What are the Different Types of Tummy Tuck? (Abdominoplasty)

Tummy Tuck, also referred to as Abdominoplasty, is a surgery performed to address concerns that relate to the belly following trauma, pregnancy and/or weight loss. The most common concerns are stretch marks (scars caused by skin that has been forced to stretch too much too quickly), excess skin, excess fatty tissue and weakened separated muscles. Other concerns may include hernias involving the belly button and significant abdominal wall muscle separation, that can affect posture and result in lower back pain. In addition, individuals can express concerns regarding their pubic area which includes fullness and ptosis (droop). This typically causes difficulties with tight fitting clothing and hygiene issues.

The Reasons for Getting a Tummy Tuck (Abdominoplasty)

The common concerns of a patient that is seeking an abdominoplasty include the following:

• Stretch marks
• Tethered scars
• Excess skin
• Skin folds
• Significant muscle separation (diastasis recti)
• Hernias

Excess skin, skin folds, and overhang (including low-hanging pubic regions) are major functional issues that need medical attention. Many of these cause sweating, rashes, and hygiene issues.

Muscle separation not only causes a fuller abdominal girth, but it also causes:

• Disturbed body biomechanics with increased arching of the lower back and its associated back pain issues.
• Reduced core strength and associated bladder and pelvic floor issues.
• Bowel issues due to an inability to increase intra-abdominal pressure due to an effective large midline hernia.
• They are often associated with umbilical hernias.

Different Types of Tummy Tuck (Abdominoplasty) Procedures

The term Tummy Tuck (Abdominoplasty) is a term that encompasses any operation that reconstructs the abdominal wall. This is because the degree of abdominal concerns one has, will dictate the type of Tummy Tuck (Abdominoplasty) that is necessary.

The different names applied to the different Tummy Tucks typically relates to the surgical scars created. Common names include:

• Mini-Tummy Tuck (Abdominoplasty)
• Standard Tummy Tuck (Abdominoplasty)
• Extended Tummy Tuck (Abdominoplasty)
• Fleur-de-lis Tummy Tuck (Abdominoplasty)
• Open Book Tummy Tuck™ (OBTT) (Abdominoplasty)
• Total Body Lift (TBL)
• OBTT with combined TBL +/- Bra Lipectomy

Each of these various Tummy Tucks can be performed with or without muscle tightening to repair any existing diastasis recti.

The amount of excess skin and acceptance of additional scarring will determine what type of Tummy Tuck you’ll best be served having.

Unfortunately, scarring is an inevitable part of surgery, and the scars will never completely disappear. So, you will have to decide whether you are prepared to accept more scars to allow for more excess skin removal, or less scars for less excess skin removal.

Below are the most common Tummy Tuck (Abdominoplasty) procedures, with an explanation of what they are, who they’re for, and the benefits of each type.

Mini-Tummy Tuck (Abdominoplasty)

The Mini Tummy Tuck is only suitable for those few women who have a little bit of loose skin in the lower abdominal area – just above the pubic level. The scar is often not much larger that a caesarean scar and the belly button is not “moved”. It’s typically a day surgery procedure and usually not associated with any muscle tightening.

Benefits of a Mini-Tummy Tuck (Abdominoplasty) include:

• Small scar length: The length of the scar along the lower abdomen is more similar to a cesarean scar, which is much smaller than a traditional Tummy Tuck scar (which is generally hip to hip). Another plus is that you won’t have any scarring of the bully button.
• Surgery and recovery time: Most patients will be able to go home the same day of the surgery (usually, standard Tummy Tucks require 2-days in the hospital). The downtime of recovery is also quicker, with most patients returning to normal activity after four weeks.

Standard Tummy Tuck (Abdominoplasty)

A traditional Tummy Tuck operation involves addressing all three abdominal wall layers; that is, the skin, fat, and muscle layers. A horizontal incision is made in your lower abdomen. This incision is usually made from hip to hip, just above your pubic region.

The resultant scar will appear under the bikini line and thus can be easily concealed by regular underwear. Another incision is made around the navel to free the navel from the skin and fatty layer.

The skin and fat are lifted from the underlying abdominal muscles to the level of the rib cage. The ‘six-pack’ muscles are usually stitched together from the top to the bottom to surgically tighten them. This helps to realign the ‘six-pack’ muscles and addresses any central hernias. Additionally, tightening these muscles acts like an internal corset, strengthening the abdomen and helping to provide a stronger core. This muscle repair can sometimes help with lower back pain and continence issues. The skin and fat layers are then stretched down, and the excess skin and fat are removed from the lower abdomen. If required, the pubic area is lifted at the same time. Finally, a new opening is made for the navel, and it is stitched into position.

OPEN BOOK TUMMY TUCK™ (Abdominoplasty)

Whilst these above Tummy Tuck (Abdominoplasty) options will be an ideal choice for most patients, with the ever-increasing number of people undergoing life altering massive weight loss, different options were necessary to reconstruct their bodies.

