What is a reverse abdominoplasty

and who needs it?

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:

E. 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.
L. 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.
M. 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.

For more information, including a list of ASPS plastic surgeons in your

community, please use our Find a Plastic Surgeon tool.