Your anatomy (long abdominal area), and lack of a lot of excess skin, is a real challenge for plastic surgeons.
You have two choices, move the umbilicus position down, or accept a small vertical scar just above the usual (not higher) horizontal abdominoplasty scar.
In my opinion, a tall woman with a long abdomen does not look good with her umbilicus at the same level as your upper hip bone. Stand in front of a mirror and decide.
I would release your abdominal skin as high as possible from your rib area, fold you into an exaggerated position in order to close the abdominal incision, and tell you that you must be able to accept a small verticle incision from the middle of the horizontal scar if I cannot safely close the wound.
I would not pull the abdominal skin low enough to close the wound if it will jeporadize the circulation and possibly lose the entire lower abdominal skin. I’ve seen this. Be prepared to wear a tight garment for months and perhaps not be able to stand up straight for two to three weeks. (Robert E. Zaworski, MD, Atlanta Plastic Surgeon)
Based on your photograph, I would definitely go with the mini-tuck with the umbilical float. If you have the full tuck, not only will you have a short vertical scar which you will hate, but the transverse scar will still be very high and you sill still have your C-sxn scar.
The mini with the umbilical float will lower your belly button to a more normal level and your transverse scar should be where your C-sxn scar is with no vertical scar. It appears that you will benefit from the muscle tightening most which can be done with either procedure. (James McMahan, MD, Columbus Plastic Surgeon)
Umbilical float tummy tuck
the biggest problem with the umbilical float is that there is no going back as the attachments and blood supply that would allow the belly button to be maintained are sacrificed. What that means in the long run is that if you need or desire more tightening of the skin of the abdomen in the future, the belly button will continue to be displaced down towards your pelvis and can end up looking too low.
A regular tummy tuck with the resultant scar from transposing the belly button is understandably not desired but it would allow for further surgery and allow the belly button to stay in a normal anatomical location. (Julio Garcia, MD, Las Vegas Plastic Surgeon)
You would do great with an floating abdominoplasty. The muscles can be repaired, the belly button brought down and the scar kept low. (Ricardo A. Meade, MD, Dallas Plastic Surgeon)
You will get a lot of opinions here, and without an exam, its hard to give you the best advice. In general, I feel that the floating tummy tuck is usually not a great idea. On the other hand, the vertical scar you would have with a full tummy tuck usually heals extremely well. Therefore, I would favor a full tummy tuck (with a short scar not much longer than your c-section scar), a full muscle repair, and a short vertical component. (Dean Fardo, MD, Atlanta Plastic Surgeon)
From you photo, it looks like you’re a great candidate for a mini-tummy tuck with floating of the umbilicus. The scar is small, low, and allows great access to tighten the abdominal muscles. It doesn’t appear that you have enough skin for a full tummy tuck.
The recovery for a mini tummy tuck is about 2 weeks off of work and 6 weeks from lifing more than 5 lbs to protect your healing abdominal muscles. (Jeffrey E. Schreiber, MD, FACS, Baltimore Plastic Surgeon)
Confusion about tummy tuck: full versus floating
I reviewed the other surgeon’s answers and I don’t blame you for being confused. There is no right or wrong answer, merely opinions and preferences based on experience. I would probably favor and umbilical float because this weould allow me to correct lower AS WELL AS upper abdominal skin laxity, fix the hernia and the diastasis while preserving the vascularity of the umbilicus.
If you are considering a full tummy tuck, you may require laparoscopic repair of the umbilical hernia to maintain viability of the stalk. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)
You have the right abdominal characteristics to float your bb. This will prevent the need for a vertical scar (which is somewhat unlikely anyway) and a scar around the bb. The question is, would you like to have your belly button lowered? (Kenneth R. Francis, MD, Manhattan Plastic Surgeon)
Umbilical float for tummy tuck with a high belly button
To give specific advice one would have to examine you and see how lax the skin is, but my impression is that you are an ideal candidate for the umbilical float. You would still be able to get all of the muscle tightening that you need, and keep the scar low where your C-section scar is.
The limitation is that the skin in the upper abdomen may not be quite as tight as with a traditional tummy tuck but in cases like yours it is a good trade-off. (Richard Baxter, MD, Seattle Plastic Surgeon)
Umbilical Float
Here is my opinion, and I respect that other doctors will disagree. I don’t like the float, as the bb winds up too low, and can get deformed looking. You may have an extension of your hernia into your umbilicus, as it appears to have a shallow “cup”.
Secondly, although in your current conditionl, you only have minimal skin, after the roundness if fixed (hernia repair, muscle tightenting), you will have more skin than you think. Based on your history and your photo, I recommend full tummy tuck. If the hole from the old bb can’t be removed, it will leave a small vertical scar in the lower abdomen, but this will be much more pleasing than the float. (Scott E. Kasden, MD, Dallas Plastic Surgeon)
The first thing I would do is examine you while you are lying down. That exam allows you to see what things look like when ther is no internal pressure on the muscle layer. Your primary problem is the muscle layer called the fascia. Once the fascia does not have the pressure on it you can get a very good idea as to how much extra skin you will have once the fascia is tightened surgically. If it looks like there is enough skin to get the spot just above the belly button down to the c-section incision then you can have a full tummy tuck with no vertical scar.
If not you will probably have a small vertical scar that represents where the belly button had been. Now, if you try the floating belly button you have to make sure that the belly button does not get too low. My guess is that you either have to accept a small vertical scar or go with the floating belly button. (John P. Stratis, MD, Harrisburg Plastic Surgeon)
I have usually done a full tummy tuck, and I have not had to do a vertical scar in years. Obviously, I would need to see you before just to make sure; however, with twins, you usually stretch the skin out so that there is plenty. Look at my web-site photos and come in for another opinion – the consultation is complimentary. (William B. Rosenblatt, MD, New York Plastic Surgeon)