The tummy tuck operation is one of the traditional and commonly performed body contouring procedures. It is most simplistically envisioned as the removal of loose skin and fat from the lower abdomen to create a flatter stomach albeit with the trade-off of a horizontal scar. While this is basically true there are many variations of tummy tuck procedures that have evolved over the years based on the changing tissue needs of presenting abdominal problems.
The fundamental concept of a tummy tuck is that tissue is surgically removed or excised and this always includes skin. Many less invasive abdominal contouring techniques have been called a ‘tummy tuck’ but if they do not remove skin it is not a tummy tuck and the expected results should not be expected to be remotely the same. Thus, liposuction is not a tummy tuck and no matter how much (or so little) skin is tightened does not make it a tummy tuck. Liposuction will always produce less of a result as it can not remove and tighten loose skin.
To help one understand the range of available tummy tuck options, a classification of levels of increasing extent of the procedure can be very helpful. This is not a formal method of describing tummy tucks ascribed to by plastic surgeons in general, but one that has allowed me to help my patients choose and understand what type of tummy tuck is best for them.
LEVEL I (mini-tummy tuck) When the horizontally-oriented segment of skin and fat that is removed is taken below the belly button, it is a mini-tummy tuck. The horizontal length of the tissue removed may be very small or larger but the length of the resultant scar will lie within the two hip points. (anterior superior iliac spine) There will be no scar on the outer belly button. The belly button may be left in place or separated from underneath at the abdominal wall and brought down into a new lower position if this will help smooth out any loose skin that exists above it. Muscle repair can still be done for the whole vertical length of the rectus muscles, just below the belly button to the pubis or not at all based on the patient’s needs.
LEVEL II (mini-tummy tuck with liposuction) Since the effects of any tummy tuck stop at the end of the incision, liposuction can be done for any bulging at the waistline into the flanks or even throughout the entire upper abdomen above where the mini-tummy tuck is done.
LEVEL III (full tummy tuck) When the horizontally-oriented segment of skin and fat that is removed is taken above the belly button, it is a full tummy tuck. The horizontal length of the tissue removed may vary its vertical height but the length of the resultant scar will always extend out to and usually somewhat beyond the two hip points. (anterior superior iliac spine) There will be always be a scar on the outer belly button as the its old stalk (usually shortened) will be brought through a new hole in the downward positioned upper abdominal skin flap. The belly button will remain in its exact same position although its outer shape is usually much improved.
LEVEL IV (full tummy tuck with flank liposuction) Since the shaping effects of any tummy tuck never go beyond the end of the incisions, many patients need liposuction of their flanks (hip rolls, love handles) to create a more complete waistline contouring effect. But liposuction is not usually done or advised throughout the entire upper abdomen due its potential adverse healing effects on the tummy tuck incision.
LEVEL V (extended full tummy tuck, abdominal pannoculectomy) When the amount of loose skin extends around the sides and into the back area, liposuction can not effectively treat it. The excision of loose skin and fat can be extended beyond that of the traditional full tummy tuck to get rid of the folds of skin. This results in a longer scar that will extend into the sides and back area. The need for this type of tummy is in significant weight loss patients, (e.g., bariatric surgery) and those patients with overhanging aprons (pannus) of tissue.
LEVEL VI (fleur-de-lis tummy tuck) In extreme weight loss patients (greater than 75 to 100lb weight loss), a horizontally oriented tissue excision pattern will still leave a vertical laxity of tissue.This creates the need for a combined vertical (inverted V) and horizontal excision of abdominal tissues in one overall excision pattern. This results in an inverted T scar pattern with a central midline scar that connects to a lower horizontal scar. The new belly button emerges from its old position into the lower end of the vertical scar. The vertical component creates a cinching effect on the waistline.
LEVEL VII (circumferential tummy tuck, belt lipectomy, lower body lift) In extreme weight loss patients, when the trunk tissues look like wax melting off a candle, the excess and loose tissues need to be removed circumferentially. Wrapping around the waistline 360 degrees, a combined full tummy tuck and upper buttock lift is achieved in one operation.
LEVEL VIII (reverse tummy tuck, upper tummy tuck) When the loose abdominal tissues is only above the belly button (usually after a fully lower tummy tuck), the concept of a tummy tuck can be reversed and done from above. Skin and fat is removed from the upper abdomen, lifted and closed along the lower breast folds. (inframammary creases) The only exposed portion of the scar is in the small area between the breasts in the midline sternal area.
Dr. Barry Eppley