Concerns with my upper ab region. What are my options?

Your photographs indicate you are an excellent patient for a standard tummy tuck, and with your BMI being 28.9, you are within the range for a standard abdominoplasty with correction of rectus diastasis.  Any bulges in the upper quadrant can be dealt with during the repair of your rectus muscles. Tummy tuck surgeons fall into one of three categories - those who do liposuction before the tummy tuck, during or after.  It is my understanding that the majority of the American plastic surgeons do liposuction after the tummy tuck, and therefore any masses in the upper part of your abdomen would have been dealt with during the first surgery and before the liposuction.Liposuction alone or with a lower abdominal skin resection will not deal with the separation of muscles (rectus diastasis) caused by your two pregnancies.  Liposuction at the same time as the abdominoplasty has a much higher complication rate and less aesthetic final result than tummy tucks followed with abdominal liposuction at a second stage.  I highly recommend you choose one of the many Board Certified plastic surgeons you have already spoken with.  Be sure you look at before and after pictures, ask what level the scar is going to be at, and be sure they do good belly buttons.  I'm completely dumbfounded by the statement of necrosis in the upper abdomen since I have no idea what that means.  

Hi, thank you for your question.You are a good candidate for a tummy tuck. The upper abdominal fullness will be mostly corrected (if not completely flattened) during your procedure. Any residual fullness that is not completely flat can be liposuctioned safely.An in-person consultation will help answer any questions you may have.I hope this helps. Best of luck! 

Hi and thank you very much for your question and photos. Based on your history and photos, I believe you would be a great candidate for a tummy tuck combined with liposuction. I suggest you consult with a Board Certified Plastic Surgeon to further discuss your concerns. I hope this helped. Best wishes! Dr. Aydin

Hello and thank you for posting your photos. Your only option is a tt with muscle and lipo. There is no reason for you to have anything other then great results because you are actually a textbook patient for a tt. I do not agree that you may have a bulge even after surgery. Muscle repair plus the stretching of the skin all the way down to the pubic area (area where the scar will eventually be), will be more the enough to flatten your entire abdomen. Excessive abdominal lipo during a tummy tuck may increase the risk of necrosis, but you do not need excessive abdominal lipo. A little bit of lipo in specific areas may be performed to enhance results, though it might not even be necessary. In any case, this will not increase risk of necrosis and you should have great results regardless. No need to worry. A tt will only make you look better.Best of luck,Dr. Miguel Mota

Dear karso,Thank you for your question. You look to be a good candidate for a tummy tuck. Your surgeon is correct, overaggressive liposuction of  the upper abdomen can cause necrosis of the skin. That being said, limited and judicious liposuction can be done safely during a tummy tuck. Flank liposuction is also safe, which based on your photos you would benefit from.Good luck,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
RealSelf Top Doctor and RealSelf Hall of Fame

A TT addresses both the loose skin and the lax abdominal wall as to give a nice, flat youthful contour to the abdomen.  The TT also creates a more youthful belly button and removes the c-section scar. All stretch marks will not be removed.
TT without muscle repair may make the recovery easier, but, if you have laxity in that area from any pregnancies, the result will be better with plication. In general, the muscles should be brought to anatomic norms. The smaller the separation, the less tightening required and probably the less discomfort. Swelling will occur irrespective of muscle repair, and almost every patient requiring a TT will benefit from the muscle repair.
Consult via Skype or in-office with a board certified plastic surgeon to determine the best treatment plan for you.
Best of Luck!

You are an excellent candidate for abdominoplasty with mesh reinforcement, if you are not planning future pregnancies.  The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.  If you are concerned about the fullness of the upper part of the abdomen then fat can be surgically resected and does not require liposuction at the time of surgery.Best Wishes,Gary Horndeski, M.D.

Thank you for your question.Based on your photos, I think you would be a good candidate for a tummy tuck. I cannot see that much of the upper abdomen in these photos. It is true, you need to be careful with liposuction of the upper abdomen during a tummy tuck. Too much liposuction in that area, can disrupt blood flow and cause skin necrosis. In these situations, I will be conservative with my liposuction during the tummy tuck. Once that patient has, healed we can always go back in and be more aggressive because we do not have worry about blood supply to the skin flap.

Thank you for your question and photos.  Your expectations will dictate the best procedure(s) for you.  From your photos, I would say you are a good candidate for a tummy tuck.  I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals.  Best of luck!
Dr Dhaval Patel
Double Board Certified
Plastic Surgeon
Chicago
Hoffman Estates 
Oakbrook 
Orland Park

Hello and thank you for your question and sharing your photos.  I
believe you are a good candidate for a tummy tuck and should have a nice result.   During tummy tuck,
extra skin in the lower half of your abdomen including the stretch marks will
be removed. In addition, typically the fascial laxity/separation of recti
muscles will be taken care of by muscle plication, giving you a flat
abdomen. The added liposuction of your hips/flanks will help with creating a
natural and aesthetic waistline. Incision can be placed very low to be
hidden under bikini. With proper surgical technique, belly button can be
designed to  be a true 'innie'. Recovery from tummy tuck is 1-2
weeks. Strenuous activity and lifting heavy weights should be avoided 6 weeks
to 3 months post op.In terms of upper abdominal fullness that your plastic surgeon has mentioned, it is true that aggressive upper abdominal liposuction should be avoided due to compromise of blood supply to abdominal skin. Having said that, liposuction of upper abdominal fat, in particular the deep fat, can be done if proper technique is used. I would seek consultation with a board-certified plastic surgeon for a full evaluation and advice. Best,

Pejman Aflaki, M.D.                                            
Johns
Hopkins-trained double board-certified plastic surgeon