Background: Pregnancy affects most women adversely from an abdominal standpoint. The expansion and stretching of the abdominal skin is most severely seen in its central aspect around the umbilicus. The peri-umbilical region is well known to develop radiating stretch marks, loose skin and be a reservoir for refractory fat collections.
For most women the amount of peri-umbilical deformity requires a full tummy tuck to adequately resolve. But for some women the amount of skin excess in the lower abdomen does not justify the long lower abdominal scar. Conversely, liposuction alone will make the area less full but will leave an irregular contour due to the skin excess. Skin with stretch marks has a dubious ability to shrink down smoothly after underlying fat removal.
For those women with an intermediate peri-umbilical abdominal problem, a strategy that combines both fat and skin removal makes the most sense. Aggressive liposuction can be supplemented by skin removal and tightening to lessen the risk of skin irregularities. A limited or mini tummy tuck an keep the lower abdominal incision very low with less scar length while creating the needed abdominal skin tightening.
Case Study: This 44 year-old female had a very large but discrete fat collection around her belly button. Given her body size and type, the amount of peri-umbilical tissue excess was disproportionate. She has reached her potential for what she could change by weight loss and exercise.
Under general anesthesia, full abdominal and flank liposuction was initially performed. A total of 3.5 liters of liposuction aspirate was surprisingly obtained. This was not expected given her body size. A low mini tummy tuck was then performed with release of the umbilicus and allowing it to float downward and then reattached from the inside.
Her six month results showed a completely flat abdomen with a much improved waistline shape. Her mini tummy tuck scar was low enough that it was situated below her underwear line.
For women that do not have enough excess tissues to warrant a full tummy tuck, combining overall liposuction with a smaller tummy tuck can be a good alternative. Some plastic surgeons feel that there is no good role for a mimi tummy tuck procedure as it does not produce enough of a result. While this may be true for many women who seek abdominal improvement, it clearly is not the case for all as this patient’s result demonstrates.
Highlights:
- Central abdominal peri-umbilical tissues distortions are common for many women after pregnancies.
- With loose stretched periumbilical skin, liposuction alone will produce an inadequate result.
3. Combining liposuction with slower skin removal and repositioning (mini tummy tuck) produces the best result in profound cases of peri-umbilical lipodystrophy.
Dr. Barry Eppley
Indianapolis, Indiana