First of all, before you decide on a surgical correction of the abdominal wall, you need to decide if you are done having any more children.
If the answer is yes, than I would suggest a full abdominoplasty or tummy tuck.
Based on your history of twins, I believe you have some relaxation of the upper abdominal fascia as well. A mini tummy tuck addresses the lower abdominal skin and muscle laxity.
If the muscle is plicated or tightened only from the belly button down, you might end up with a bulge under your rib cage in the upper abdomen. It is like squeezing a long baloon at one end, you will have distention at the other end. In my practice only less than 5% of my patients qualify for a mini tummy tuck procedure.
I’ve converted several mini tummy tucks to full tummy tucks to correct the deformity I just described. These were done by other well trained board certified plastic surgeons in the Seattle area. It is not the length of the incision that you should focus on, but the ultimate shape and contour. THAT would tell your surgeon if a FULL Tummy Tuck would be needed to give you a better result than a mini tummy tuck procedure.
Very few women benefit by a mini tummy tuck.
I know the mini tummy tuck procedure sounds less scary, but you will only be happy with a flat stomach. Most women need full correction, and there is little more scarring.
If your goal is to look better in clothes – then a combination of a Mini tummy tuck procedure and Liposuction seemingly would work. But for an optimal result with a totally flat tummy when naked, we must make sure that any tummy laxity and looseness are corrected.
A physical examination of the abdomen is required. With a history of having 3 babies in 2 pregnancies, I must make sure just how wide your 6 pack (rectus) muscle separation (diastasis) is and how much tummy laxity you have when you lean over and completely relax your abdomen.
I would also suggest a laser assisted liposuction or ultrasound liposuction to contour your waist if you are considering having [more] children. (Raffy Karamanoukian, MD, FACS, Los Angeles Plastic Surgeon)
The scar for the mini tummy tuck and tummy tuck are the same. It does not depend on which procedure is selected, it depends on how much skin needs to be removed.
In general the scar for the mini tummy tuck procedure is shorter than the scar for the full tummy tuck, but this is because normally there is is less skin to remove when we are doing a mini tummy tuck procedure. So if your main concern is the length of scar, it will be the same.
So how do you choose? The best way is to see a Board Certified Plastic Surgeon for an in person consultation. Review the pros and cons of each procedure. From your picture you could have either procedure, but there are some aspects that will only be improved with a full tummy tuck. If you cover the area below the belly button and are happy with the appearance of the upper abdomen, then you will likely be happy with the results of a mini tummy tuck procedure. Features of the upper abdomen to push towards a full tummy tuck are, roundness of the muscle wall and loose skin extending above the umbilicus.
There are other options, and some hybrid techniques too, but these details are best discussed in person. I’ve included a link and a video below for additional information. (Joseph Mele, MD, Walnut Creek Plastic Surgeon)
Mini vs full tummy tuck
If you have loose skin above and below the umbilicus and have a diastasis above and below then you need a full tummy tuck. (Steven Wallach, MD, Manhattan Plastic Surgeon)
It’s difficult to tell from your photo – what you actually need. I rarely do a mini tummy tuck procedure. I find that the scar from a mini is almost as long as a full tummy tuck.
In addition with a mini you adequately manage the muscles and the umbilicus gets distorted. (Michael Weinberg, MD, Toronto Plastic Surgeon)
With the limited information above, It has been my experience that a full tummy tuck is required after a twin delivery to obtain the best contour. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)
A mini tummy tuck procedure means different things to different surgeons. In my case there no significant difference in the location or length of the incision.
Therefore, there is no significant difference in the scar. It appears from your photo that you would benefit most from a full tummy tuck. (John Whitt, MD, Louisville Plastic Surgeon) The most important thing is that you be evaluated and have the proper procedure. usually after pregnancy, a full tummy tuck is the correct operation. (William B. Rosenblatt, MD, New York Plastic Surgeon)
In general, here are the factors that determine whether you would get the best result from a mini or a full tummy tuck: Both will tighten the muscles if they have been separated with pregnancy, which is very likely after twins, and not something correctable with exercise.
Both will remove any extra fat that has accumulated in the abdominal area. But the mini only tightens the skin below the belly button, so to do this the skin in the upper abdomen has to be in pretty good shape.This is why you would need to see the plastic surgeon who can advise you on what your results would be.
Occasionally, when the belly button is a bit high like yours, we do a variation of the mini with what is called an umbilical “float” which means that it is moved lower by about an inch. This allows for a small degree of skin tightening in the upper abdomen without doing the full TT. (Richard Baxter, MD, Seattle Plastic Surgeon)