Tummy tuck fleur de lis is a well know operation, but it has limited indications. Most patients will get an excellent result with one of the “standard” horizontal scar abdominoplasty, and they will not have a visible scar across their abdomen.
Because the ribcage margin is an inverted V, the area above the belly button will have more laxity than the skin below the belly button, but the amount of laxity is generally acceptable.
In my mind, it is only reasonable to consider this operation in patients who have excessive amounts of skin (very massive weight loss), or a pre existing midline scar that starts at the base of the breast bone.
The decision for this operation has to balance the benefit of the additional tightening with
1) the visible scar,
2) the increased risk of complications (wound healing complications are significantly higher with this version of tummy tucks.) (Michael A. Bogdan, MD, FACS, Dallas Plastic Surgeon)
While an “inverted T” closure can increase tightening and make it easy on your surgeon technically in some cases, it also increases the risk for skin necrosis (poor healing.) Get a few opinions before you have your surgery this way. (John P. Di Saia, MD, Orange Plastic Surgeon)
I usually reserve a “T” type closure when I treat patients with massive weight loss. They often have laxity that is both in the vertical and horizontal component. (Steven Wallach, MD, Manhattan Plastic Surgeon)
A tummy tuck (TT) or abdominoplasty is an operation that address the skin, fat and muscle of the abdomen. More recently it also includes the hips and into the back. Each TT procedure is customized to the individual including the incision choice and subsequently the scar.
The “T” incision describes a scar that has 2 components, a low horizontal incision and a vertical incision in the mid line that extends below the belly button. It is commonly utilized when there is very little skin removal or there is an existing vertical scar from a previous surgical procedure.
A “standard” abdominoplasty incision encircles the belly button and the skin is then pulled inferiorly and the excess skin is trimmed.
The belly button is left behind and a new opening is made for the belly button in the skin that used to be above the belly button. When the incision around the belly button is pulled down, it is usually surgically removed and the old opening disappears. If only a small amount of skin is removed, the old circular opening is still present, but in a lower position on the abdomen.
Well, you can’t leave the circular opening alone, so the opening is closed in a LINEAR fashion. This creates the mid line vertical scar in the “T”. The blood supply in a “T” closure is a little bit more compromised and the vertical scar is more noticeable in 2 piece clothing, so the “T” incision closure is not popular and we try to avoid it. You may be a candidate for an UMBILICAL FLOAT ABDOMINOPLASTY instead. Discuss with your PS why he/she has recommended the “T” incision and if there are any other choices for you instead. (David Finkle, MD, Seattle Plastic Surgeon)
The T incision is sometimes necessary to address significant horizontal laxity that some patients present with. Without a photo, its impossible to comment on your anatomy. However, if your surgeon feels that this extensive procedure is important for an optimal outcome, he probably knows what he’s talking about. (Scott C. Sattler, MD, FACS, Boca Raton Plastic Surgeon)
There are 2 different types of an inverted “T” incision. It is important to know the difference: A Fleur de Lis incision Small inverted “T” from the old belly button site A large inverted “T” incisions is also known as a Tummy tuck fleur de lis. This pattern of skin excision is used most commonly when a patient has an excessive amount of skin in the horizontal as well as the vertical aspects of the abdomen (such as a massive weight loss patient).
The Fleur de Lis incision is sometimes necessary to create the desired contour in the flanks. The obvious disadvantage is the scarring up the midline of the abdomen. If your surgeon simply meant that you need a small “T” incision below the belly button, he may be referring to the inability to remove all the skin between your current belly button position and the proposed incision line. In this instance, the “T” portion is actually the hole where the belly button used to be. If there is significant fat in the upper abdomen, it may be difficult to pull the abdominal skin downwards far enough without creating a small T incision. Liposuction of the deep fat can help significantly in the movement of the skin and may avoid this small “T” incision. (David Bogue, MD, Atlanta Plastic Surgeon)
Tummy tuck fleur de lis that combines a vertical with a horizontal incision is primarily for patients with massive excess of skin with poor tone. There are usually massive weight loss patients. For almost all other patients, excellent results can be obtained through a horizontal incision across the lower abdomen. (Vincent N. Zubowicz, MD)