Abdominal plasty with and without plication-effects on trunk muscles,lung function,and self-rated physical function

Background: Weight loss after obesity and pregnancy is associated with excess abdominal skin and weakness of the abdominal wall, which is assumed to cause low back pain and reduce lung function. Today, abdominoplasty is the only known method to treat excess skin, and plication is used to improve aesthetics and function alone or in addition to surgery. There is lack of evidence concerning the surgery’s effect on trunk muscles, lung function, and physical function. The aim was to evaluate the effect on trunk muscle endurance, lung function and self-rated physical function after abdominoplasty with and without muscle plication.

Aim: To evaluate the effect on trunk muscle endurance, lung function, and self-rated physical function after abdominoplasty with and without muscle plication.

Methods: A series of 125 people were randomised to abdominoplasty with or without rectus abdominis muscle plication. Trunk muscle endurance, lung function, and self-rated physical function (disability rating index) were measured before and 1 year after surgery.

Results: There were no significant differences in any of the measured variables between the groups either before or after surgery. A significant decrease (p?=?.02) in back muscle endurance was seen after abdominoplasty without muscle plication. A significant positive effect (p?=?.04) in one of the activities (running) assessed by DRI was reported after abdominoplasty with muscle plication.

Conclusions: No significant differences in trunk muscle endurance, lung function, or self-rated physical function were found after abdominoplasty with vs without plication. As the primary indication for surgery was excess skin and not diastasis of the rectus abdominis muscles, there is a need for future trials before conclusions can be drawn of effect of abdominoplasty and plication.     

Evaluation of Cutaneous Abdominal Wall Sensibility After Abdominoplasty

Changes in cutaneous sensibility are common after diverse plastic surgical procedures. Although prior studies examined aesthetic results, combined procedures, and new abdominoplasty techniques, few examined the effect of undermining on cutaneous sensibility. This study aimed to analyze and quantify cutaneous sensibility after classic abdominoplasty. Two groups of patients were studied: a control group of 10 patients without surgery and another group of 25 patients who had undergone classic abdominoplasty. The abdominal wall surface was divided into nine regions. Pain sensibility was evaluated by tests with needles, and thermal sensibility by test tubes containing hot and cold water. Superficial tactile sensibility was tested using the Pressure-Specified Sensory Device (PSSD), which is capable of determining the cutaneous pressure threshold. Statistical analysis was conducted using Student’s ‘t-test’. The results showed a decrease in the three types of sensibility. Statistical analysis showed a significant difference (p < 0.05) between the groups for all regions tested. The centermost regions of the abdominal wall presented the highest index of analgesia and thermal anesthesia, as well as higher cutaneous pressure thresholds.     

Abdominoplasty with Total Abdominal Liposuction for Patients with Massive Weight Loss

Background Massive weight loss after bariatric surgery is associated with significant skin excess, laxity, and ptosis over the abdomen. Good results have been achieved with abdominoplasty and circumferential lipectomy. However, blood transfusions are sometimes needed, and patients may require long hospital stays. Furthermore, morbidity rates are high. Total abdominal liposuction performed with abdominoplasty allows for the preservation of lymphatic vessels below Scarpa’s fascia and eliminates the need for upper flap undermining. This study aimed to evaluate this technique in patients with anterior abdominal redundancy attributable to massive weight loss after bariatric surgery. Methods The charts of 60 patients treated between December 2001 and October 2004 were retrospectively reviewed. All the patients had undergone previous bariatric surgery as well as subsequent total abdominal liposuction and abdominoplasty. Results The average amount of wetting solution used was 3.1 l, and the average total aspirate was 2.5 l. The mean pannus weight was 3,649 g, and the average dimension was 48 × 25 × 6 cm. No patient required a blood transfusion. The median in-hospital stay was 1 day, with 42% of the patients treated as outpatients. The median follow-up period was 3 months. Morbidity was 22%. Factors associated with the development of complications were weight of the pannus, transverse dimension of the pannus, and body mass index. All the patients were satisfied with the results. Conclusions Total abdominal liposuction followed by abdominoplasty is adequate treatment for anterior abdominal redundancy for patients with massive weight loss.     

Transient femoral neuropathy after abdominoplasty

Femoral nerve injury is a rare complication of abdominal and pelvic surgery. Although it has been described after a variety of operative procedures, this article describes what may be the first reported occurrence of femoral neuropathy after abdominoplasty.     

