Revision Abdominoplasty: Retuck and Resuck

Many patients think that their abdominoplasty results cannot be revised or improved upon. Revision Abdominoplasty surgery can be performed and there are numerous reasons why and how they can be revised.

Abdominoplasty or tummy tucks are a very common procedure performed by plastic surgeons. There are variable types and techniques in abdominoplasty and sometimes these techniques leave patients with too high of a scar or lack of abdominal contour.

Utilization of mini-abdominoplasties and a more modern lipo-abdominoplasty can help provide a lower scar and improve the abdominal contour, though if not applied primarily the principles can be utilized in secondary abdominal revisions.

Common reasons for revision include 

  1. High scar placement
  2. Contour irregularity and fat deposits
  3. Belly button size and position
  4. Muscle laxity

High scar placement is commonly seen in patients who are more mini abdominoplasty candidates or do not have enough horizontal skin laxity to create a lower scar. In certain traditional techniques a high scar placement is normal. 

  • If there is not enough horizontal laxity a small vertical scar may be used to maintain a lower abdominal scar. 

Lowering the abdominal scar can be as easy as removing skin below the abdominal scar and moving it downwards. If more movement is needed then more skin release including releasing the umbilicus and moving it down. In this scenario an umbilical reconstruction may be needed.

Fat deposits can be decreased when liposuction is primarily applied to the abdomen in a lipo-abdominopalsty. In a traditional abdominoplasty, liposuction is used sparingly and can leave central fat deposits. These can be eliminated with secondary liposuction.

This can help contour the central abdomen and waistline, and could be incorporated in a secondary revision with skin excision and scar lowering.

Umbilical position and size can be improved if needed. High central tension and deep umbilical plication sutures can help to decrease high positioning and abnormal scarring. Umbilical size can be decreased with a scar revision under local anesthesia. If a new belly button needs to be created, an umbilical reconstruction with a neo-umbilical creation can be performed.

Muscle laxity can be residual from no muscle repair being performed in the initial tummy tuck  (a skin-only abdominoplasty) to loosening of the repair in the initial healing process or recurrent laxity over time. Muscle laxity can lead to a lack of abdominal shape and contour as well as central and waistline bulging. A secondary repair can be performed through the lower incision with either primary plication of the central muscle or secondary repair without the need for removing the previously placed sutures.

Abdominoplasty revision plans need to be discussed with an in-office consultation and some of the revisions could be performed in an office-based procedure, but the majority may be better served with a two hour operative procedure. Recovery may be variable and can range between 10 days for a minor scar revision to 6 weeks for a secondary muscle repair.

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