What is a mini tummy tuck and why can’t I just get one of those?

A mini abdominoplasty or mini tummy tuck is a variation of a tummy tuck. A mini abdominoplasty has multiple variations within itself. Let’s first discuss the differences between a standard full abdominoplasty and a mini abdominoplasty. The typical scarring for a full abdominoplasty is a lower curved scar and a scar around the umbilicus (belly button). The mini abdominoplasty typically has a shorter lower scar and no scar around the umbilicus. While, the lower scar can vary in length, the lack of belly button scar is the key difference. With a full abdominoplasty (or tummy tuck), the belly button stays in essentially the same place (which is still attached to the abdominal wall fascia from below), but the skin of the upper abdomen is pulled down over the belly button and sewn together to the lower abdomen. A hole is made in the overlying skin to allow the belly button to pop back through and it is sewn in place there. With a mini-abdominoplasty, there is no scar around the umbilicus, so it does not move relative to the surrounding skin. A smaller ellipse of skin is removed from the lower abdomen which mainly addresses lower abdominal skin excess. The belly button can be released from the underlying abdominal wall fascia and moved downward. This amount that the belly button moves down is the amount of upper abdominal skin tightness that can be achieved. The issue is that there is a limit to how much the belly button can be moved down. If the belly button is moved too far down, it will look strange and often times can make the abdomen look more “masculine” as males tend to have lower positioned belly buttons. Now, I mentioned there were variations of the mini abdominoplasty. There is a skin only mini tummy tuck that is exactly what it sounds like. An ellipse of lower abdominal skin that tightens up the lower abdominal skin and does not release the belly button. This can be combined with lower abdominal rectus muscle plication (muscle repair) to the belly button. Full abdomen muscle repair can be done with a mini abdominoplasty by releasing the belly button from its base and repairing the muscle from the xiphoid (bottom part of the sternum) to the lower abdomen (just above the pubic bone). Now, why are these not done more often? This is something I asked myself after reading about a mini abdominoplasty in a textbook early on in my residency. I remember telling myself that I was going to do more mini tummy tucks. Then I learned more about the differences in the results and with proper patient selection, the simple answer is that very few patients are good candidates. There are a portion of patients that are good candidates that when I have given the choice between the two (full vs mini), and after discussion of the anticipated results of each, they elect for a full abdominoplasty.