Management of Upper Abdominal Laxity After Massive Weight Loss: Reverse Abdominoplasty and Inframammary Fold Reconstruction

Background  

Central to body contouring after weight loss surgery is treatment of the abdominal region, often through a circumferential abdominoplasty. This procedure, however, neglects the laxity of the lower thoracic/upper abdominal region. A reverse abdominoplasty with reconstruction of a new inframammary fold (IMF) corrects this deformity through removal of excess skin along the IMF. Since 2002, we have performed 88 reverse abdominoplasty procedures within the context of a single or staged total-body lift (TBL).     

Hematological variables and iron status in abdominoplasty after bariatric surgery

Background

Abdominoplasty, the treatment for abdominal wall deformity stemming from weight loss after bariatric surgery, can cause postoperative anemia. Moreover, bariatric surgery has been associated with iron deficiency, which by itself can compromise erythropoiesis. The objective of this research is to describe the development of anemia after postbariatric abdominoplasty.

Methods

The study group consisted of 32 adult women who had received bariatric surgery. Treatment group included 20 patients who were undergoing postbariatric abdominoplasty. Control group included 12 patients waiting for abdominoplasty. Values of hemoglobin, reticulocytes, iron, ferritin, and the transferrin saturation were obtained on the evening before abdominoplasty and during the first, fourth, and eighth postoperative weeks. Hemoglobin was measured at 48 h.

Results

Mean hemoglobin levels for treatment group decreased from 12.98 to 10.8 g/dL after 48 h, increased on day 7 to 11.53 g/dL, but did not increase further after day 7. The reticulocyte number increased in the first week. Serum iron and transferrin saturation index fell during the first week and remained low. Ferritin levels increased non-significantly from 29.77 to 37.24 ng/mL at week 1, then fell until they were decreased (16.44 ng/mL) by day 56.

Conclusions

As expected, hemoglobin fell after abdominoplasty. However, after a one-third recovery of hemoglobin concentrations by week 1 postoperative, they failed to return to preoperative levels by the eighth week. Additionally, by the eighth postoperative week, 45 % of abdominoplasty patients had developed an iron deficiency and hemoglobin deficit that was higher than that of patients who maintained normal iron stocks.     

Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study

Purpose

This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods.

Methods

This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone.

Results

A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05).

Conclusion

Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.

Graphical abstract

     

Ambulatory abdominoplasty tailored to patients with an appropriate body mass index

BackgroundThe office-based surgery setting potentially offers advantages to both the patient and the plastic surgeon, but some patients may not be considered good candidates for abdominoplasty or combined abdominoplasty/lipoplasty performed in the ambulatory setting.ObjectiveWe conducted a retrospective case review of 22 patients who underwent ambulatory abdominoplasty to correct diastasis recti during a 1-year period to evaluate the utility of body mass index (BMI) in patient selection for office-based abdominoplasty procedures using a tumescent technique.MethodsPatients selected for ambulatory abdominoplasty in an office-based setting had BMIs ranging from 22 to 34, with an average BMI of 27, and were American Society of Anesthesiologists (ASA) class I or II. Patients with a BMI that placed them in a “morbidly obese” category (BMI of 35 or above) received general anesthesia with an overnight hospital stay. In borderline cases involving obese patients, a qualified anesthesia provider was consulted to determine whether ambulatory surgery was appropriate, based on the patient's airway and an overall evaluation of the patient's history and physical examination. Patients who underwent ambulatory abdominoplasty received a tumescent anesthetic solution of 50 mL 1% lidocaine with 1 mg epinephrine per liter of normal saline, up to 35 mg/kg body weight. Lipoplasty of the lateral and epigastric regions was routinely performed at the end of all abdominoplasties. The length of surgery was 3 hours to 5.5 hours, depending on the number of regions undergoing lipoplasty.ResultsThere were no reportable surgical or anesthetic complications in any of our patients. Patients reported a high level of satisfaction with the results.ConclusionsBMI evaluation, and in some cases additional risk assessment by a qualified anesthesia provider, can be helpful in determining proper candidates for ambulatory abdominoplasty and combined abdominoplasty/lipoplasty procedures.     

