A “muffin top” refers to the protuberance of the upper abdomen which results in a protrusion (bulging outward) of the upper abdomen and concave (curving inward) lower abdomen. This contrasts to the more desirable “ideal” abdominal shape characterized by a concave upper abdomen and gentle convexity of the lower abdomen. Below is an example of a patient who underwent a tummy tuck with muscle repair by another surgeon. As you can see in the picture, her surgery resulted in a less than desirable “muffin top” appearance.
What Causes This Complication?
The question that patients consulting me for a revision tummy tuck routinely ask me is why did this happen?
To understand how this complication occurs, we have to review the anatomy and surgical maneuvers used during tummy tuck surgery. After lifting the skin off the muscles, surgeons repair them by plicating the muscles in the middle like a corset. Plicating just translates to “tightening”. This vertical tightening of the muscles is performed both above and below the belly button.
If one tightens the muscles above the belly button less than the muscles below, it can create a muffin top. Optimally, your surgeon should tighten the muscles above the belly button just slightly more than the muscles below the belly button in order to provide you the desirable concave upper abdomen and slightly convex lower abdomen.
Another possible cause of the muffin top can occur despite appropriately placed tension of the repaired muscles. Thinned out muscles and their lining causes this muffin top deformity in some patients. This occurs following muscle tightening if the increased tension makes the muscle and lining stretch out again. The medical terminology for thinned out muscles is muscle attenuation. Unfortunately, it is not possible to tell if your muscle repair will hold until after your surgery.
Tummy Tuck Revision to Repair a “Muffin Top”
We can fix a “muffin top” in two ways. If improper muscle tightening by the previous surgeon is the cause, then a revision tummy tuck will require resetting the proper tension so that the upper muscles are tightened slightly more than the bottom muscles. If the muffin top resulted from muscle attenuation, then you will require a Tri-Modality repair, which will not only tighten/repair but also reinforce your entire abdominal musculature, thereby eliminating the potential for further muscle stretch.
Pictured above, a 48 year old mom with identified muscle attenuation who underwent the comprehensive Tri-Modality repair during her tummy tuck to avoid a post-operative “muffin top” deformity.