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  • Writer's pictureDr. Megan Dreveskracht

THE TUMMY TUCK: NOT ONE SIZE FITS ALL

Updated: Apr 13

Year after year, the Tummy Tuck has remained one of the most popular procedures I perform in my Seattle Plastic Surgery practice. All patients seeking a Tummy Tuck are really getting at a single goal: to improve the appearance and contour of the abdomen. Despite a relatively singular goal, however, there is truly no prototypical Tummy Tuck patient. From the 33 year old mom of 2 kids who wants her flat-ish stomach back, to the pilates instructor or weight-training coach, to the higher BMI patient stalled in weight loss from the challenges of exercising with extra abdominal tissue– this procedure spans ages, body mass indices, body shapes and sizes, and fitness levels.


Despite patient variability, we tend to lump all versions of a Tummy Tucks under a relatively singular term. Naturally, however, it makes sense that the procedure itself would have different iterations aimed at addressing all the different patients who seek it. Below, I will walk you through the most common versions of the Tummy Tuck procedure and how I choose which one is right for each of my Plastic Surgery patients.



A woman being marked for her tummy tuck plastic surgery procedure

Standard Tummy Tuck:

The variations in Tummy Tucks will all make a bit more sense once you understand the reference point-- the Standard Tummy Tuck--so it’s a good place to start. A Standard Tummy Tuck is a procedure that will tighten loose skin both above and below the belly button. To accomplish this, all the skin below your belly button gets removed, the skin right above your belly button will get stretched down to an incision low in the groin area, and we create a new hole for your belly button to pull through. The incision is placed just above the pubic bone and will extend roughly hip to hip, strategically positioned to be hidden under a bathing suit or underwear. This approach allows full exposure of the underlying rectus muscles such that, when indicated, a repair of the muscles can easily be done at the same time. Liposuction can also be performed to the waist and mons region during this procedure to enhance the overall appearance of the entire abdomen.


It is important to note that in order to be a candidate for this procedure, you need enough loose skin above the belly button to be able to stretch all the way to the lower incision without significant tension. If there is enough skin laxity but just a tad too much tension, then a small vertical incision (usually 2-3 cm in length) can be added in the middle of the lower incision to get the skin edges successfully closed.


If there is enough abdominal skin laxity such that the incision extends onto the sides of the waist, some surgeons refer to this as an Extended Tummy Tuck.


Mini Tummy Tuck:

Most patients who have heard of a Mini Tummy Tuck get hooked on the idea of a smaller scar. While true that the scar tends to be shorter, this procedure has very specific indications that eliminate many patients from being good candidates. A Mini Tummy Tuck is a procedure designed to tighten loose skin below the belly button. To accomplish this, a small ellipse of skin is removed from just above the pubic bone and closed to leave an incision that, similar to a Standard Tummy Tuck, can be hidden underneath underwear or a bathing suit. There is no surgical dissection above or around the belly button and, as such, no tightening of skin above the belly button and no exposure of the rectus muscles above the belly button. As a consequence, the ideal candidate for a Mini Tummy Tuck is someone who only has loose skin below the belly button and, if present, only has a rectus diastasis in need of repair below the belly button.


Fleur De LIs Tummy Tuck:

A Fleur De Lis Tummy Tuck is usually reserved for patients who have significant loose skin of the upper and lower abdomen. Oftentimes, these patients have undergone bariatric surgery and, as a consequence, have experienced a massive weight loss. In this procedure, the skin below the belly button is removed (as in a Standard Tummy Tuck) to tighten the abdomen horizontally, but skin is also removed in the midline to tighten the skin vertically. This will leave the patient with a scar that looks like an upside-down ‘T’. The rectus muscles are exposed in this approach and can be tightened simultaneously. Due to the large incisions and concerns for maintaining blood supply, liposuction is often limited.


Reverse Tummy Tuck:

This is the least-known of all the Tummy Tuck options and for good reason. Very few patients are truly good candidates for this variation. A reverse Tummy Tuck places an incision underneath the breasts, as opposed to all other variations which place their incisions in the lower abdomen. Its main goal is to tighten only the skin above the belly button. The skin and muscles below the belly button are not addressed in this procedure. The main drawback of this procedure for most patients and surgeons is the scar– it's a hard place to want a large scar, and the surgical vector of pull (upwards) tends to fight against the natural vector of pull (downward). The latter can cause scar migration over time, increased visibility, and poor healing. One very appropriate time to consider this procedure is when (a) the patient only has loose skin above the belly button and (b) we are concurrently planning a breast lift or reduction, which would already be placing horizontal scars underneath the breasts.


Choosing the Right Tummy Tuck for You:

Deciding which type of tummy tuck is best for you requires a detailed consultation with a Board-Certified Plastic Surgeon and a thorough review of both your individualized anatomy and your unique goals. Remember, when it comes to Plastic Surgery, it all ultimately boils down to anatomy– which layers of the abdomen need to be addressed (muscle, fat, skin) and to what extent.


 


If you are considering a Tummy Tuck and would like to schedule a consultation with Seattle based Plastic Surgeon Dr. Megan Dreveskracht, call 206-860-5582 today. If you have questions you would like addressed in future blog posts, please leave them in the comments below.


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