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Background:  The standard treatment for abdominal excesses and muscular wall laxity is the tummy tuck procedure. Based on a horizontally oriented segment of skin and fat excision the underlying abdominal wall can be tightened underneath and the superior skin flap advanced to reshape the entire stomach area. This results in a scar line on the lower half of the abdomen at the lower end of the vertical distance between the belly button and the pubis. Its horizontal length in these more standard cases stops at the anterior superior iliac spine points.

But the larger the excess abdominal soft tissue excess becomes, the bigger the excision size will be. This subsequently translates into the need for a longer resultant scar to satisfactorily complete the excision pattern. The outer ends of the scars now pass the bony anterior point of the hips and end up on the flanks or back. Such extensions are necessary to avoid soft tissue bunching at the ends of the incisions known as ‘dogears’.

It is important that patients understand before any type of tummy tuck both its vertical height as well as the horizontal extent of the scar line on both sides. While no patient wants a long scar this is the tradeoff for a more complete soft tissue excision and a more narrow waistline effect.

Case Study:  This middle aged female had a moderately-size abdominal pannus and overhang. She had rectus diastasic by examination but no umbilical hernia.

Under general anesthesia she had a a full tummy tuck performed with significant midline facial plication using subfascial infiltration of Marcaine with epinephrine for immediate after surgery pain control.

The large abdominal skin flap was closed over the excision site with retrieval of a shortened umbilicus brought up through a new skin hole. To work out the excess skin and prevent dog ears the final scar line extended way past the hips into the flank area.

The extended tummy tuck, what I call a type 5 tummy tuck, is needed when the tissue excision extends beyond the hips.  This usually creates a better result than just liposuction alone even if the redundant (dog ear) excision was not necessary. This scar line typically heals well without scar widening.

Case Highlights:

1) Tummy tucks are done with different amounts of tissue excision and incisional length.

2) The larger the abdominal overhang the needs to be excised the longer the resultant scar line will be. (extended tummy tuck)

3) The recovery from extended tummy tucks is no greater than that of a more standard tummy tuck.

Dr. Barry Eppley

Indianapolis, Indiana

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