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Not every Tummy Tuck is the Same

Decision Making 101

There are many versions of abdominoplasty (or tummy tuck) as it is commonly known. The decision making starts with an assessment of skin quality and quantity.  Quality assessment deals with elasticity issues such as stretch marks, thinness or thickness of skin, and quantity deals with attachments to underlying tissues.  Poorly adherent skin and fat slides significantly around, is quite mobile, and makes people look fatter than they actually may be.  Additional excess skin may present also as folds or rolls of skin.

The location, above and or below belly button (umbilicus), of the skin issues is a key determining factor in the TYPE of tummy tuck.  (Fat issues and abdominal wall issues are the other two key issues and will be dealt with in future blogs.)  If the skin is in excess, and mobile or poor quality limited only below the belly button, then tummy tuck may not require an incision visible on surface of umbilicus.  If the “incision” of umbilicus is just where belly button meets the abdominal wall on the inside it is hidden from view and known as an “umbilical float” procedure.  The belly button is reattached slightly lower as the upper skin is pulled slightly.  The excision is of lowest abdominal skin and limited to about 6 inches. If there is skin excess and/or laxity above AND below belly button, then there must be an incision on the surface of the belly button to separate it from the skin so that the maximal amount of skin can be removed.  This is more typical and is known as umbilical transposition abdominoplasty.  The skin removed here is often 10-15 inches of excess skin!

Now let’s move on to what determines the length of the incision. The incision length depends on the amounts of excess skin and how far lateral on the belly (toward the flank) the laxity or poor quality extends.  Incisions are shortest when there is essentially no significant skin excess and access is only needed to eliminate a bulging or repair a weak abdominal wall.  If no abdominal wall work is required then the procedure is called a “skin only” or “limited” procedure.  If abdominal wall tightening is done, then it is a ‘traditional abdominoplasty.”  I prefer these terms rather than silly terms like ‘mini.’ A term like ‘mini’ usually means mini results.

Visit www.drspiro.com to view numerous examples of my patients’ abdominoplasty outcomes.

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