Obese and nonobese patients: complications of abdominoplasty

We analyzed 80 patients who underwent abdominoplasty at the University of Tor Vergata "Policlinico Casilino", Rome to determine the effect of obesity on the incidence of complications after this surgery. The study patients were divided into 3 groups, obese, overweight, and normal weight, based on the degree to which their preoperative weights varied from their ideal body weight. A history of previous bariatric surgery was also analyzed to determine what impact that might have on subsequent abdominoplasty. Results showed that the records of 80 patients who underwent an abdominoplasty at University of Tor Vergata Policlinico indicated that 76% of obese patients had complications compared with the overweight and normal-weight patients, who had complication rates of 35% and 33%, respectively. Previous gastric bypass surgery had no significant effect on the incidence of postabdominoplasty complications. Based on these findings, the authors conclude that obesity at the time of abdominoplasty has a profound influence on the wound complication rate following surgery, regardless of any previous weight-reduction surgery.     

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

Background The number of patients after gastric bypass being referred to plastic surgery units for secondary plastic surgery procedures is increasing. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars in the upper abdomen. Often a limited abdominoplasty of the low transverse type with limited undermining only up to the level of the umbilicus is performed in order not to compromise blood supply in the zone between the old transverse and the new transverse scar. Method We propose a new, modified and safe surgical technique to perform a complete abdominoplasty with wide undermining up to the xiphoid process in patients with preexisting transverse subcostal scars after gastric bypass surgery, by selectively dissecting and preserving one to three periumbilical abdominal wall perforator vessels to secure flap blood supply. Vessel tunnelling through the rectus sheath and muscle and ligation of the cephalad branch of the perforator provide sufficient flap mobility without perforator tension or traction. Flap undermining is performed around these perforator vessels. To match dissected flap perforators with blood-flow, we performed postoperative color-flow duplex scanning. Results We treated two patients according to this new technique. In both cases the postoperative course was uneventful and a good aesthetic result was achieved. Conclusion We conclude from our experience that with this perforator-sparing abdominoplasty technique, safe and complete abdominoplasty can be performed with no additional risk of complications and that a good cosmetic result can be achieved in patients after open gastric bypass surgery.     

Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country

Few reports about body contouring surgery after massive weight loss (MWL) have been produced in the developing countries. As Mexico is considered a developing country, we performed a retrospective analysis of medical records of patients who underwent this type of surgery to evaluate their demographic characteristics as well as their outcomes and complications. Results from 684 patients with MWL, 69 (10%) had abdominoplasty; the type of abdominoplasty influenced the operative time, bleeding, and complications (P < 0.05); the body mass index influenced the weight of resected tissue (P < 0.000) and hospital stay (P < 0.020), but did not affect the type of abdominoplasty performed, surgical time, complications, reoperation, or transfusion rates. In contrast with the developed countries, in these procedures, operating time was higher and the patients had more surgical bleeding with higher rates of transfusion and a longer hospital stay, but with the same clinical results and percentage of complications.     

Secondary Abdominoplasty

BACKGROUND: Abdominoplasty is the most frequent excisional body contour procedure performed in aesthetic surgery. Secondary abdominoplasty refers to a new excisional procedure for a patient who has previously undergone an excisional abdominoplasty. In the authors' practice, more than 7% of abdominoplasties are secondary cases and deserve special consideration. METHODS: The authors present a retrospective analysis of their experience with 21 secondary cases among 298 abdominoplasties performed between 2001 and 2006. They have considered as secondary cases only those involving patients who have undergone excisional abdomen contour surgery previously. RESULTS: A total of 17 patients underwent surgery during the first year after the primary procedure, and 4 patients had surgery more than 5 years after that procedure. Following the principles described in this report, it was possible to solve the problem in each particular case and to obtain improvements in both trunk contour and patient satisfaction. CONCLUSIONS: In planning and designing the procedure, a precise diagnosis of the abdominal deformities is essential. The risks in secondary abdominoplasty are similar to those in the primary procedure.     

Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy

Abstract

It is well known that the risk of complications after abdominal contouring surgery is high. Sparse data in published reports exist, suggesting that complication rates are higher in postbariatric patients compared with patients who have lost weight by dieting. The aim of this study was to analyse the incidence of complications after abdominoplasty in postbariatric patients compared with in patients who have not had weight loss surgery. The aim was also to identify predictive factors associated with the development of postoperative complications. This study retrospectively analysed 190 consecutive patients operated on with abdominoplasty due to abdominal tissue excess from January 2006 to December 2008 at Sahlgrenska University Hospital. Variables analysed were sex, age, max body mass index (BMI), delta BMI (max BMI minus preoperative BMI), preoperative BMI, method of weight reduction, resection weight, and complications. The early complication rates were significantly higher in postbariatric patients (48%) than in patients who had not had weight loss surgery (29%). Resection weight was significantly higher for patients with early local complications compared with patients without early local complications. Max BMI, delta BMI, or preoperative BMI had no influence on the incidence of complications. In conclusion, this study confirms in a fairly large sample that the complication rate after abdominoplasty seems to be higher in postbariatric patients compared with patients who have not had weight loss surgery. However, no predictive factors could be identified explaining these differences. Further studies need to be conducted to identify predictive factors for the occurrence of complications after abdominal contouring surgery.     

Microvascular Transplantation of Adipose Tissue and Serum Level of Adipocyte Products

Microvascular transplantation of subcutaneous adipose tissue is an essential step in reconstructive surgery after breast carcinoma. Serum levels of adipose tissue products may serve as indicators for transplant function. This study aimed to determine serum leptin and tumor necrosis factor (TNF)-alpha plasma levels pre-, intra-, and postoperatively in 20 patients undergoing reconstructive breast surgery and in 7 women undergoing abdominoplasty operation. In the patients undergoing reconstructive breast surgery, the serum leptin levels decreased intraoperatively from 14.5 +/- 13.1 to 9.1 +/- 7.3 ng/ml, a decrease of 63%. An increase in serum leptin levels to 13.5 +/- 12.7 ng/ml (93% of the initial value) was found on postoperative day 1. This was paralleled by similar changes in the plasma levels of TNF-alpha (preoperatively, 20 +/- 7.3 pg/ml; intraoperatively, 17 +/- 11.4 pg/ml; postoperatively, 21 +/- 10.8 pg/ml). In the patients undergoing abdominoplasty, plasma leptin and TNF-alpha levels decreased intraoperatively (20% and 27%, respectively) and postoperatively (44% and 27%, respectively). The results of our pilot study indicate that a postoperative increase in the level of serum leptin after reconstructive breast surgery may be related to successful transplant function.     

The Repair of Incisional Hernia Following Roux-en-Y Gastric Bypass—With or Without Concomitant Abdominoplasty?

Background  Incisional hernia, found in up to 25% of patients, is a typical complication of open bariatric surgery. Methods  Open Roux-en-Y gastric bypass (RYGB) was performed in 204 patients. They have been followed-up for at least 6 months. Thirty-two patients in whom incisional hernia was diagnosed were divided into two groups—they were scheduled for hernia repair or hernia repair with abdominoplasty. The surgery was performed, on average, 20 months after RYGB operation. Fourteen patients [mean body mass 86.4 kg, mean body mass index (BMI) 30.0 kg/m²] have had hernias repaired. The mean duration of hospital stay was 7.2 days. Hernia repair along with abdominoplasty was performed in 18 patients with mean body mass 89.4 kg and BMI 31.5 kg/m². The mean duration of hospital stay was 8.7 days. Results  Both examined groups were similar in body mass, BMI, age, and duration of hospital stay (p > 0.05), as well as gender distribution. The wound infection was diagnosed in six patients. Conclusion  The simultaneous abdominoplasty does not prolong the time of hospital stay of the patients undergoing incisional hernia repair. Infection is the most frequent complication of incisional hernia repair.     

"Classical" abdominoplasty]

The term "classical" abdominoplasty includes those procedures designed and performed before the introduction of liposuction techniques. All of these operations leave a considerable scar: the importance of this residual scar makes abdominoplasty the poor cousin of cosmetic plastic surgery. In practice, it should be generally considered to be a functional comfort surgery, which sometimes resembles cosmetic surgery. All wall lesions must be treated during abdominoplasty: retightening of the musculo-aponeurotic plane when it is distended, correction, of more or less localized fat overload, resection of any excess skin. The desire to obtain scars as small and as hidden as possible has led to the development of a large number of techniques, performed with varying frequencies. However, there has been a renewed interest in some of these techniques since the development of liposuction. The abdominoplasty skin procedures can be divided into two groups: localized abdominoplasties, only concerning a limited part of the abdomen, and extensive abdominoplasties, concern all of the abdominal wall and requiring extensive skin detachment and a procedure on the umbilicus. The most classical method of abdominoplasty is low transverse abdominoplasty with umbilical transposition. This operation raises a number of aesthetic problems and one or several defects are fairly frequently observed during objective analysis of our results. It nevertheless provides a real personal gain for the patient, in the way he or she moves and dresses and can even allow weight loss after the operation. This gain is not related to the results observed on photographs. The introduction of liposuction techniques has radically modified the technical modalities and indications for these so-called "classical" operations.     

