GMommy Tummy Tuck

What a GMommy Tummy Tuck Has to Treat

A GMommy tummy tuck is unique because it has to treat three findings at once: sagging and fullness of the pubic region, fullness in the flanks, and sagging of the lateral thighs. A traditional tummy tuck that only flattens the abdomen leaves those three in place. The changes come from prolonged gravity on skin and soft tissue, and from the cables that hold that skin down.

Those cables are cutaneous retaining ligaments. They attach the skin to the underlying muscles as they cross the fatty soft tissue, and they create adherence of the skin and soft tissue to the deeper structures. Where a ligament holds, the tissue stays. Where it has stretched, the tissue falls and bunches. The fall is uneven, which is why a GMommy abdomen is not a uniform apron. It is a pubis that has been leaned on, flanks that have bunched, and lateral thighs that have dropped below their own band.

This operation does not raise the breast. The findings are on the abdomen, the pubis, the flanks, and the lateral thighs. Recovery follows how far the incision has to travel to reach those findings. A scar that stops above the belt band, or that stops at the love handle, has not done this operation, no matter how flat the central abdomen looks.

The Belt Band and the Pubic Region

Sagging and fullness of the pubic region come from prolonged leaning of the saggy abdomen on the pubis. A horizontal band along the belt line separates the abdomen from the pubic region. That band is tight. Abdominal fullness and sagging hang over it and lean on the pubic region. The lean pushes the pubic region down. The pubis then sags and stays full. The band is a retaining cutaneous ligament, not a clothing mark.

A conventional tummy tuck improves the tummy only. Its incision sits above the retaining cutaneous ligament band, so the pull never reaches the pubic region. The abdomen can look tighter while the pubis stays full and ptotic, still leaned on by whatever tissue remains above the band. That is the limit of an incision placed above the belt line.

The GMommy modification puts the incision below the abdominal band. That lower line lifts and tightens a sagging pubis and still tucks the abdomen. It also decreases the volume of the pubic fullness toward a more proportionate pubis. The pubis is lifted because the incision is below the band that was blocking the pull, not because the abdomen above the band was pulled harder.

Flank Fullness and the Lateral Thigh

Fullness in the flank, the love handle, is another effect of aging. Gravity has acted for a long time on the lower and middle back. The retaining cutaneous ligaments stretch as an extension of the abdominal band along the flanks. Sagging tissue bunches in the flank and forms the love handle. The same gravity drops the lateral thigh. Tissue below the lateral retaining cutaneous ligament band sags and bunches along a further retaining cutaneous ligament at the mid lateral thigh. The flank bunch and the thigh bunch are two stops, not one roll.

The second modification extends the tummy tuck incision around the lateral hip. A lateral thigh tuck incision that sits above the lateral abdominal retinacular ligament band can reduce love handle prominence. That higher line does not pull the lateral thigh skin redundancy and fullness, because the thigh tissue is below the band. Placing the incision above the band treats the flank and leaves the thigh.

On a GMommy tummy tuck, the lower central abdominal incision is extended below the lateral cutaneous retinacular ligament band. That lower extension pulls the lateral thigh and the flank together. At the same time, the upper excision line of the tummy tuck is positioned above the lateral abdominal retaining cutaneous ligament. The surgeon can then eliminate love handle fullness and lateral thigh fullness in the same closure. One line below the band takes the thigh. The upper line above the ligament takes the love handle. Stopping at either line leaves the other bunch.

High definition liposuction of the back and flanks can thin flank fat, and the 66-year-old photograph includes that liposuction plus a Brazilian buttock lift. Liposuction does not move the incision below the ligament band, and it does not pull a sagging lateral thigh. The flank still has to be excised between the upper line and the lower extension. Suction of the love handle without that extension leaves the lateral thigh where it bunched.

Muscle Diastasis Is a Separate Decision

A traditional tummy tuck addresses fullness and redundancy of the tummy and the love handles. A GMommy tummy tuck adds the full, ptotic pubic region and the sagging lateral thighs by moving the incision below the bands those areas hang from. The abdomen is still tucked. The difference is which structures the pull can reach.

Loosened abdominal muscles, termed muscle diastasis, may require tightening with a plication repair. That repair is a separate decision from the incision height. A pubis can sag from leaning tissue even when the muscles are firm, and a diastasis can be present when the incision still needs to sit below the belt band. Plication draws the separated muscles together. It does not lift a pubis that the incision never reached, and it does not pull a lateral thigh that stayed below an incision placed above the flank band.

The American Society of Plastic Surgeons describes a tummy tuck as removal of excess abdominal skin, with tightening of the abdominal wall when that is part of the plan. On this operation the skin removal has to include the pubis and the lateral thigh, which means the incision crosses below the belt band and below the lateral ligament band. Wall tightening, when the muscles are loose, is the plication. It is added when the diastasis is there. It is not a substitute for the lower incision.

The 66-year-old front right view shows a tummy tuck with a Brazilian buttock lift and high definition liposuction of the back and flanks. It does not label whether the incision sat below the belt band, and it does not label whether a plication was added. Those two decisions are made on the standing exam: where the pubis has been leaned on, where the flank has bunched, where the lateral thigh has dropped, and whether the abdominal muscles are loose. Cost follows that extent, because an incision that also lifts the pubis and the lateral thigh is not the same closure as a tummy-only tuck.

The exam is done standing, at the tummy tuck locations, with the belt band and the lateral bands visible. Gravity is what produced the lean on the pubis and the bunch at the flank and mid thigh, so a photo taken lying down hides the very drop the incision is placed to catch. A plan that marks the incision above the abdominal band will miss the pubis. A plan that marks it above the lateral band will miss the thigh.