losing weight) many of these options will undoubtedly be available to you, there is no doubt that one or two of the options will be better for you as an individual.

Which is best for you will depend on many things, including your current appearance, your goals for appearance, recovery, experience, etc

It is therefore not possible, and would be irresponsible, to recommend one option over another to you without the benefit of a careful consultation and physical examination.

Your best bet is to find a talented and skilled surgeon certified by The American Board of Plastic Surgery, and with a lot of experience in all of these options, and visit for a consultation.


Tummy tuck after massive weight loss

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Tummy tuck after massive weight loss is most often more than that, and can involve a full circumferential lift, a midline reduction, incorporate a pubic lift. There are books published on body contouring after significant weight loss. One source is the ASPS website under their video education section. Rather that try to find out about all procedures, get some good consultations to see what fits your particular needs.

Best of luck,

Peter Johnson, MD

Body Lift After Massive Weight Loss

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Congratulations on achieving your 150 lb weight loss.  The best solution for removing the left over excess skin is different for each person.  A lower body lift gives more improvement than an abdominoplasty or extended abdominoplasty alone.  You can see improvement in areas adjacent to the trunk, such as your back and thighs and groin.  The fleur de lis approach is used primarily in people that already have a large midline upper abdominal incision.  The cost is generally proportional to the amount of time the surgery requires to perform, not by the length of scar. Come to a consultation with an open mind.  Identify a plastic surgeon with much experience  in treating the massive weight loss population certified by the American Board of Plastic Surgery.  Do not allow your bypass surgeon, a general surgeon to do your abdominoplasty.

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.