What is a Reverse Abdominoplasty?
Doctor Answers 24
Reverse Upper Abdominoplasty or Tummy Tuck
Not infrequently I see patients in whom there is as much skin laxity in the upper abdomen as there is in the lower abdomen. In fact, some patients after pregnancy will have fairly 'toned' lower abdominal skin, but very lax and redundant upper abdominal skin. In these situations, the removal of skin in a vertically downward direction ( a conventional tummy tuck) is not adequate to correct the upper abdominal skin laxity. Such patients are often very good candidates for what I refer to as a 'reverse upper' abdominoplasty.
This surgical technique involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts. In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.
A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.
Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.
Reverse tummy tuck
A reverse tummy tuck is a procedure that is performed in order to correct for the laxity of the upper abdominal region. I have found the procedure of tremendous use in those who also need a breast lift. The incisions are placed within the fold under the breast through the incision that is often needed for a breast lift.
Reverse abdominoplasty tightens upper abdomen
Reverse abdominoplasty refers to an upper abdominoplasty done to tighten upper abdominal skin that cannot be tightened by a lower abdominoplasty or mini tummy tuck.
The scars are usually placed beneath the breasts to conceal the scar.
This procedure is done on patients who have only lax upper abdominal skin or in patients who have had a lower or mini tummy tuck and are left with loose upper abdominal skin.
The reverse abdominoplasty or upper tummy tuck is complex and requires skill and experience by a board certified palstic surgeon.
The most common problem with this procedure is that although the scar is placed beneath the breast, it is necessary to cross the midline-the skin between the breasts below the cleavage. Surgical incisions placed in this region are more prone to hypertrophic or red raised scars.
Good results are possible- BUT careful design of the incision below the sternum(breast bone), and agressive scar therapy with IPL, Laser or steroid medication is usually needed to prevent an unsightly scar between the breasts.
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Reverse Tummy Tuck
This procedure involves marking incisions bilaterally along the inframammary folds and connecting them across the midline.The skin is then undermined in the inferior direction and advanced in a superior direction.The excess skin is then removed and the wound is closed.
This procedure is rarely indicated, but under specific circumstances can be extremely helpful.This is especially true when combined with breast lift surgery.Its major drawback is scarring that’s hard to hide.
If you’re considering this type of procedure, a consultation with a board certified plastic surgeon is appropriate.This surgeon should be able to determine if you’re a candidate for this type of procedure.
Reverse tummy tuck is for upper abdominal skin laxity
Consider a reverse tummy tuck as a tummy tuck done upside-down. Excess skin and fat from the upper abdomen, that would not be well-addressed with a classic tummy tuck, is excised. The abdominal flap is pulled up and the wound closed. The scar ends up under the breasts and across the lower chest.
This is not a common operation for several reasons. First, significant upper abdominal skin laxity that would necesitate this approach is much less common than lower abdominal skin laxity. Secondly, the scar is extensive and more visible. Often, the procedure is not considered unless there are pre-existing scars under the breasts. The scar across the lower chest tends to become thick. The result may be limited due to gravity pulling the abdominal skin flap back down.
Having said that, there is some renewed enthusiasm for the procedure, often combined with a classic tummy tuck, for patients with large amounts of lax skin after gastric bypass surgery.
It is not appropriate for the vast majority of patients.
What is a Reverse Abdominoplasty?
The reverse abdominoplasty is quite popular in South America but has not gained the same popularity in America. To me, this is reminiscent of vertical(lollipop) breast lifts and reductions as opposed to the inverted "T"(anchor) scars still commonly employed in the United States.
As with the vertical breast scar procedure, there is a significant learning curve associated with the reverse abdominoplasty procedure.
Sub-optimal quality scars were visible in the lower cleavage and scars migrated from the breast crease caudally(downward). However, these issues have been solved with some important surgical modifications.
With the reverse abdominoplasty, the umbilicus(belly button) is elevated into a more youthful position and vertical configuration, the torso is elongated, and the waist is thinned via a full 180 degrees of the lower abdominal skin elevation.
The scar can be continued around the back as a back/bra strap excision, smoothing the back rolls from hip to shoulder blades.
This procedure will not remove lower abdominal skin excess and muscle tightening of the lower abdomen requires another but small(C-section size) scar.
Residual lower abdominal skin excess may be amenable to Ultherapy.
Upper abdominal skin removed using conventional abdominoplasty(in my experience) requires not only a periumbillical(belly button) scar but a large amount of lower abdominal skin removal increasing the horizontal scar length to the hips, potentially widening the scar quality due to increased tension and perhaps a traction deformity of the mons, while giving the abdomen a shorter wider appearance.
Once the issues of the upper abdominal scar were solved, reverse abdominoplasty has become the procedure of choice for abdominal rejuvenation, when appropriate.
The combination of no periumbllical(belly button) scar, elongation of the waist and tapering of the skin from the hips speaks for itself.
The cost ranges from $7000 to $8500 including abdominal and anterior hip lipoplasty.
Hope this helps.
The Reverse Tummy Tuck is an option for treating cellulite like wrinkling above the navel
The Reverse Tummy Tuck is a potential surgical option to treat loose, wrinkled, cellulite looking skin changes located above the navel. It becomes the operation of choice particularly if there is no problem with skin laxity below the navel. A reverse tuck involves removing half moon shaped portions of skin below each breast. Once the resultant defect is sutured the final scar is strategically hidden in the fold beneath each breast. The effect is to pull up and thereby tighten and smooth the skin in the upper abdomen. Although a similar result could be achieved with a traditional Tummy Tuck the Reverse Tummy Tuck is a less complex operation leading to an easier recovery.
In highly selected patients, either due to severe laxity and fat in the upper abdomen or scars on the abdomen a reverse abdominoplasty is chosen.
The position of the scar is put in the infra mammary crease and joined inthe midline between the breasts.This will tighten the upper abdomen, and it also goves access to the breast if any surgery is contemplated on the breast.
One can use the extra skin and fat in the upper abdomen and fold it into the breast to enhance the size and shape of the breast
Reverse abdominoplasty is not a great procedure
A reverse abdominoplasty is not a great procedure in my opinion. The incision is under the breasts and the tension on the area tends to pull the breast down. I have been practicing plastic surgery for 25 years and have done only one of these. That one time I regretted it. There are many other ways to modify your body in that area which are less potentially deforming.
Thank you for your question. A reverse abdominoplasty involves making a long incision at the upper margin of the ribcage, dissecting a flap of abdominal skin and soft tissue in a downward direction, and pulling the excess upward before removing. Resulting in a scar that is far more visible than a traditional tummy tuck scar, it is generally recommended against in most patients.
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