As such, the Open Book Tummy Tuck™ (Abdominoplasty) was an operation born out of necessity. Dr Dona coined the term “Open Book” based on how the abdominal wall appears halfway through the operation – the skin and fatty layers are opened like a book before being closed into its reconstructed form.

As is explained by Dr Dona, “when someone loses a massive amount of weight, they become, fitter, healthier and smaller – unfortunately the skin has a limited amount of elasticity and is unable to shrink-wrap around the smaller body.”

The Open Book Tummy Tuck™ allows for a greater amount of excess skin to be removed in areas that other abdominoplasty techniques do not allow.

Who are Candidates for a Tummy Tuck (Abdominoplasty)

If you’ve got some stubborn fat pockets that just won’t budge, and no/minimal excess skin, liposuction alone may be a more suitable option for you.

On the other hand, if you have concerns with loose/stretched skin from weight loss or other issues on your lower belly, a Tummy Tuck (Abdominoplasty) might be an option worth considering to address your concerns. This is also the case if you have significant muscle separation issues (diastasis recti).

Typically, it’s men or women who’ve shed a significant amount of weight or post-pregnancy women that opt for this procedure.

The ideal candidates are those who have realistic expectations and understand the recovery required and potential complications.

Potential Complications of Abdominoplasty

Every operation comes brings benefits, but they also come with risks. It’s important that you weigh up these issues to determine if the potential benefits far outweigh any potential risks. It is always important to talk to a suitably qualified healthcare professional about the potential side effects of any medical procedure.

Like every surgical procedure, Tummy Tucks do come with potential complications. This includes general complications such as: bleeding; infection; having a bad reaction to the anaesthesia; allergic reactions; blood clots; stroke; death.

Other potential issues include but are not limited to:

1. Seroma: Fluid accumulation beneath the skin. Drainage tubes will be used after surgery to minimise the risk, and you may require ultrasounds and needle drainage of any such collections during your recovery phase.
2. Poor wound healing: There is a possibility that certain areas along the incision line may heal poorly or break down.
3. Scarring: The incision scar from a Tummy Tuck is there for life. However, Dr Dona usually places it below the regular underwear line. The length and visibility of the scar can vary from case to case.
4. Fat and/or skin necrosis (loss): this may be small or large. Such issues may warrant further surgery to reconstruct.
5. Belly button issues: your surgery may result in poor quality appearing belly button or even loss.
6. Changes in skin sensation: Repositioning the abdominal tissues during a Tummy Tuck will affect the nerves in the abdominal area and, in some cases, in the upper thighs. This will result in permanently reduced (loss) of sensation in these areas.

The wounds are larger with a more complex Tummy Tuck surgery (especially in the case of an open-book surgery) than with surgeries with smaller incisions. In these operations the areas at greatest risk of wound issues are at the bottom and top of the midline scar, where it meets the horizontal scar. That’s the region where you have the highest level of tension and the least blood supply.

Some operations come with a greater risk of complications, and some individuals are at greater risk of complications. If you fit any of the following profiles, you are at greatest risk of complications:

• Elderly
• Overweight
• Diabetics
• Smokers
• People with weakened immune systems, including those taking certain immunosuppressive medications.

One needs to consider all these factors before surgery.

How Should You Prepare for a Tummy Tuck (Abdominoplasty)?

During your first visit, be ready for the following:

• Reviewing your medical record: You’ll need to answer questions about any past or current medical conditions. Discuss the medications you’re on or have recently taken and any previous surgeries you’ve undergone. Basically, a full medical history will need to be disclosed.
• Physical examination: During the consultation, Dr Dona will conduct a thorough physical examination of your abdomen to determine the most suitable treatment options for your specific case. Photographs of your abdomen will be taken for your medical records.
• Discussion of expectations: Clearly communicate your motivations for wanting a Tummy Tuck and the specific results you hope to achieve. Be sure to weigh the benefits and risks associated with the procedure, including the scarring.

Before undergoing a Tummy Tuck procedure, you also need to be ready for the following:

• Smoking cessation: If you are a smoker (or consume any nicotine), refrain from nicotine for a minimum of 2 weeks before and after the surgery. Smoking reduces blood flow in the skin, impairs healing, and increases the risk of tissue damage.
• Medication restrictions: You’ll likely need to avoid certain medications like aspirin, anti-inflammatory drugs, and herbal supplements in the weeks leading up to the surgery. These substances can increase the risk of bleeding and interfere with the healing process.
• Stable weight maintenance: Maintain a stable weight for at least 6 months before undergoing a Tummy Tuck. If you want to lose weight, then you should seek the opinion from a suitably qualified healthcare professional regarding the same. A tummy tuck is not a weight loss operation.
• Recovery assistance: Arrange for support during your recovery period. This includes having someone drive you home after the surgery and stay with you for at least the first few days.