Financial Analysis of Factors Impacting Reimbursement for Abdominoplasty

Background  With growth in numbers of abdominoplasty procedures performed, we studied our experience with reimbursement and factors that impacted reimbursement and indirectly access to care. Methods  From July 2004 to June 2007, 245 patients had abdominoplasty. Demographic and financial variables were noted. Twenty different insurance plans were categorized as a single “commercial insurance” group in our analysis, and the other two study groups were “self-pay” and “Medicare” patients. Results  Of the 245 patients studied, 87 paid for surgery (“self pay”), while 134 had commercial insurance, and 24 had Medicare. One hundred sixty patients (65%) had gastric bypass surgery (gbs). Medicare paid 28% less than insurance, and insurance paid 48% less than patients who prepaid. Of the 24 Medicare patients, 16 (67%) resulted in zero payment. On multiple logistic regression analysis, BMI, gbs history, and coincident hernia repair significantly impacted payment. BMI negatively impacted reimbursement, with every unit increase in BMI leading to a 0.77 percentage point reduction in reimbursement. Coincident hernia repair was associated with 17.5 percentage points reduction in reimbursement (p = 0.002). History of gbs improved reimbursement by a factor of 11 (p = 0.01). Neither age, gender, race, nor weight of tissue removed impacted reimbursement. Conclusions  Higher BMI and coincident hernia repair impaired reimbursement for abdominoplasty, while massive weight loss after gbs improved compensation. While having patients pay for their surgery guarantees the best reimbursement, strategies such as assuring authorization prior to surgery, which Medicare will not do, will secure better reimbursement. Presented at the American Association of Plastic Surgery meeting held on April 5–8, 2008 in Boston, Massachusetts     

Lipoabdominoplasty: Liposuction with Reduced Undermining and Traditional Abdominal Skin Flap Resection

Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowmetry color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study confirmed the preservation of perforator arteries in the periumbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermining.     

Heating-pad burn as a complication of abdominoplasty.

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.     

Should a panniculectomy/abdominoplasty after massive weight loss be covered by insurance?

Body contouring after massive weight loss (MWL) is a rapidly growing area in Plastic Surgery. Panniculectomy/abdominoplasty is primarily a cosmetic procedure with some functional benefits (a large pannus may hamper mobility, prevent further weight loss, and cause recurrent skin infections) and hence many insurance companies are changing their guidelines to include this as a medical procedure. This study assesses reimbursements for a large academic institution in Massachusetts for panniculectomies/abdominoplasties performed in MWL patients. We performed a retrospective review of charges and reimbursements for panniculectomy/abdominoplasty in MWL patients performed at Lahey Clinic. Records for patients who underwent a "medical" panniculectomy by a single surgeon from August 2002 to August 2006 were reviewed with special emphasis on the charges, reimbursements, insurance carriers, and prior preauthorizations. Fifty-two patients underwent a medical panniculetomy/abdominoplasty (Current Procedural Terminology code 15831) for laxity of skin/pannus as a result of MWL. All patients except Medicare required and obtained precertification for the procedure. Patient ages ranged from 35 to 59 years, which included 42 females and 10 males (n = 52). Forty-three underwent bariatric surgery; their procedures were performed between 13 and 62 months after their initial surgery. Weight loss ranged from 65 to 345 pounds. Body mass index at the time of the surgery ranged from 22 to 48. The standard surgical charge for a medical panniculectomy at Lahey Clinic is $3,086. The range of reimbursements was zero to the full amount with the mean reimbursement of $615 and the median being $899. Reimbursements for panniculectomies are remarkably low and in many instances (35% in our series) absent despite obtaining prior precertification of medical necessity. Although insurance companies have extended their indications for panniculectomy/abdominoplasty, we think that it is a cosmetic procedure. Plastic surgeons must bear these reimbursements in mind when faced with a patient requesting this.