Disclaimer: Some images on this website feature professional models and are intended for illustrative purposes only. They do not represent actual patients or guaranteed treatment outcomes.
A reverse tummy tuck (also called an upper abdominoplasty) is a procedure that is done for patients with loose skin on their upper abdomen or fat rolls below the breasts, yet the lower abdominal contour is satisfactory. Much of the scar of a reverse tummy tuck is hidden in the crease under the breasts, rather than across the lower abdomen as occurs with a regular tummy tuck. During a consultation it is important not only to understand whether reverse tummy tuck will achieve your desired results, but also the pros and cons of different tummy tuck procedures.
Your appointment with Dr. Andrade starts by understanding your specific concerns, and expectations for the cosmetic result. A medical history is obtained, with a focus on issues that might increase surgical risks or healing, plus life events (like major weight fluctuations or pregnancy) that could affect overall skin tone. The physical examination involves determining the amount of fatty tissue present, tone of the overlying skin, and whether there are other physical abnormalities. The physical examination needs to rule out the presence of a hernia, rectus diastasis or abdominal mass. Dr. Andrade will then offer an opinion whether reverse tummy tuck is likely to achieve the desired outcome, plus explain the unique surgical risks and alternatives.
A reverse tummy tuck is done under a full general anesthetic, so patients must fast the night before. All anesthetics are delivered by a fellowship-trained anesthesiologist. The duration of surgery is typically about 2 hours, and patients are discharged home afterward.
Most patients report only mild to moderate pain, which is managed by over-the counter or prescription medications. We encourage patients to mobilize the same day as their procedure, to decrease the risk or respiratory complications or a clot in the legs (deep vein thrombosis, DVT). In most cases an abdominal compression garment called a binder is worn for 3 weeks postoperatively to decrease postoperative swelling. However, after a few weeks, some patients prefer to simply use their athletic compression wear or conforming garments, which is acceptable. We apply an antimicrobial dressing that can be left alone for 5-7 days after surgery. Patients can simply sponge bath during this period, then we can change their dressing when they come for their first postoperative visit. Showering can resume after this postop appointment, but patients need to avoid soaking in a bath tub, hot tub or pool for several weeks until the incisions are well-healed.
Bruising and swelling are common after reverse tummy tuck surgery. Bruising is usually gone by 2-3 weeks, but intermittent swelling can persist for many months. It can take a year or longer to see the final result.
Most patients return to work within 2-3 weeks after reverse tummy tuck surgery, but for 6 weeks they should avoid lifting over 10kg, or activities involving repetitive squatting, bending, twisting or overhead reaching.
The majority of patients having abdominal surgery will not have a complication, but every surgery has risks. Bleeding, subcutaneous fluid collection called seroma, infection, and abnormally thick scars (keloids) can develop postoperatively. Rarely, major organs, nerves or blood vessels could be injured. Having a general anesthetic for any procedure entails the risk of dental damage, windpipe (trachea or vocal cord) injury, extremity numbness, DVT, allergic reactions or other problems. A reverse tummy tuck can alter the appearance or position of the fold under the breasts. Aesthetic surgery is not an exact science so the procedure can result in asymmetry and focal contour depressions.
Alternatives to reverse tummy tuck surgery include not having the surgery, or trying non-surgical interventions which might result in a modest reduction of skin laxity or fat deposits in a given area. The degree of improvement with these techniques is subtle, but might be sufficient for some patients. On the other end of the spectrum, patients with a larger amount of excess fat and skin might benefit from more extensive surgery than a reverse tummy tuck, like a traditional full tummy tuck, fleur-de-lys tummy tuck, belt lipectomy, or other options to remove the redundant tissue.
This information is intended to complement the advice of Dr. Andrade obtained during a proper consultation, and it is not guaranteed to be current, exhaustive or complete.
Tummy tuck surgery is not an OHIP-covered procedure. Removal of loose skin on the the body is not covered by provincial insurance regardless of the cause (even after massive weight loss or previous surgery for obesity). Another abdominal procedure called “panniculectomy” may be an OHIP-insured procedure in certain patients who have a very large overhang of skin (called a “pannus”) on the lower abdomen. In order to qualify for surgery, the patient must have evidence that the pannus causes serious problems like recurrent infections requiring prescription antibiotics. Panniculectomy surgery is not the same as tummy tuck surgery because it does not involve tightening the abdominal muscles or improve the appearance of the upper abdomen. It simply involves removing the overhang of skin.
Ideally it is best to be at a steady weight prior to having abdominoplasty surgery. This ensures that the maximal amount of skin can be removed. If there is significant weight loss after surgery there can be some recurrent skin laxity, depending on each patient’s skin tone. Some patients will still have an excellent contour. This patient had a tummy tuck and was very happy with the appearance, but she was motivated to lose another 30 pounds postoperatively. After this additional weight loss the abdominal contour was further improved. The photos below show her appearance at each stage.
Before
After Surgery
After Surgery + Weightloss
The outcome of tummy tuck surgery depends on each person’s existing anatomy, not just the procedure itself. The operation only removes excess skin and fatty tissue which is superficial to the muscles. Any abdominal bulging due to tissue deep within the body (organs or intraperitoneal fat) will not be correct. Patients who have lost weight and have loose, hanging skin and fat will typically see the most dramatic contour improvement. In contrast, those patients who have a tight, protruding, barrel-shaped abdomen will not have correction of the bulging contour. It is important to find before-and-after photos of people with a similar body shape as yours, to determine if you might be satisfied with the degree of improvement than can be realistically achieved.
“Hourglass abdominoplasty surgery” has the potential to substantially improve the overall abdominal contour, including the waistline. However, the operation does not change the bony structure, (like the shape of the ribs and pelvic bones) and it does not alter the muscles lateral to the abdomen. Patients who have pre-existing waist curvature will typically see this contour improved. Conversely, those patients who have a straight, trunk-like waistline before surgery likely will not achieve an hourglass waistline afterward. Dr. Andrade always does a thorough in-person consultation to assess each person’s unique anatomy (never delegating this important role to someone else), then he discusses the anticipated improvement that may be achieved.
Liposuction is an important addition to tummy tuck surgery, but it is not always desired or needed. This procedure enables the surgeon to target focal bulges (for example, on the upper abdomen and flanks) that might not be addressed by tummy tuck surgery alone. The degree of additional improvement is typically modest, perhaps removing 30-40% of the fat in a given area. The additional contour gains must be weight against the additional risks and costs of the procedure. Dr. Andrade does not automatically recommend liposuction for each patient, but rather he makes individualized recommendations based on each patient’s anatomy, goals and expectations.
