Circumferential Abdominoplasty for Sequential Treatment after Morbid Obesity (original) (raw)
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Aesthetic Surgery Journal, 2002
Background: Traditional abdominoplasty, with or without lipoplasty, can achieve pleasing aesthetic results but is associated with serious postoperative complications. Objective: We describe an abdominoplasty procedure that combines resection of excess skin with lipoplasty but without panniculus undermining or resection. Methods: The redundant pannus was marked, and the dermis in this region was resected, but the underlying subcutaneous fat, connective tissues, and all vessels were preserved. Lipoplasty of the abdominal wall was performed at a plane below Scarpa's fascia, allowing the cutaneous and subcutaneous panniculus to slide over the muscular aponeurotic wall while preserving all perforating vessels as multiple pedicles. If appropriate, plication of the aponeurotic structures was performed through a starshaped incision in the umbilical region. Results: We achieved excellent improvement of body contour with fewer complications and less discomfort to the patient compared with traditional abdominoplasty procedures. Conclusions: Abdominoplasty without panniculus undermining enables treatment of localized adiposity and excess abdominal wall skin as well as reinforcement of the muscular aponeurotic structures while significantly reducing the risk of seroma formation and other complications. The technique is not indicated for cases where complex reconstruction of the abdominal aponeurotic wall is necessary.
Circular Abdominoplasty (Belt Lipectomy) in Obese Patients
Body Contouring and Sculpting, 2016
Circular abdominoplasty, belt lipectomy, 360° abdominoplasty and lower body lift are all synonyms of a body contouring procedure with the aim of sculpting the torso, modifying abdominal contour, loins and lower back contours. Apart from buttock lifting and affecting lateral thighs, these procedures tremendously affect patients' waist size and body image. In the literature, different incision levels, different dissection extents according to the sex of the patient, with different areas of anatomical adherence and different modifications like buttock enhancement by de-epithelialized lower back flaps are described. Most of these operations target post-weight reduction patients. Still these procedures can be performed in obese patients, either after failed diet control, failed bariatric surgery or patients refusing GIT operations though seeking lifestyle modification through body contouring. A group of patients with obesity affecting pre-, intraand post-operative course, with increased complication rate, when performed with a knowing what-to-do team takes about 3-4 hours. However, with the help of anaesthetists accustomed to this risky group of patients, it could be executed safely and efficiently.
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2014
Análise retrospectiva de pacientes pós-bariátrica submetidos à abdominoplastia com neo-onfaloplastia: 70 Casos ABSTRACT Introduction: With the increasing surgical treatment of obesity, a new group of patients is being attended by plastic surgeons: those with large flaccid skin following weight loss. For patients treated with conventional or open bariatric surgery, vertical, anchor-line, or inverted "T" abdominoplasty has been widely used to improve the abdominal contour. In this study, abdominoplasty was associated with umbilical amputation followed by neo-omphaloplasty. Methods: Seventy patients with stable weight for at least 18 months underwent surgery at the UNICAMP Plastic Surgery Outpatient Clinic, from March 2011 to April 2013. In all patients, anchor-line abdominoplasty with excision of the original navel was executed, together with the surgical specimen and preparation of neo-umbilicus, through bilateral dermal-fat flaps. A retrospective analysis of medical records and photographic archives was performed. Results: The 70 patients were predominantly female (91%) and white (83%) with a mean age of 40 years. After a wait time of approximately 16 months, they were subjected to anchor-line abdominoplasty associated with neo-omphaloplasty, which lasted an average of 2 hours. There were post-operative complications in 29.85% of the patients, including small dehiscence, unsightly, enlarged, or hypertrophic scars, keloid, seroma, relevant dermo-fatty excesses, and wound infection. The neo-umbilicus obtained from the surgery is very similar to the original umbilicus. We did not observe necrosis, stenosis, morphological distortions, or bad positioning. Conclusion: This technique has made it possible to obtain an umbilicus with a natural look, is easy to perform, and shortens operating time.
Clinics in Plastic Surgery, 2006
New technique with minimal trauma on subcutaneous panniculus Selection of patients and indication for surgery Surgical demarcations The operation & Discussion & References Abdominoplasty is one of the most frequent procedures in plastic surgery. There are two important components-an esthetic and a reconstructive approach-that provide a wide variety of options in abdominoplasty. The esthetic component is inherent to the surgical act, because it aims to create a new silhouette harmonizing the abdomen with the other segments of the body contour. The reconstructive component is related to the need for reinforcement of the musculoaponeurotic wall during abdominoplasty, which, in some cases, is a mandatory procedure to treat extensive alterations caused by repeated pregnancies, unesthetic and retracted scars secondary to previous surgeries, or many other etiologies.
New Concepts on Safer Abdominoplasty
Body Contouring and Sculpting, 2016
Abdominoplasty was one of the first techniques described in literatura, and in some of his writings, Hippocrates mentioned the resection of skin and the apron-like abdominal flaps. The first standardization of this procedure was carried out by H.A. Kelly, who was a gynecologist, in 1890, but the procedure gained some popularity when Pitanguy published his report in 1967. With the advent of liposuction, they tried to replace abdominoplasty; however, in many cases, they yielded unreliable results. It was in the year 2000, with the advent of the pull down abdominal flap technique proposed by Avelar and then spread by Saldanha, surgeons significantly increased the indications for abdominoplasty. This was reflected in international statistics since abdominoplasty climbed from the 15th place in the 1990s to the 4th place in 2012. According to some publications, traditional abdominoplasty generally includes extensive dissection of upper abdominal flap all the way to the costal margin with a consequent decrease of blood flow of 50-70%. We present a technique with no flap undermining, including inbloc resection of premarked área from the umbillicus scar to the suprapubic area, dissecting the tissue with an instrument called Iconoclast, thus preserving blood flow, after hydrodissection with tumescent solution, which varies if the patient is under general anesthesia or sedation. It has been shown that simultaneous liposuction of flap and flanks in the conventional abdominoplasty technique increases the risk of necrosis and seromas, so in many cases it is contraindicated. Therefore, our technique allows us to perform the liposuction of the upper abdominal flanks and waistline without running any risks. In this technique umbilicus scar its recreated with the use of skin graft. Unlike conventional abdominoplasty techniques, the presence of previous abdominal wall scars is not a limitation. In the case of smokers patients, risks are reduced by keeping the blood flow of the upper flap constant. We do not recommend this technique for very thin patients, with multiple pregnancies and regularly an important rectus muscles diastasis where we indicate the abdominal wall.vertical plicature.