Patients who are good candidates for a full tummy tuck generally have more excess skin than those who get a mini-tummy tuck either because of more pregnancies, larger weight gain with pregnancy or greater weight loss resulting in more loose skin.
In a standard tummy tuck, all of the excess skin and fat is removed from just above the belly button down to the pubic area as a large ellipse. The belly button is separated from its surrounding skin and the abdominal muscles are tightened with stitches. The upper abdominal skin is pulled down, the incision closed in layers with sutures and the belly button is brought out through a new opening but in the same place on the stomach as it was before. In general, no liposuction is performed on the skin of the abdomen but it may be performed on other areas of the body at the same time. Two drains are commonly placed during a regular tummy tuck, which are removed, one at a time in 4-7 days.
During a mini-tummy tuck procedure, it is common to perform liposuction on the fatty layer of the abdomen. A smaller amount of skin is removed from the lower stomach and only the muscles below the belly button are tightened. The scar from a mini-tummy tuck is generally shorter in length and lower in position than that of a standard tummy tuck and usually only one drain is placed. There is no scar around the umbilicus with a mini-tuck because the skin in that area is not repositioned as is done with a full abdominoplasty.
Patients who have a mini-tummy tuck are usually younger than those who have a standard tummy tuck, have less excess skin and have concerns mainly with their lower abdominal contour.
There are variations on both procedures to make the surgery fit the needs of the patient as well as much larger surgeries for patients who have lost a tremendous amount of weight. An extended mini-tuck can be performed to take out a little more skin by transecting the umbilicus from the muscle, tightening more of the muscle to several centimeters above the belly button and lowering the umbilicus a little.
A lower body lift is often done in patients who have lost a large amount of weight, which combines a standard tummy tuck with removing excess skin from the flanks and lower back resulting in a buttock lift. This is also known as a circumferential abdominoplasty and in cases where a large amount of skin is removed from the flanks, can result in somewhat of an outer thigh lift as well.
Another variation in patients who have undergone massive weight loss and a lot of excess skin is the fleur-de-lis tummy tuck. With this procedure, a vertical wedge of skin and fat is removed from the abdomen along with the standard lower horizontal wedge. This results in tighter skin horizontally on the abdomen which may not be accomplished with a standard tuck.