Background: Tummy tuck surgery is the most aggressive form of abdominal reshaping. By removing large segments of skin and fat, improvement of the waistline shape is inevitable. The horizontal excision pattern ensures that there is a vertical tightening effect on the central abdomen. Differing lengths of the excision pattern will determine how far to the sides of the waistline this effect will occur.
The history of midline abdominal incisions from either intra-abdominal surgery or c-sections is waning. Laparoscopic surgery has replaced most midline incisions for open intra-abdominal access and most c-sections today are done with a low horizontal incision.
But occasionally a vertical midline abdominal scar is seen. The most common reason it exists today is because the patient either had abdominal surgery as an infant or child or an emergency c-section was done. Such a scar can end up as a midline depression either due to scar contracture or because fat has accumulated around it with weight gain. The combination of a depressed midline scar and thicker sidewalls due to fat thickness creates the impression of a ‘buttocks’ appearance on the stomach
Case Study: This 50 year-old female had a history of multiple intra-abdominal surgeries as an adult through a midline vertical incision from above the umbilicus down to the pubis. Her vertical scar was stuck down to the abdominal wall and the umbilicus was distorted. Even though she was not overweight, the combination of more normal fat thickness on her abdomen with an indented scar created the frontal buttocks appearance.
Under general anesthesia she had power-assisted liposuction (PAL) performed on her full abdomen and love handle areas. removing a total of nearly 800cc of aspirate. A vertical excision of skin and fat was done down to the abdominal wall. The umbilicus was reconstructed to a midline location within the closure with a more normal shape.
Her three months after surgery results show significant improvement in the shape of her lower abdomen and the elimination of the buttocks appearance. Her scars were slightly hypertrophic which may settle down as they mature over the next year.
The role of the vertical tummy tuck is usually limited to treating pre-existing proboematic abdominal scars. Eve when scars exist between the umbilicus and the pubis, they would be excised with a more traditional horizontal tummy tuck provided there is enough tissue laxity to do so. In this patient’s case her thinner frame and tighter skin precluded the horizontal tummy tuck option.
Highlights:
1) A vertical tummy tuck is a very uncommon abdominal reshaping procedure.
2) It is most commonly used when a pre-existing depressed midline abdominal scar is present with an associated umbilical deformity.
3) A vertically-oriented tummy tuck allows for simultaneous liposuction, muscle tightening and an umbilicoplasty.
Dr. Barry Eppley
Indianapolis, Indiana