A reverse upper abdominoplasty involves making some incisions in the inframammary crease which is located just below the breast, more commonly referred to as the breast line. This procedure elevates the abdominal skin that is lax or the loose upper abdominal skin that has not been addressed very well in the past, unless the patient had a full lower abdominoplasty. A lot of times, patients do not need or desire a bigger procedure and their skin laxity is confined to the upper abdomen above the level of the belly button or slightly lower. This can be performed with an upper or “reverse” upper abdominoplasty.
There is a subset of patients that have pretty good abdominal tone and musculature in both the lower and upper abdomen but have loose skin that is mainly confined to the upper abdominal area about the level of the belly button and working up. A lot of these patients are in very good shape even if they have had babies. Their muscles have come back pretty well but they have upper abdominal looseness that is hard to address using liposuction assisted procedures such as laser assisted or ultrasonic assisted liposuction alone.
Most people qualify for the procedure because, once again, they are often in very good shape and their muscles have not been terribly spread out. This procedure does not really address their musculature. It is mostly people in good shape who really want to do something about the loose skin at the upper abdomen. They also want to avoid the lower abdominal incision scars and longer recovery that come with an abdominoplasty or “tummy tuck”.
Most of the patients for a reverse upper abdominoplasty do not need muscular work. It is really the skin laxity that the surgeon is addressing through an incision in the inframammary fold. The procedure can be combined with liposuction in any form of the entire abdomen as well as the areas that are to be elevated. The incision is made in the inframammary crease so it is well hidden underneath the breast. The dissection happens above the muscle fascia and the skin is elevated. The surgeon basically sutures it down to the rib fascia and then removes the extra skin. This incision does not cross the midline so it stays hidden underneath the breast. Performing the procedure in combination with some form of liposuction of the areas adds to the patient’s contour.
The amount of time required to do this procedure, as well as the recovery time, are much shorter and easier than a full abdominoplasty. It is an outpatient surgery that takes an hour to an hour and a half. Patients are put in compression garments after the surgery and they normally do not need any drains put in.
The compression garments stay on 24 hours a day for two weeks. However, patients can take them off and get in the shower after two days. The garment must be worn 24 hours a day for two weeks and then 12 hours a day for two weeks after that.
The level of discomfort is relatively minimal. Patients can go back to most normal activities within 10 days or so. It takes about 2 weeks to return to a full level of normalcy.
Since the surgeon is moving in an upward direction and fighting some gravity during the procedure, he needs to secure the tissue of the abdominal skin that is being elevated. It has to be secured fairly deeply to make sure it holds and does not recur. That is the number one limitation of the procedure.
The second limitation happens once the surgeon pulls the skin up and locks it to the deeper tissue so that it holds. It takes a little while for everything to settle so the patient can look overly corrected and over pulled for two or three weeks. However, it all smoothes down nicely and everything looks dramatically improved.
The other limitation is that the surgeon is not addressing muscle laxity. If abdominal bulging is the issue, then a full abdominoplasty is indicated. The reverse upper abdominal lift combined with liposuction of the rest of the abdomen will give a great result in the properly selected patient. The combination avoids the longer recovery period and discomfort associated with the full tummy tuck.
It is highly unusual for this procedure to have a complication because it is above the muscles. The main complication would be a little bleeding but that is highly unlikely. There is a possibility of irregularity but something like that can be smoothed out with touchup liposuction. The main issue is would be under correction or recurrence if the tissue is not secured tightly to the rib fascia. Also, the surgeon has to be careful and keep the incision as short as possible to hide the incisions under the breast line.
Even though this is a less extensive procedure than a tummy tuck, the final results are just as long lasting in the right patient. It offers a nice answer for a problem that arose in the past or, in some cases, still needs to be addressed without having a more extensive operation and recovery period that some people do not want or need.
If a patient does gain some weight back, the skin should be able to accommodate the change in weight. People tend to gain weight easily but that is not what really causes the skin to stretch. A lot of times the laxity can be due to post-baby stretching. Most of the issue is in the upper abdomen as opposed to the lower abdomen in more diffuse bulging. If patients lose weight, it should come off pretty easily and evenly. If they gained weight, a doctor can look at doing more body contouring on them.
A reverse upper abdominoplasty is an ideal choice for patients whose skin laxity is confined to the upper abdomen above the level of the belly button or even slightly lower. In order to determine if they are a good candidate for the procedure, potential patients need to schedule a consultation appointment with a board-certified plastic surgeon. The doctor is best qualified to decide if patients can achieve their goals by having a reverse upper abdominoplasty or if they need to undergo a full abdominoplasty.
Written by Cosmetic Town Editorial Team- MA
Based on exclusive interview with Miles Graivier, MD in Roswell, GA