Reverse tummy tuck

Reshaping the contour of the abdomen is frequently requested in my office consultations. The most common techniques are various forms of liposuction with or without an abdominoplasty. Another tool in our repertoire which can yield effective results is the “Reverse Abdominoplasty.” The classic indications for a regular abdominoplasty is a torso which has loose excess inelastic skin of the lower abdomen, abdominal wall rectus muscle separation (diastasis), and varying degrees of excess fatty tissue. The technique eliminates the excess skin and fatty tissue in the lower abdomen, reconnects the rectus muscle together to tighten the abdominal wall, and excess abdominal fatty tissue can be reshaped with liposuction to provide a pleasing shape.

A reverse abdominoplasty is chosen for the individual who has loose excess skin in the upper abdomen, who generally does not have a full diastasis which is affecting the lower abdominal contour, and may have excess fatty tissue in the lower abdomen without skin excess. The technique is to start with incisions that follow the lower breast fold then cross the lower sternum to connect both sides of the abdomen. These scars generally hide very well even in two piece bathing suits. The full thickness skin is elevated down the abdomen preserving the vital blood supply on either side of the belly button. If upper rectus muscles need to be tightened this can proceed. Any abdominal fatty excess can also be corrected with liposuction at this time. The elevated released excess abdominal skin can be addressed in several ways depending on the needs of the patient:

1. If a women who has the upper abdominal skin excess and also desires rejuvenation of the breast the excess elevated skin of the abdomen can be utilized as a self-augmentation under the breast to provide added fullness and shape. This is often done in conjunction with a breast lift (Mastopexy) and can avoid the need and expense of an implant. I have even performed this procedure with a woman who many years ago had bilateral mastectomies for breast cancer and we reconstructed her with implants. She had experienced some weight fluctuation and was becoming very active and requested the elimination of her breast implants but still desired a smaller breast to remain. We utilized a reverse abdominoplasty skin excess, removed the outer skin, and placed it in her implant space to fill the void and added tissue volume and shape provided with fat grafting harvested from her back, thighs, and lower abdomen giving her a smaller but still reasonable breast shape.

2. The Reverse Abdominoplasty could be incorporated as part of a treatment plan to tighten the upper abdominal contour. After the incision and elevation of the abdominal excess loose skin, the surgeon can remove the undesirable portion and fixate the remaining tissue to the rib fascia of the lower breast fold to avoid the scars from migrating inferiorly thus preventing the exposure of the scars on the upper abdomen. I have used this as a primary surgical procedure for women with loose skin of the upper abdomen that would not respond favorably to liposuction alone. I have also used this as a secondary procedure on women who have previously had an abdominoplasty with good results but over time the lower abdomen has maintained its results yet the upper abdomen has become loose and has excess as a result of weight changes, sun exposure, and of course gravity. The excess skin can be removed providing a nice tight appearance to the whole abdomen.

3. Another situation for the reverse abdominoplasty is for women with loose upper abdominal skin combined with previous augmentation mammoplasty in which the implants have become mal-posed and have drifted inferior and lateral to the correct position. In this case, the excess elevated tissue can be utilized as an autologous (meaning from your own body) soft tissue sling to help reposition and stabilize the implant similar to an Acellular Dermal Matrix (ADM) graft without the significant added cost of the product to provide long lasting results.

One of the aspects in my profession of plastic surgery I am most proud of is the innovative nature of the field. We take problem sets that patients present to our office and we create unique methods that achieve a sound result with the least amount of surgery and the lowest costs to ensure successful and happy patients. The reverse abdominoplasty is an example of one of these offshoot procedures which fills a vital niche in my practice.

A reverse tummy tuck is the opposite of a traditional tummy tuck in that it targets the upper abdominal area instead of the lower one. 

Usually, it’s the lower abdomen that’s more problematic because of the hanging skin and excess fat. However, occasionally, the upper abdomen can have similar concerns. In a case like this, you can benefit from this type of tummy tuck. 

But before you do that, it’s important that you understand exactly what this surgery entails and whether or a not a traditional tummy tuck might be better for you. 

