In some cases, the incision can be altered to accommodate your favorite swimsuit style. But in general, three types of incisions are commonly used. The classic W-shaped incision begins at the hipbones and descends diagonally to just above the pubic hairline. If you have had a Cesarean section, the incision may incorporate your C-section scar and extend upward to the hipbones, creating a half-circle.
The third approach, called "high lateral tension abdominoplasty," uses an incision across the lower belly that angles sharply upward at the sides, along the lines of a French-cut bathing suit. High lateral tension abdominoplasty puts more tension on the side portions rather than the middle of the incision, which may improve the appearance of the scar.
Regardless of which incision is best for you, a secondary incision around the belly button may also be needed to free up the navel from surrounding skin during the operation.
Some surgeons are trained in endoscopic abdominoplasty, in which a viewing scope and other flexible tubes are threaded into the abdomen through small incisions hidden in the pubic hair and belly button. Surgical instruments are manipulated through the endoscopes to tighten the abdominal muscles. Endoscopic abdominoplasty is best suited for relatively young patients who have a moderate degree of muscle laxity, localized fatty deposits in the lower abdomen and a minimal amount of excess skin.
What Happens After the Incisions Are Made?
In the traditional open operation, the surgeon separates the skin over the belly from underlying tissue and then lifts the skin up to the bottom of the ribcage. The belly button is usually left attached to its underlying tissue. If necessary, a small quantity of excess fat is cut away from the upper portion of the skin flap.
If the abdominal, or rectus, muscles are tightened toward the midline to create the inner-girdle effect the surgeon then removes the loose skin and excess fat between the belly button and the pubic area. The remaining skin is pulled down tightly. A new hole for the belly button is made in the appropriate location on the skin flap. The edges of skin are then sewn together. Stitches are also used around the belly button to hold it in place.
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