Background:Tummy tuck surgery accomplishes what no diet and exercise program can, a dramatic flattening and tightening of the abdominal wall. It is a radical approach to the problem but is highly effective because of the amount of skin and fat removed in a short period of time. There is always the aesthetic tradeoff of a low horizontal scar but for many patients this is a better ‘problem’ than what they currently have.
While patients in need of tummy tucks come in an endless variety of shapes and weights, tummy tucks can only be done in two basic variations, a mini- and a full tummy tuck. The fundamental difference in the two types of tummy tucks is in the excisional pattern of tissue removal. The full tummy tuck incorporates a cut out of skin and fat that goes from the level of the pubis to above the belly button in a horizontal elliptical pattern. The mini-tummy tuck has a similar horizontal elliptical pattern but it stays below the belly button, removing less skin and fat and not extending as far to the sides.
The indications for a mini- vs a full tummy tuck depends on the location of the excess skin and fat. Any loose or rolls of skin above the belly button indicates that a full tummy tuck is going to create a flatter and tighter stomach. If there is only a little loose skin way below the belly button then a mini- tummy tuck is better.While in many cases these distinctions are quite clear, there are patients were the choice between the two is difficult
This ‘tweaner’ type of patient is usually a thin and lean female. Pregnancy has caused loose skin and stretch marks that largely lie below the belly button but there is wrinkling of skin around and above the belly button as well. It will be more effective to do a full tummy tuck but the lean frame will end up having a higher than desired scar level. A mini-tummy tuck will keep the scar very low but will not remove the ideal amount of skin to get the best tightening result. The desire to have a low scar in lean female is advantageous as this is exactly the type of patient who may wear more revealing clothing options.
Case Study: This 40 year-old female wanted to tighten up her abdomen and get rid of her loose and stretched out abdominal skin. She was an active boater and swimmer and wanted to look better in her swim suit and during the summer on the lake. She was concerned, however, about how high and long the tummy tuck scar would be. She was very thin and in good shape and her abdominal skin would only stretch so much.
Under general anesthesia she underwent a full tummy tuck removing the maximal amount of loose and stretch-marked abdominal skin. She had abdominal muscle plication but only in the lower half of her abdomen. Her skin closure was tight and a new belly button was made. A small single abdominal drain was used.
Her postoperative course was uneventful and she had the drain removed five days after surgery. He final scar position was higher than I would normally like but she opted for the most skin removal at the price of a higher scar. The scar did remain below her swimsuit line. But this may not be possible in all patients and is highly influenced by the style of swimsuit.
Case Highlights:
1) The removal of loose skin and tightening the abdominal wall can pose a dilemma in a thin lean woman.
2) With loose skin located mainly below the belly button, the choices are a mini- or a full tummy tuck. Each has their own advantages and disadvantages.
3) To remove the maximal amount of loose abdominal skin, a full tummy tuck will achieve that but at the expense of a higher than desired horizontal scar.
Dr. Barry Eppley
Indianapolis, Indiana