Most women who have had children have a weakness in their abdominal wall caused by stretching of the muscles apart from the midline.
This causes an area down the center of the abdomen from the sternum to the pubic bone. It is called rectus diastasis. Since the muscles are literally separated, no amount of exercise can correct it.
The muscles need to be sewn together to flatten the abdomen and get back to a normal anatomic situation. This is one of the things that is done during a full abdominoplasty.
A mini uni abdominoplasty is used when only the lower half of the abdomen is an issue. You mentioned a concern about the umbilical scar. In my experience the tummy tuck scars are excellent.
You should review photos with your surgeon to see some. Another thing I would add here is that mini aplasties can distort the belly button a descent amount.
By not incising around it and pulling down on the lower abdomen to excise excess skin, the belly button can get elongated downward. You can mimick it by pulling down on your skin and watching the change in the shape of your belly button.
You our need to have a consultation with a physical exam and discussion of all the positives and negatives of all the different types of tummy tuck. From your photos and statement, I think you would be most satisfied with a full abdominoplasty. (Julian Gordon, MD, Atlanta Plastic Surgeon)
Your type of abdominal problem is one of the hardest in which to make the ideal decision. The quality of the skin is suspect so liposuction alone will not fully address your concerns. A full tummy tuck is the definitive answer to your loose skin and belly button issues but with a trade-off of a long horizontal scar.
A mini-tummy tuck is better than liposuction alone but not nearly as effective as a full tummy tuck. As you can see in your case, all abdominal types of tummy tuck can be considered each with their own advantages and disadvantages. These are issues best reviewed with a plastic surgeon during a consultation who has the advantage of actually examining you. (Barry L. Eppley, MD, DMD, Indianapolis Plastic Surgeon)
It appears that you do not need either a full tummy tuck or a mini tummy tuck. What you do need is a consultation and examination with an experienced body contour plastic surgeon. (Robert T. Buchanan, MD, Highlands Plastic Surgeon)
Your need to be examined by your operating surgeon. Scarring, the belly button, skin elasticity, something you cannot determine from a photo, all are part of the assessment.
Asking specific questions, of you, as part of that assessment help to formulate the procedure designed and recommended to you. The conventional tummy tuck is probably what will be recommended. Please see a Plastic Surgeon. (James R. Benjamin, MD, Bowie Plastic Surgeon)
Would a full tummy tuck or mini be best for me?
Best is to seek an in person consultation with an experienced Board Certified PS. But based on these photos – I think you will benefit from a full abdominoplasty to remove excess skin and fat, tighten your muscles (Thomas Trevisani, Sr., MD, Orlando Plastic Surgeon)
That said most multigravida women would benefit from a full abdominoplasty though the fascia alone can be tightened via a small incision (Frederic H. Corbin, MD, Brea Plastic Surgeon)
There are many types of tummy tuck. Your primary problem is with muscle wall laxity. You may be a candidate for a modified abdominoplasty but will need to have the muscle repaired from the xyphoid to the pubic bone.
From your photographs it is not possible to assess your level of skin laxity. (Jeffrey Zwiren, MD, Atlanta Plastic Surgeon)
Full or mini tummy tuck?
This is the most common question for moms who have stayed in good shape after kids. Also you are correct that the belly button is the issue. The final answer will depend on the skin laxity on physical exam. Here are a few fundamentals I have found helpful over the years. Technique – regardless of a full or mini (or in between) the traditional American method where the upper abdominal skin is undermined so that it can be released and advanced downward is not something I feel is best anymore.
I now routinely use Saldanha technique which is where the skin of the entire abdomen is liposuctioned first , not released , and then advanced. This method, also called lipoabdominoplasty Is both safer and has better aesthetic outcome. In addition I use Vaser which is also less traumatic. Muscles- while most people need muscle repair after 3 kids, we are finding that we now don’t need to do repair in many cases and still get great results. Muscle repair is the difference in recovery , not the length of the tummy tuck incision so a mini can be just the same in termsoif recovery if the muscles are done.
I use full abdominal blocks for pain control if I do muscle repair. Full vs mini vs endo – skin determines everything. Significant laxity with a desire to be as tight as possible is a full. The scar has to be low.
Very good skin with minimal laxity is an endoscopic and in between is a mini. However, a mini has some trade offs. First of all , the umbilical opening should never be floated. It looks bad and burns bridges for the future.
Accepting a small scar lower mid abdomen from the closure of the umbilical opening with a shorter supra public scar is less desirable in my opinion. Therefore the only time I recommend a mini is if the skin above the belly button is good enough that we only need to remove lower abdominal skin and the umbilical stalk stays intact though it can be lowered 2 cm and keep it’s stalk intact. Last of all if you do a full , don’t settle for a circular scar. They look bad. I do a lower half flap which looks more natural. (Grady B. Core, MD, Birmingham Plastic Surgeon)