What is a Reverse Abdominoplasty?

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.

A reverse abdominoplasty is a less common surgical procedure compared to the traditional tummy tuck (abdominoplasty). This procedure primarily targets excess skin and fat in the upper abdomen rather than the lower abdomen. It is typically considered for patients who have skin laxity and excess primarily above the navel, which is not as common as lower abdominal issues.

In a reverse abdominoplasty, the incisions are made near the under-breast fold, allowing for the removal of excess skin and fat from the upper abdomen, with the possibility of tightening the skin that drapes downward. This technique may be an option for individuals who have previously undergone abdominoplasty but have since developed skin laxity in the upper abdomen, or for those whose abdominal issues are predominantly above the belly button.

However, I rarely recommend reverse abdominoplasty for several reasons:

Limited Correction Scope: Reverse abdominoplasty mainly addresses the upper abdomen, leaving the lower abdomen, which is a more common area of concern, untreated.
Scar Placement: The scars from a reverse abdominoplasty are located under the breasts, which can be visible with certain clothing or swimwear.
Combination with Other Procedures: While it can be combined with other surgeries (like breast surgery) for a more comprehensive upper body lift, it's not universally suitable for all patients looking to improve abdominal aesthetics.
For most patients seeking abdominal contouring, a traditional or extended tummy tuck, which addresses the entire abdomen, is often more beneficial. These procedures allow for the removal of excess skin and fat from both the upper and lower abdomen, and the tightening of the abdominal muscles if needed, providing a more comprehensive improvement in abdominal contour.

Every patient's body and goals are unique, and the best approach is always determined through a thorough consultation. During this consultation, we can discuss your specific concerns, evaluate your anatomy, and determine the most appropriate procedure to meet your goals, whether it's a traditional abdominoplasty, a reverse abdominoplasty, or another body contouring option.

Sincerely,

Dr. Katzen
Plastic Surgeon

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.

A variety of
abdominoplasty variants exist for treating abdominal contour deformities. It’s important to tailor the surgical
treatment to address the patients’ specific needs. Rarely patients have loose saggy upper
abdominal tissue with relatively tight lower abdominal skin. In other cases they have upper abdominal
scars which prevent traditional abdominoplasty. Under these circumstances, a reverse abdominoplasty may be indicated.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.

A reversed abdominoplasty is an aesthetic procedure done in patients that have more excess skin in the upper abdomen rather than the lower abdomen. In carefully selected patients, this can work. The scar is in the upper abdomen and crosses the center and can be problematic in some patients. It is not routinely recommended. I would highly suggest that you visit a Board Certified Plastic Surgeon that specializes in this type of surgery before making any decisions on this type of procedure.

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.
Good Luck!

The reverse tummy tuck is a very good option in a small number of patients. The traditional tummy tuck tightens the entire front of the abdomen from the ribs to the pubic area, by removing a football-shaped area of skin between the belly button and the pubic area. The skin above the belly button is then lifted up and pulled down to the bottom edge of where the tissue was removed, leaving a scar horizontally across the lower abdomen. Some patients however have good skin tone in the lower abdomen but some laxity in the upper part. In these cases it might make sense to tighten by pulling up instead of down.
The major trade-off is the scar in a more visible location. It can be hidden along the bottom crease of the breast, and works well if a breast lift is needed at the same time so that it can be done with the same scar. The more visible part is where it crosses the middle.

Most patients with loose skin/muscle in the tummy area will be better off with a regular tummy tuck procedure. A reverse tummy tuck tightens the upper abdomen only and most people have loose skin either all over or mostly in the lower abdomen. Thus, few people are good candidates for a reverse tummy tuck. The reverse tummy tuck is done through incisions in the fold underneath the breasts. The skin is then lifted, pulled upwards and trimmed. This is the reverse of a standard tummy tuck where the skin incision in made very low and the skin is pulled down.

A reverse tummy tuck is a method of liftin the skin upwards instead of pulling it downwards.  The skin incision is placed immediately below and under both breasts. It generally removes loose skin in the midriff area.

Abdominal scars influence the type of abdominoplasty to perform. In rare cases, an abdominoplasty is performed using an incision underneath the breast and pulling up of the abdominal flap instead of the usual lower incision with pulling down of the abdominal flap and skin.
The incision is usually placed underneath the breast in the inframammary fold. The abdominal flap is raised superiorly and the excess skin is removed from the upper abdomen.
Be cautious of the reverse abdominoplasty in terms of flap vascularity, incision placement, and scar widening. Always seek a board certified plastic surgeon who is experienced in this procedure.