A reverse tummy tuck usually takes place under general anaesthesia, so you won’t be awake during the procedure. 

Once it’s taken effect, your surgeon will begin by making incisions in the inframammary folds – the boundary underneath the lower half of the breasts.

In some cases, however, these incisions extend all the way to the middle of the chest (sternum). 

Following that, if you need to get your abdominal muscles repaired, they’ll be sutured. Excess skin will be cut out, and then you’ll be stitched back up. 

Here, it should be noted that some surgeons also use this excess skin in the upper abdomen to perform a breast augmentation. 

The skin can act as a substitute for an implant (although the results won’t be as dramatic), and even fat can be grafted there for more fullness.  

And if you already have implants, this excess skin can also be used to create a support structure for them. Additionally, as mentioned above, you can also get liposuction or other lifting procedures with it. 

The reverse tummy tuck can take around 2-4 hours, but it can vary depending on any other surgeries you’re having. Once you’re done, you’ll need about 1-2 weeks to recover. 

Reverse tummy tuck results are permanent because the loose skin is cut out from the body. However, your skin can re-stretch as a result of weight fluctuations or pregnancy (which is why surgeons recommend this surgery after you’ve completed your family).

Also, keep in mind that your skin can naturally change due to ageing and the effects of gravity. But your abdominal contour will appear tauter with the surgery than without it. 

A reverse tummy tuck can significantly improve the contour of your upper abdomen, making it look well-toned and smoother. Therefore, it can be worth it. 

But you must keep in mind that a reverse tummy tuck is not for weight loss. It will only reshape a part of your body. Still, if that’s your goal, it can be very effective.

One of the biggest downsides of a reverse tummy tuck can be its scar. While your incisions are likely to stay hidden underneath your bra, there’s a higher risk of them thickening. 

According to a study published in the Annals of Burns and Fire Disaster, because of mechanical tension, scars in parts of the body, like the sternum, are quite often hypertrophic (thick and raised). 

Other than that, even though it’s the very nature or the surgery, another of its problems is that it only focuses on the upper abdomen. This is even when people usually have problems in the lower areas of their abdomen. 

This doesn’t mean that you can only ever have one tummy tuck (either in the upper or lower abdomen). It’s just that you won’t be able to have the two at the same time. 

If poor skin quality is an issue across your entire abdomen, your surgeon will likely recommend a surgery for the lower abdomen first. And you can get one for the upper abdomen after 6-12 months.

In the UK, a reverse tummy tuck can cost you anywhere from £5,000 to £11,000. You can expect a reverse tummy tuck to be slightly more expensive than a traditional tummy tuck because not everyone offers it. 

Moreover, you should know that the prices can change depending on the: 

• Location of the clinic

• The expertise of the surgeon 

• Type of anaesthesia 

• Aftercare (medicine, compression garment) 

• Additional surgeries 

You can, however, save on the UK cost by becoming a medical tourist. In Turkey, you might be able to get a reverse tummy tuck starting from £2,500. 

It’s not because of unregulated or poor healthcare in the country. It’s because of the lower cost of living and currency exchange. 

The main difference between a traditional tummy tuck (or full abdominoplasty) and reverse tummy tuck is that the former targets the lower abdomen while the later focuses on the upper abdomen.

Other than that, in a full tummy tuck, a complete diastasis recti repair is possible, while it can only be partially sutured in the reverse abdominoplasty.

Also, there are, of course, differences in the placement of the incisions. In a traditional tummy tuck, it’s either made across the abdomen (mini tuck) or from hip to hip (full tuck). In a reverse, it’s under the breast fold, sometimes meeting at the sternum. 

For more clarity, here’s a summary of the differences between the two procedures. 

A reverse tummy tuck can help you improve the appearance of your upper abdomen. It can especially help you achieve a more toned and even look if your lower abdomen is already tight. 

But if that’s not the case, you should remember that you might need a separate full abdominoplasty for it (only for the lower abdomen). 

In any case, it’s important that you consult a board-certified medical professional who’s experienced in performing this surgery, especially if you want to combine it with other procedures as well.