Most surgery scars do not preclude having a tummy tuck with a few exceptions. Vertical scars on the middle of the stomach do not limit a patient from having a tummy tuck but may limit how far down the skin can be pulled. Vertical midline abdominal scars above the umbilicus will persist after a tummy tuck, however those midline scars below the belly button are often times completely eliminated as they are removed with the redundant skin. These lower scars that are completely removed do not limit how far the skin can be pulled down.
Lower and Small Scars
Horizontal scars on the lower abdomen from cesarean sections and hysterectomies also do not preclude a patient from having a tummy tuck. These scars are usually removed during the surgery and are replaced with the tummy tuck scar. Those that are very low may not be removed by a full tummy tuck but can almost always be removed with a mini-tummy tuck. Laparoscopy scars do not interfere with having a tummy tuck but are not uncommonly associated with small Incisional hernias, especially those that are positioned around the belly button. These can be repaired at the time of an abdominoplasty and are often covered by insurance.
Horizontal or oblique scars on the upper abdomen are the scars that can be an issue when performing a tummy tuck. During these surgeries, such as for liver surgery, open gall bladder surgery and elective removal of the spleen, many of the blood vessels which go to the abdominal skin have been damaged or destroyed. Under normal circumstances, this is not a problem as many other blood vessels also supply the skin on the abdomen. During a tummy tuck procedure, however, most of these other blood vessels have to be removed in order to tighten the abdominal muscles and reposition the skin. As a result of losing too much of its blood supply, this skin can die requiring its subsequent removal and skin grafting.
In these situations, sometimes a modified tummy tuck can be performed to improve the shape and contour of the abdomen but limiting the surgery to reduce the risk of skin loss. In these cases, there is less undermining of the skin, especially in the upper abdomen where the skin is at greater risk. The skin is not pulled down as far, so there is less skin removal, though still more that what is typically removed with a mini-tummy tuck.
Reverse Tummy Tuck
Sometimes in cases where there are scars precluding a full tummy tuck, a reverse tuck can be combined with a mini-tummy tuck to obtain a nice, flat abdomen with very little risk of skin loss from losing it’s blood supply.