I am frequently asked whether a patient can have just a “mini” tummy tuck rather than a full in order to tighten loose tummy skin. I want to discuss tummy tucks and how we decide and why we choose the different types.
A tummy tuck is a procedure where an incision is made in the lower tummy beneath a swimsuit line, placed just above the pubic hairline and curving up towards each hip. Since we will be freeing up under the skin and releasing the skin attachments so that we can re-drape and trim loose skin, how long the incision will be depends upon how much loose skin there is to be removed and how far to the sides the laxity extends.
Full vs. Mini
If there is loose skin that is located below the belly button, then the undermining of tissues would stop at the belly button. The excess skin would then be pulled down, trimmed, with resultant scar located at the lower abdomen hidden in the underwear. This is referred to as a “mini” or “lower” tummy tuck. The skin above the belly button is not affected or tightened. If there is skin issues above the belly button these will not be corrected.
If loose skin at and above the belly button is present, a full tummy tuck is required. The attachment of the tummy skin to the belly button needs to be released so that the upper tummy skin is not tethered at the belly button. Then pulling downward on the skin will tighten the upper as well as the lower tummy skin.
The main deciding factor deciding between the “mini” and “full” tummy tucks are whether the belly button and upper abdominal skin are stretched and loose. If this is the case then only a full tummy tuck will correct this. If not, and the loose skin is entirely in the lower tummy, a “mini” alone is the answer.
The Appearance of Scarring
In a full tummy tuck, there is, in addition to the lower tummy scar, a small scar around the belly button where it is reinserted through the upper tummy skin that is tightened and pulled over it. This allows us to correct any defect in a belly button such as being stretched out or overly large. In this way, a stretched out and overly large belly button can be made to look much better.
I strive very hard to create a small, natural-appearing belly button with the scar mostly hidden in the shadow lines with the best cosmetic appearance. What happens to the hole where the belly button used to be attached? It is pulled down with the surrounding loose skin. If there is enough loose skin that is above the belly button, this skin will be advanced allowing the old belly button hole to move below the incision and removed. If there is not quite enough laxity of the skin to remove this hole, then it will be closed with a short vertical scar in the lower belly area.
Some surgeons will attempt this short vertical scar that results from closing the old belly button hole. This puts extra tension on the closure of the tummy tuck, sacrificing the hidden scar causing the scar to rise to a higher move visible location. I feel that this is a poor decision and in turn raises the scar too high and also raises the public hair higher as well. This can also cause the distance from the belly button to the pubic hair to be abnormally short and not aesthetically pleasing. This is too high of a price to pay in order to avoid a very short scar by the belly button.
Tummy Tucks and Muscle Tightening
There are some other factors we need to also think about when doing a tummy tuck. Sometimes after pregnancies the abdominal wall can stretch quite a bit. This stretching causes the abdominal muscles, the six pack muscles, to be stretched apart leaving a gap in-between them when a woman goes to stand up or does a sit up (known as “diastasis recti”). Many people think this is a hernia, when in fact it is not a true hernia but rather just a stretching of the fascia. This stretching of the fascia does not give proper support to the woman’s abdominal wall is not properly supporting her “bowels”. That is why, in most full tummy tucks, we usually are tightening the fascia and muscles prior to tightening the skin. Sometimes there are small hernias next to or in the belly button and these can be fixed at the time of surgery as well.
Of course there are many situations where this tightening is not required. Some patients seek treatment simply because of this bulging. This protruding fascia fills out the loose skin so that they are more aware of this bulging than of the problem of loose skin. In most patients, once the fascia is tightened and the muscles are placed back in their normal location, the overlying loose skin becomes more noticeable and need for a full tummy tuck is more apparent. If the fascia and muscles are protruding both above and below the level of the belly button, a full tummy tuck with release of the belly button is needed to gain access to repair the upper abdominal wall.
If it is noted that the facia of the lower abdomen only is mildly lax when doing a ‘mini’ tummy tuck, then only this part needs to be repaired. When doing this it is important to be careful because if the lower fascia is tightened too tight this can cause the upper fascia to bulge creating the appearance of upper abdominal fullness.
Tummy Tucks and Fat Reduction
There is definite controversy about the safety of removing fat via liposuction of the upper abdomen at the time of a tummy tuck. Unquestionably the fat from the lower abdomen will be removed and advanced with the incisions created for the tummy tuck. But what about the fat that remains in the upper and mid abdomen? When the tummy tuck is performed this fat is definitely tightened and moved toward the tummy tuck incision, but not all the fat is completely removed. Some surgeons will remove this fat with liposuction during the tummy tuck BUT this does not come without its risks. There is a higher risk of damaging blood supply to the skin in those areas potentially causing the skin to die as a result of trauma caused by liposuction at the same time. Many surgeons, including Dr. Wright, prefer to avoid these risks by staging the procedures. By avoiding having to liposuction the central abdominal area, the same area where the undermining of the skin is done for the tummy tuck, the risk of necrosis is avoided. This liposuction can safely be performed by simply waiting a few months until the skin has healed and new blood supplies formed or by doing it a few months before the tummy tuck.
The “In Between a Mini and Full Tummy Tuck” Option
To be complete there is one variation of a tummy tuck that is in-between the mini and the full, called “umbilical float”. If a patient has minimal loose skin above the belly button and the belly button sits higher above the pelvic bones or not to far from where the ribs meet in the middle at the sternum, then the belly button can be released from the fascia. The belly button stalk is divided at the fascia which frees the skin at this point, allowing the muscles to be tightened if needed, and the skin to be advanced inferiorly. The belly button is then reattached to the fascia.
This umbilical float technique will allow some mild tightening of the skin above the belly button without an umbilical scar or a vertical scar. Unfortunately most woman are not candidates for this as their belly buttons must be high to begin with, not stretched out, and have minimal skin laxity above the belly button.
The decision to have a tummy tuck and which option to choose can be difficult. Dr. Wright will work closely with you to help you decide which tummy tuck is best for you based on your body type and the goals you are wanting to achieve.