What is a reverse abdominoplasty?
A reverse abdominoplasty removes excess skin and subcutaneous tissue from the upper abdomen (above the umbilicus). Unlike a conventional abdominoplasty, where tissue is pulled downward toward a low pubic incision, the reverse technique advances the upper abdominal flap upward and places the scar within the inframammary fold (IMF), where it is typically concealed by the natural breast contour and undergarments.
| Standard Abdominoplasty | Reverse Abdominoplasty | |
|---|---|---|
| Target zone | Lower abdomen (infraumbilical) | Upper abdomen (supraumbilical) |
| Incision | Low transverse, suprapubic | Inframammary fold (bilateral ± midline connection) |
| Flap direction | Advanced caudally | Advanced cranially |
| Umbilicus | Usually transposed | Usually left in place |
| Scar concealment | Underwear line | Bra line / breast shadow |
Indications
Isolated upper-abdominal skin laxity
With a relatively good lower abdomen.
Residual upper laxity after a previous tummy tuck
Where further downward pull is limited.
Concurrent breast surgery
Augmentation, mastopexy or reduction — the IMF incision is shared.
Existing IMF scars
Scars from prior breast surgery that can be reused.
Selected post-weight-loss patients
Predominantly upper-abdominal / epigastric excess, often as part of an upper body lift.
Epigastric skin redundancy
Folds or rolls under the breasts.
Who may not be an ideal candidate
- —Predominant lower-abdominal excess or significant infraumbilical skin (standard or combined procedure more suitable).
- —Active smokers / nicotine users (higher wound and flap complications).
- —Elevated BMI or unstable weight; planned future pregnancy.
- —Significant rectus diastasis requiring full-length repair (reverse access to the lower rectus is limited).
- —Prior upper-abdominal scars (e.g., subcostal/Kocher incisions) that may compromise flap blood supply — requires individual vascular assessment.
- —Male patients or women with a poorly defined/flat IMF, where the scar may not be concealed.
- —A personal history of hypertrophic or keloid scarring (particularly relevant to the presternal region).
Technique — Step by Step
Step 1 / 6
Preoperative marking (standing)
The IMF is marked bilaterally; a pinch test estimates the vertical excess that can be advanced; the midline and planned new IMF level are marked.
“The success of a reverse abdominoplasty depends less on how much skin is removed and more on how securely the new inframammary fold is anchored.”
Different Approaches
Isolated Reverse Abdominoplasty
IMF incision only.
Best suited for: Pure upper-abdominal laxity
Reverse Abdominoplasty + Breast Augmentation (AMBRA)
Shared IMF access; flap advancement can support the lower pole and help define the fold.
Best suited for: Laxity + volume loss
Reverse Abdominoplasty + Mastopexy / Reduction
Combines breast reshaping with upper abdominal tightening via the same fold.
Best suited for: Ptosis or large breasts + upper laxity
Reverse Abdominoplasty + Liposuction
Contouring of the flanks and epigastrium; liposuction in the undermined flap is kept conservative to protect perfusion.
Best suited for: Laxity + localised fat
Combined with Standard / Mini Abdominoplasty
For global laxity; extensive undermining from above and below can endanger perfusion, so staging or limited undermining is often preferred.
Best suited for: Upper and lower excess
Upper Body Lift (post-massive weight loss)
Part of a circumferential upper-torso lift, sometimes including lateral chest and back excision.
Best suited for: Massive weight loss
Progressive Tension / Quilting Sutures
Distributes tension, reduces dead space and may reduce drain requirement.
Best suited for: Adjunct to any approach
Visual Guide
- Zone I — deep epigastric
- Zone II — external iliac
- Zone III — intercostal / lumbar
After undermining, the flap relies mainly on zone III (intercostal) perfusion, which is why dissection is limited to what advancement requires.
- Upper onlyReverse
- Lower onlyStandard / Mini
- BothCombined or staged
- + Breast concernsCombined with breast surgery
Clinical photographs shown only with written patient consent and in accordance with applicable regulations.
Scar Healing
The scar lies within the inframammary fold, where breast shadow and undergarments usually conceal it. Like all surgical scars, it is permanent and matures over 12–18 months.
Days 0–14 — Inflammation & epithelialisation
Incision sealed; sutures/tapes managed; keep dry and clean.
Scar-care protocol
Recovery & Risks
Typical recovery (illustrative, varies by patient)
- •Hospital stay: usually 1 night (depending on combined procedures).
- •Drains: typically a few days.
- •Compression garment + supportive bra: approx. 4–6 weeks.
- •Desk work: approx. 10–14 days.
- •Strenuous exercise and heavy lifting: avoid for approx. 6 weeks.
Possible risks (discussed at consultation)
Seroma · haematoma · wound separation (especially at the midline junction) · delayed healing · hypertrophic or widened scar · IMF descent or asymmetry · contour irregularity · altered breast position or cleavage blunting · sensory changes · infection · venous thromboembolism · need for revision.
Frequently Asked Questions
It is placed in the fold under the breast and is usually concealed by clothing and swimwear, but it is permanent and its quality varies between individuals.
References
- Rebello C, Franco T. Abdominoplasty through a submammary incision. Int Surg. 1977;62:462–463.
- Baroudi R, Keppke EM, Carvalho CG. Mammary reduction combined with reverse abdominoplasty. Ann Plast Surg. 1979;2:368–373.
- Huger WE Jr. The anatomic rationale for abdominal lipectomy. Am Surg. 1979;45:612–617.
- Halbesma GJ, van der Lei B. The reverse abdominoplasty: a report of seven cases and a review of English-language literature. Ann Plast Surg. 2008;61:133–137.
- Zienowicz RJ, Karacaoglu E. Augmentation mammaplasty by reverse abdominoplasty (AMBRA). Plast Reconstr Surg. 2009;124:1662–1672.
- Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105:2583–2586.
- Mustoe TA, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–571.
- Gold MH, et al. Updated international clinical recommendations on scar management: part 2. Dermatol Surg. 2014;40:825–831.
Is a reverse abdominoplasty right for you?
Every abdomen is different. A personal assessment determines whether a reverse, standard, or combined approach best suits your anatomy.