Umbilical Float or Standard Tummy Tuck with Possible Vertical Scar? (To Fix Diastisis, Hernia and Stretched Skin) (photo)

I have diastasis, umbilical hernia and stretched skin. 2 pregnancies (1 c-section). I've seen 2 board certified PS and they told me the same thing. I could do a full standard tummy tuck and could have a vertical scar component because there possibly isn't enough skin to bring the bb all the way down past my c-section scar (which is very low). OR do an umbilical float. I worry about loose skin being left above the bb with the float vs having vertical scar? Which surgery do you recommend?

Doctor Answers 4

Umbilical Float or Standard Tummy Tuck with Possible Vertical Scar? (To Fix Diastasis, Hernia and Stretched Skin)

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     Only an exam will be able to determine which is best.  I have offered both options to patients, and I think either would be appropriate in your case.  The dissection for the float should continue above the belly button and loose skin should be pulled tight from the upper abdomen and lower abdomen as well.  Find a plastic surgeon with ELITE credentials who performs HUNDREDS of tummy tucks each year.  Look at the surgeon's website before and after photos to determine who will get you to your goals.  Kenneth Hughes, MD Los Angeles, CA

Umbilical Float or Standard Tummy Tuck

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Given the two choices, the small vertical scar would be the best choice if you want maximum tightening. But I have found that to be very rare in my practice and I make the major scar very low. As long as the surgeon dissects up over the lowest ribs and closes with a progressive advancement technique you should have little need for a vertical scar.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

? Vertical scar with tummy tuck

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It's often surprising how far the upper abdominal skin flap can be pulled down once the tissues are freed up in surgery. I generally keep the tummy tuck scar very low, even in patients who may not seem to have that much skin above the umbilicus, and have rarely needed to add a vertical scar. If the opening in the skin that results from cutting around the umbilicus cannot be pulled down enough to remove it together with the lower abdominal skin, the opening would likely reach close to the lower skin flap. This then results in a short scar extending up from the main horizontal scar. The vertical scar is often covered by swimsuits or underwear anyhow, and tends to look inconspicuous (it doesn't scream out "cosmetic surgery"). The surgeon who has examined you can give you the best advice, but don't be afraid of a short vertical scar (which may not even be necessary... to be determined at the time of surgery). Good luck!

Andres Taleisnik, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 42 reviews

Concerns Prior to Tummy Tuck Surgery?

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Thank you for the question and pictures.  In my practice, I would likely recommend what your consultants have recommended to you in person. I have found the use of “progressive tension sutures” technique to be helpful for patients in your situation;  this technique allows for decreased tension along the closure line. In some cases, I find that it helps avoid the need for the vertical scar.

 Ultimately, you may have to decide between using an incision above your C-section  scar or the possibility that you will “need” a short vertical scar perpendicular to the transverse scar.

 Given that you are preparing for tummy tuck surgery, some additional advice may be helpful to you:

1. Make sure you are doing the procedure for the right reasons (for yourself)  and that you have realistic expectations.  Be aware that an improvement in the “problem area” may not translate to an overall improvement in your life   situation.  You are bound to be disappointed with results of the procedure if your motivation for doing the surgery is not internally driven.

2. Time your surgery carefully; generally, it is not a good idea to have surgery done during or immediately after a stressful period in life (for example divorce or death of a loved one). The additional stress of surgery will undoubtedly be  more challenging to deal with if a patient's emotional reserves our already exhausted. Remember, that an improvement in your physical appearance will not translate to an improvement in your life situation.

3. If possible speak to patients who have undergone similar procedures and query them about the toughest times of their recovery period. Any practical hints previous patients can provide may be very helpful.

4. Make sure you are aware of potential complications that may arise how to reach your surgeon if necessary.

5. Make sure you have a strong and patient support system (several people if possible) in place who have time/patience to take care of you. Arrange for professional nursing if any doubt exists regarding the availability and/or stamina  of your caretakers.

6. Be patient with the healing process, understanding that it will take several weeks to months to feel “normal” again. It may also take many months/year to see the end results of your surgery.

7. Be prepared to distract your mind with things of interest such as books, magazines, and movies.

8. Expect less of yourself; do not go back to work, school or chores too early and let others take care of you (for a change).

9. Pick your surgeon carefully (a well experienced board-certified plastic surgeon) and trust in his/her advice. Keep in close communication with your surgeon and do not hesitate to communicate questions/concerns and the   emotional swings that you may experience.

10. Resume all medications that you were using preoperatively when cleared by your plastic surgeon and stop the use of narcotics and sedatives as soon as feasible after surgery.

11. Keep in mind the end results as you go through the tougher emotional times after your surgery.
I hope this helps.

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.