Extended Abdominoplasty with Liposuction of the Detached Abdominal Flap in 200 Consecutive Cases: An Approach to the Overweight and Mild Obese Patient
Goals/Purpose: Abdominoplasty plays a central role in body contouring surgery. Interestingly, although there are many options to address abdominal contour deformities, there is not an optimal approach for the overweight and mildly obese patient (BMI between 25 to 30 and 30 to 35 kg/m2 respectively). In this setting the first step in management is always lifestyle and diet modification with the goal of losing the excess weight in order to obtain an optimal postoperative result. Most of these patients feel discouraged when confronted with this situation and opt for a second opinion or abandon their aspiration falling in the vicious cycle of weight gain, depression, becoming sedentary, eating more and gaining weight. Many plastic surgeons will refuse surgery for this type of patients since the common body contouring techniques fail to address the problem providing suboptimal results. Others will offer staged surgeries including liposuction and regular abdominoplasties in different occasions. However, in these patients combining aggressive liposuction with extended abdominoplasty can be offered as a safe option.
Methods/Technique: Combination of tumescent liposuction of flanks, back, and abdomen together with extension of the abdominal incision to the lower back are described. The abdominal flap is elevated in the standard fashion to the level of the xyphoid and costal margin. The fat deep to Scarpa's fascia is excised directly. Pre and post-operative pictures were obtained for comparison; surgeon and patient satisfaction evaluations were recorded.
Results/Complications: From August 2006 to August 2011, 200 female patients underwent abdominal contouring surgery following the proposed technique. Ages ranged from 38 to 65 years of age (mean=46). The mean BMI was 28 kg/m2, of which sixty percent were overweight and forty percent mildly obese. The amount of tissue removed ranged from 10 to 22 pounds, including liposuction volume. No major complications such as seromas, necrosis, or dog ears were noted. The only minor event noted in six patients was a minimal dehiscence of the high tension area over the lateral waist line. Satisfaction was recorded as high in all patients.
Conclusion: We present a combination of extended incision abdominoplasty and aggressive liposuction of the abdomen that is safe and provides excellent results to a suboptimal patient population. This technique also provides the benefit of achieving a significant improvement of the waistline avoiding dog ears and enhancing the lateral thigh.
