A mini-abdominoplasty is similar to a standard abdominoplasty with a few differences. Like the latter, the mini -abdominoplasty uses a waist crease incision but often (but not always depending upon the amount of skin to be removed) the incision is not quite as long as with the standard procedure. A shorter incision does not mean you will heal faster or have a shorter recovery, the difference in incision length is not enough to make such a difference. Wounds heal side to side, not end to end, so a shorter incision heals in the same time as a longer incision. There are some other substantial differences. There is no incision made around the umbilicus, and it is for this reason that when the skin is lifted up off the abdominal wall, it is only to the level of the umbilicus. As only the lower abdominal wall is exposed, only the lower abdominal muscles can be tightened. There is a variety of the procedure where the umbilicus is left intact on the outside skin but cut at its base from the abdominal wall. This is called floating the “umbilicus”. this will allow the surgeon access to the upper abdominal muscles for tightening. I am not a big fan of this procedure. More on this in a bit. Lastly, when the abdominal wound is closed, the umbilicus may be pulled down slightly, usually no more than a centimeter or so, and this doesn’t appear to cause any concern in my experience.
The indication for a mini-abdominoplasty is basically excess lower abdominal skin with or without a lax lower abdominal wall. The upper abdomen is in good shape, no excess skin or lax wall. In these cases there is no reason to alter the upper abdomen and thus no need to get the umbilicus out of the way and therefore there is no need for an incision around the umbilicus. the recovery from this procedure is probably a little easier than the standard because only the lower half of the abdomen is operated, as opposed to the entire abdomen. An easier recovery is not a reason to select this procedure if you need a standard abdominoplasty if and you select this procedure, you will probably be very disappointed. However, if you do have a mini-abdominoplasty and you really need a standard abdominoplasty or later on with weight changes you develop the need for a standard abdominoplasty, the performance of a mini-abdominoplasty now will not burn any bridges for later. That is to say, if you have a mini-abdominoplasty now, you can convert to a standard abdominoplasty at any time later.
There is a version of this procedure called “floating the umbilicus”. In this procedure, the umbilicus is left intact to the surrounding skin on the outside, but as the abdominal skin is lifted upwards off the abdominal wall, when the umbilicus is encountered, it is transected (cut) from its attachment down below on the abdominal wall. Now the umbilicus floats upward off the abdominal wall, remaining attached to the abdominal skin. While this does give easy exposure to the upper abdominal muscles, there is a trade-off. As the abdominal skin is pulled downwards to the pelvis, one cannot predict at what vertical position the umbilicus will now reside. In other words, the umbilicus can now lie way too low on the abdominal wall and that does not look good! It is also a very difficult, if at all, problem to fix.
The steps in performing a mini-abdominoplasty:
Step 1: The blue ellipse indicates the proposed amount of skin to be removed. The lower solid blue line is where the initial incision is made. The dotted blue line is the proposed upper portion of the skin excision (removal). This can vary upwards or downwards depending upon how much skin excess exists. In this procedure, there is no incision made around the umbilicus. The umbilicus remains attached to the underlying abdominal muscles as well as to the remaining abdominal skin. There will not be a circular hole in the skin flap. The yellow area shows the extent to which the abdominal skin is elevated off the abdominal wall.
Step 2: The abdominal skin is elevated off the abdominal wall, the abdominal musculature is revealed. The skin is elevated to just below the umbilicus in the midline, a little higher to either side of the umbilicus so as to maintain the attachment of the umbilicus to the abdominal wall.
Step 3: The abdominal wall musculature is tightened using a special running suture. The muscles are brought together in the midline.
Step 4: The completed repair of the abdominal musculature is shown.
Step 5: The excess skin is elevated above the abdominal wall and pulled downward. The area of resection (removal) is indicated with a dotted line. There is no hole in the abdominal skin flap because there was no incision made around the umbilicus.
Step 6: The final result is shown with the location of the scar across the waist crease of the abdomen. There is no scar around the umbilicus.