Reverse Tummy Tuck

A reverse tummy tuck, also called a reverse abdominoplasty or upper tummy tuck, treats loose or crepey skin of the upper abdomen — the area between the lower ribs and the belly button. Instead of pulling the skin downwards to a scar above the pubic area, as a standard tummy tuck does, the surgeon lifts it upwards and removes the excess through an incision placed in the inframammary fold, the natural crease beneath the breasts, where it is covered by a bra or bikini top.

A mini reverse tummy tuck is a smaller version of the same operation for mild, localised laxity of the upper abdomen. The incision is limited to a shorter segment of the breast fold — often only the central or inner part of each fold — and less skin is lifted and removed. It suits patients with good skin quality whose looseness is confined to a band just below the breasts, and it is frequently performed alongside a breast lift or reduction.

The direction of the pull and the position of the scar. A regular tummy tuck pulls the abdominal skin downwards and places the scar low, above the pubic area; it is the right operation for loose skin and muscle separation below the belly button. A reverse tummy tuck pulls the skin upwards to a scar in the breast fold; it treats laxity above the belly button that a regular tummy tuck often cannot reach, because the lower incision is too far away to tighten the skin just under the ribs.

The ideal candidate has loose or wrinkled skin mainly in the upper abdomen, with a reasonably firm lower abdomen; is at a stable weight; and has a breast fold where the scar can sit hidden — or is planning a breast lift, reduction or augmentation anyway. Typical situations are upper-abdominal laxity after weight loss or pregnancy, residual upper looseness after a previous standard tummy tuck, and women who want their breast surgery and abdominal tightening done through one incision.

Patients whose main problem is the lower abdomen — a hanging lower belly, stretch marks below the navel or a C-section overhang — need a standard or full tummy tuck instead. A reverse tummy tuck is also less suitable when there is no breast fold to hide the scar (for example in many men), when the bulge is caused by fat or muscle separation rather than loose skin, in active smokers, and when a large amount of weight loss is still planned.

The scar sits in the inframammary fold — the crease under each breast — and in a full reverse tummy tuck the two segments may be joined across the breastbone. In women it is concealed by a bra or bikini top. Across the midline, where the folds meet, the scar is more visible in low-cut clothing; this is the main trade-off of the operation and is discussed openly at the consultation. In a mini reverse tummy tuck the scar is shorter and usually limited to the fold itself.

Yes, and this is the combination that makes the most sense. A breast lift, breast reduction or augmentation already uses an incision in the breast fold, so the upper-abdominal skin can be lifted and tightened through the same scar with no additional incision. The combination is particularly common after pregnancy or weight loss, when the breasts and upper abdomen have both lost their support.

No. The reverse tummy tuck pulls abdominal skin upwards and anchors it at the breast fold; it does not lift sagging breasts, and badly planned it can even push the fold upwards or distort it. If the breasts have dropped, a breast lift is performed in the same operation. Dr. Michels fixes the breast fold to the deep tissues over the ribs so that the fold stays where it belongs.

Often, yes. Residual loose skin or a bulge in the upper abdomen after a standard tummy tuck is a common reason for a reverse tummy tuck, because the original lower incision could not tighten skin so far from it. The first step is to find out what the bulge is made of: loose skin responds to a reverse tummy tuck, whereas fat responds to liposuction and a persistent muscle gap needs a muscle repair. Ultrasound and examination decide which applies.

The upper part of the rectus muscles can be brought together through the breast-fold incision when the separation is confined to the area above the navel. When the gap extends below the belly button — which is the usual pattern after pregnancy — a full tummy tuck or MILA, Dr. Michels' minimally invasive endoscopic muscle repair, treats the whole length more effectively.

Frequently. Liposuction of the upper abdomen and flanks is used to refine the contour and to release the skin so it can be lifted evenly. The amount depends on the fat present; in very lean patients little or none is needed.

Yes. In patients with loose skin both above and below the navel — most often after major weight loss — the two can be combined, with one scar in the breast fold and one low on the abdomen. For patients with excess skin around the whole trunk, an upper body lift or a Fleur-de-Lis abdominoplasty may be the better plan, and the options are compared at the consultation.

Usually not. Because the skin is lifted from above, the belly button generally stays in place and keeps its natural shape. When a reverse tummy tuck is combined with a regular tummy tuck, the navel is repositioned as part of that operation.

Besides the risks common to any abdominal operation — bleeding, infection, fluid collection (seroma), delayed healing, blood clots and anaesthetic risk — the specific risks are a visible or widened scar across the breastbone, and displacement of the breast fold, where the upward pull raises or distorts the fold and the breasts look higher or uneven. Careful anchoring of the fold to the deep tissues, conservative skin removal and correct patient selection are what prevent these.

Generally less painful than a full tummy tuck, because the incision lies away from the lower abdomen and there is usually no extensive muscle repair. Patients describe tightness under the breasts for the first days. As with every abdominal procedure in this practice, ultrasound-guided nerve blocks are placed by the anaesthesiologist before you wake, which markedly reduces early pain and the need for strong painkillers.

Most patients return to desk work in about 7 to 10 days, wear a compression garment for 4 to 6 weeks, start light cardio after 3 to 4 weeks and return to full exercise at around 6 weeks. When a breast lift is done at the same time, the breast recovery and the abdominal recovery run in parallel and the timeline is essentially the same. A mini reverse tummy tuck is usually quicker.

It depends on the amount of liposuction and dissection. When the operation is limited, Dr. Michels uses progressive tension sutures to close the space where fluid would collect, which allows a drainless recovery; after more extensive combined procedures a drain may be used for a few days to control swelling.

The removed skin does not come back, so the improvement is long-lasting as long as your weight stays stable. Skin continues to age, and a large weight gain or a future pregnancy can stretch the abdomen again; for that reason surgery is best planned once family planning is complete.

The cost depends on whether it is a mini or full reverse tummy tuck, whether it is combined with a breast lift, liposuction or a lower tummy tuck, and on the hospital stay. Fees are quoted individually after the consultation, once the plan is defined, and include the surgeon, the anaesthesiologist with nerve blocks, the hospital and theatre, compression garments, discharge medication and follow-up. No fixed price list is published.

Neither is better — they treat different areas. A reverse tummy tuck is better for loose skin above the navel with a firm lower abdomen; a regular tummy tuck is better for loose skin, stretch marks and muscle separation below the navel. Choosing the operation for the wrong area is the most common cause of disappointing results, which is why the examination matters more than the name of the procedure.

It is possible, but men have no natural breast fold to hide the scar, so the incision would be visible on the chest. For men with loose upper-abdominal skin after weight loss, a standard tummy tuck, an upper body lift or a combination with gynecomastia surgery is usually the more discreet route.

For mild laxity with good skin, non-excisional skin tightening such as Renuvion (J-Plasma) or BodyTite combined with liposuction can improve the upper abdomen without a scar in the breast fold, though the effect is more modest. For fat rather than skin, liposuction alone is enough. For laxity of the whole abdomen, a full tummy tuck, lipoabdominoplasty or a Fleur-de-Lis abdominoplasty is the appropriate operation.

Yes. Many of Dr. Michels' body-contouring patients live in Dubai. All consultations and surgery take place at Elyzee Hospital in Abu Dhabi, and the pre-operative tests, surgery and follow-up visits are grouped to keep the number of journeys to a minimum.