Lipoabdominoplasty: An exponential advantage for a consistently safe and aesthetic outcome

Abstract

Background: Extensive liposuction along with limited dissection of abdominal flaps is slowly emerging as a well proven advantageous method over standard abdominoplasty.

Materials and methods: A retrospective study analyzed 146 patients managed for the abdominal contour deformities from March 2004 to February 2010. A simple method to project the post operative outcome by rotation of a supine lateral photograph to upright posture in 46 patients prospectively has succeeded in projecting a predictable result. All patients were encouraged to practice chest physiotherapy in 'tummy tuck' position during the preoperative counseling. Aggressive liposuction of entire upper abdomen, a limited dissection in the midline, plication of diastasis of rectus whenever indicated, panniculectomy and neoumblicoplasty were done in all patients.

Results: The patients had a mean age of 43, youngest being 29 and oldest 72 years. Majority were of normal weight (94%). Twelve were morbidly obese; 57 patients had undergone previous abdominal surgeries; 49 patients had associated hernias. Lipoabdominoplasty yielded a satisfactory result in 110 (94%) patients. The postoperative patient had a definitely less heavy harmonious abdomen with improved waistline. The complications were more with higher BMI, fat thickness of more than 7 cm and prolonged operating time when other procedures were combined.

Conclusions: Extensive liposuction combined with limited dissection method applied to all abdominoplasty patients yielded consistently safe, reliable and predictable aesthetic results with less complications and faster recovery. The simple photographic manipulation has helped project the postoperative outcome reliably. The preoperative chest physiotherapy in tummytuck position helped prevent chest complications.

Keywords: Lipoabdominoplasty; limited dissection; liposuction; neoumblicoplasty; sliding flap.

Figure 1

(a,b,c,d) The pre and post operative result 8 months after Lipoabdominoplasty in a scarred abdomen with skin laxity,and musculoaponeurotic weakness

Figure 2

(a) Photographic manipulation-pre op profile (b) Pre-op photographic manipulation :patient supine profile (c) Pre-op photographic manipulation: Rotated upright (d) Pre-op photographic manipulation and comparison to post –op result in a flat abdomen.

Figure 3

Pre-op photographic manipulation and comparison to post-op result in a protuberant abdomen

Figure 4

Pre-op chest physiotherapy counseling in ‘tummy tuck ‘ position

Figure 5

Pre-op marking in standing position-back for circumferential lipectomy

Figure 6

Schematic picture showing areas of tumescent infiltration and liposuction

Figure 7

(a) Areas of dissection (b) limited midline dissection

Figure 8

(a) A port site in right iliac fossa with incisional hernia And huge pendulous abdomen (b) hernia- mesh repaired and full lipoabdominoplasty (c) two years after surgery

Figure 9

Umbilical stalk telescoped to the anterior rectus sheath

Figure 10

Diastasis repair by continuous criss cross suturing from Xiphisternum to pubis

Figure 11

Neoumblicoplasty:disc of skin and cone of fat excision

Figure 12

(a) When umbilicus was excised,the elliptical skin window was anchored to the rectus sheath.The inflamed areas were sterile fat necrosis (b) six months later,complete resolution and well formed umblicus

Figure 13

An enhanced waistline and aesthetic umbilicus,after Lipoabdominoplasty of a featureless abdomen

Figure 14

An unsatisfied patient with pot belly appearance

Figure 15

Open liposuction for reduction of fat thickness

Figure 16

Gross diastasis with protrusion of intraabdominal Volume.Repair of diastasis corrected this protrusion