There are a large number of different types of tummy tucks including standard, mini, extended mini (with and without umbilical float), circumferential and fleur-de-lis in addition to many different combinations of these. Probably the least known is the reverse tummy tuck.
Traditional abdominoplasty procedures begin with a curved horizontal incision on the lower abdomen and the skin is elevated off of the underlying muscles, which are tightened before the excess skin is pulled downward and removed. The majority of patients seeking a tummy tuck have most of their excess skin on their lower stomach which is one of the reasons why most standard tummy tucks concentrate on removing lower abdominal skin. Another reason to perform a tummy tuck from below is to keep the scars as low and as invisible as possible so that, hopefully, it can be covered up with a two-piece bathing suit.
The Reverse Procedure
A reverse abdominoplasty, as the name implies, is performed from above and the pull is upwards towards the chest instead of downwards. This procedure is almost exclusively performed in women as the upper abdominal incision is kept mostly hidden in the creases underneath the breasts known as the inframammary folds or IMF’s. It is most commonly performed in patients who already have scars in this area from a previous breast reduction or breast lift or in patients who have already had a tummy tuck but the upper abdominal skin did not tighten up as much as desired.
Indication and Technique
The indication for a reverse abdominoplasty is when the lower abdomen is flat and the skin is tight while the upper abdominal skin and muscles are loose. The incision is made in the IMF’s and connected across the midline. The skin and fat on the upper abdomen is elevated off of the underlying muscles which then may be tightened with sutures. The excess skin is pulled upwards and is removed prior to closure of the incision. To avoid pulling down of the breasts or distortion of the IMF’s, these creases are reinforced with sutures to the underlying muscles at the time of closure.
Modified Reverse Abdominoplasty
As was described above, the standard reverse abdominoplasty has a scar that runs along the breast folds which connect across the middle of the chest. It is this scar on the lower aspect of the chest that is at most risk of being visible. This portion of the scar can be eliminated with a modified procedure where the incisions under the breasts are not connected across the midline; eliminating the most obvious portion of the scar but removing less skin and not performing the muscle tightening. In these cases, the scars tend to run laterally more on the sides of the chest and there is less skin tightening as less is removed for the tradeoff of not having a lower midline chest scar.