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A tummy tuck remains as one of the most common and successful body contouring procedures. No other cosmetic procedure can change the shape of the abdomen as well, particularly when loose skin, stretch marks, and extra fat exist between the belly button and the pubic area. Cutting out loose skin and fat is the cornerstone of the operation which often has liposuction added in to improve bulging areas where the tummy tuck does not reach.

While there are different variations of tummy tucks, and no two are ever exactly alike, they are done with two basic approaches. Going by different names, they are essentially a mini- or limited tummy tuck and a fuller or complete tummy tuck. What such names refer to is where the location of the tissue cutout is done. A full tummy tuck removes an elliptical-shaped tissue segment from the pubis to above the belly button. A mini-tummy tuck removes less with an elliptical-shaped tissue segment taken below the belly button.

There are advantages and trade-offs to each procedure and some patients clearly would benefit by one or the other. But a fair number of patients could be done with either approach and the decision is not as clear cut. Understanding the scar trade-offs of each tummy tuck approach can help patients make a better informed decision. In the end, the only outcomes that patients care about are the scar and how good is the result afterwards.

One very important difference in tummy tucks is the final location of the horizontal scar. While every patient wants the lowest scar possible, not everyone can get it. The mini-tummy tuck is the most assured way to keep the scar as close to the pubic hairline as possible. Besides not having as long as a horizontal length to the scar (between the hips), it can be kept low because less tissue is removed. (cutout below the belly button) In a full tummy tuck, the initial incision may be marked low but it will end up higher due to the tension on the wound when it is closed. (larger cutout above the belly button) Since the incision is longer, it can end up above the panty or swimsuit line depending upon their style… particularly the tail ends of the incision. In addition, there will be a scar around the recreated bellybutton that does not result from a mini-tummy tuck.

While there are scar differences, they will almost always be differences in the abdominal result as well. With the greater cutout that comes with a full tummy tuck, the abdomen is more likely to be flatter and more stretch marks will be removed. In the mini-tummy tuck, liposuction is more extensively removed in the upper abdomen to make it flatter as a substitute for less skin and fat excisional removal.

For those abdominal patients that are what I call ‘tweeners’, (could do either tummy tuck approach or is between these two choices), one has to weigh how much scar can one tolerate for how much result. If scar is not an issue then a fuller tummy tuck is the best choice. But for those that have scar concerns, the mini-tummy tuck could be a better option.

Dr. Barry Eppley

Indianapolis, Indiana

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