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A tummy tuck or abdominoplasty is a well known body contouring procedure. It is used widely after childbirthing in women and significant weight loss in both men and women. While the number of men who undergo a tummy tuck has increasedin the past decade due to bariatric surgery, the majority of tummy tuck patients are still women. Women seek the procedure to get rid of outer concerns of loose skin, fat and stretch marks as well as internal muscle tightening and repair of hernias.

While the tummy tuck operation has been given a lot of different and snappy names for marketing purposes, there are fundamentally only two different types. These types are differentiated by the amount of skin and fat removed and the resultant incisions/scar that results. A full tummy tuck removes an elliptical-shaped segment of skin and fat that is placed above the belly button and extends down to the pubis below. This is why the bellybutton ends up with a scar around it as it is made ‘anew’ in the skin flap which is pulled down to cover the abdominal wall defect. The mini- or limited tummy tuck removes a smaller elliptical-shaped tissue segment that is placed below the belly button. This is why the belly button does not end up with any scar around it. It may be allowed to ‘float’ lower but it remains uncut from the outside.

For many women, the decision between a full or mini- tummy tuck is quite clear. When one’s stomach tissues are quite floppy, loose skin extends well above the belly button, or when skin hangs over the waistline, the need for a full tummy tuck is clear. Conversely, when the amount of loose abdominal skin is not more than a pinchable few inches or the stretch marks and loose skin clearly lies mainly below the belly button, no more than a mini- tummy tuck is needed.

But some tummy tuck patients are what I call a ‘tweaner’. Their abdominal tissue problems do not lie clearly in either category and they could have either a full or a mini-tummy tuck. The choice between the two tummy tuck options is not clear and, hence, they are in between the two operations.

When faced with this choice, it can be difficult to decide and one must look at their comparative benefits and liabilities. The key to making that decision is to understand what can be achieved for what trade-off. A full tummy tuck will remove the most skin and fat and get the flattest result. But it does so at the trade-off of a long horizontal scar that will run from one hip to the other. But the real scar concern to be aware of is that it will end up higher than most patients will like and it will pull the pubic hairline up higher. That is the price of the flattest and tightest result in the tweaner patient.

A mini-tummy tuck will not completely remove all loose skin and fat and, while every patient is different, will remove less than 50% of what a full tummy tuck does. But it offers the benefit of a shorter horizontal scar that will remain lower and can be kept just at the level of the top of the pubic hairline. (without stretching it out) That is the benefit of less tissue removed in the tweaner patient.

Dr. Barry Eppley

Indianapolis, Indiana

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