Lipoabdominoplasty: What We Have Implemented and What We Have Modified over 26 Years

Abstract

Lipoabdominoplasty is one of the most commonly performed procedures in body-contouring surgery. We present a retrospective study of our 26 years of experience to improve the results and assure the greatest possible safety in lipoabdominoplasty. We include all of our female patients who underwent lipoabdominoplasty performed from July 1996 to June 2022, dividing the patients into two groups: group I underwent circumferential liposuction avoiding abdominal flap liposuction for the first 7 years, and group II underwent circumferential liposuction including abdominal flap liposuction for the subsequent 19 years, pointing out the differences in the processes, results, and complications of both groups. Over a period of 26 years, 973 female patients underwent lipoabdominoplasty: 310 in group I and 663 in group II. Ages were very similar; however, weight, BMI, amount of liposuction material, and weight of the abdominal flap removed were higher in group I. Twenty percent of patients in group I were obese compared to 7% in group II. The average amount of liposuction in group I was 4990 mL compared to 3373 mL in group II and 1120 g of abdominal flap in group I versus 676 g in group II. Minor and major complications were 11.6% and 1.2% in group I versus 9.2% and 0.6% in group II, respectively. In our more than 26 years of performing lipoabdominoplasty, we have maintained most of our initial procedures. These processes have allowed us to perform surgery safely and effectively with a low morbidity rate.

Fig. 1.

In 1996, we began to perform circumferential liposuction with abdominoplasty, avoiding liposuction on the abdominal flap. The areas where liposuction was performed are indicated in red. In the posterior region, liposuction was performed on the upper and lower back, lumbar region, and flanks (A). In the abdominal area, liposuction was completed on the flanks and was performed on the lateral abdominal area, lateral to the midclavicular line. In the central abdominal portion, indicated in green, liposuction was avoided and detachment was limited to a central tunnel, just enough to plicate the rectus abdominis muscles (B). The area of the abdominal flap to be resected is indicated in purple.

Fig. 2.

In 2003, we began to perform liposuction of the central portion of the abdomen, corresponding to the abdominal flap, indicated in orange. This liposuction must leave the flap a little thicker than the rest of the liposuction area, so that together with the plication of the flap to the fascia, the rectus abdominis muscles are simulated. The detachment of the abdominal flap is kept limited in its central portion to preserve the vascularity of the flap.

Fig. 3.

Patient 1. A 32-year-old female patient, operated on 30 years ago. Significant lipodystrophy of the abdominal and waist area.

Fig. 4.

Patient 1. Six months after surgery. In 1991, when this patient underwent surgery, we did not perform circumferential liposuction in conjunction with abdominoplasty. The improvement of the abdominal area is important, but there is no improvement in the waist contour. The incision was high to be hidden in the bathing suits that were used 30 years ago. Significant improvement of the abdominal profile is observed, but without any improvement of the waist contour or in the lumbar region.

Fig. 5.

Patient 1. Lateral view of the patient showing significant lipodystrophy and abdominal flaccidity.

Fig. 6.

Patient 1. Postoperative with significant improvement in abdominal flaccidity but with lipodystrophy in the upper part of the abdomen and no improvement in the lumbar region.

Fig. 7.

Patient 2. A 29-year-old patient, significantly overweight, with marked abdominal flaccidity and significant lipodystrophy in the entire thoracoabdominal area.

Fig. 8.

Patient 2. One-year postoperative. In this patient, abdominoplasty with circumferential liposuction was performed on the entire thoracoabdominal area, except for the abdominal flap. An improvement of the entire lumbar region and the back can be observed, but due to the absence of liposuction in the abdominal flap, it still remains with marked lipodystrophy. The scar is lower, following fashion patterns.

Fig. 9.

Patient 2. Marked lipodystrophy in the lumbar, lateral, waist, and back regions. No adequate contour in the gluteal region.

Fig. 10.

Patient 2. Circumferential liposuction achieves a significant improvement of the thoracoabdominal contour, even improving flaccidity in this area. Improvement is observed in the gluteal contour due to the elimination of fat in the lumbar region.

Fig. 11.

Patient 3. A 38-year-old female patient with moderate abdominal flaccidity and lipodystrophy in the abdomen and waist area.

Fig. 12.

Patient 3. Eight months after surgery. Significant improvement of the contour in the waist area due to the liposuction performed in the abdominal flap. Performing liposuction of the abdominal area and leaving the central flap a little thicker, and attaching the flap to the abdominal fascia with adhesion stitches, allows the rectus muscles to be simulated and the midline to be marked.

Fig. 13.

Patient 3. Significant presurgical abdominal flaccidity and severe lipodystrophy of the waist area.

Fig. 14.

Patient 3. Low scar according to the current swimsuit. Significant improvement in abdominal flaccidity and thoracoabdominal contour, especially in the waist area. Simulation of the rectus abdominis muscles and the abdominal midline can be seen.

Fig. 15.

Patient 4. A 35-year-old female patient with moderate thoracoabdominal lipodystrophy and abdominal flaccidity.

Fig. 16.

Patient 4. Six months after surgery having performed abdominoplasty, thoracoabdominal circumferential liposuction, and fat infiltration in the buttocks and hips. The improvement of the abdominal area, waist, and hip contour is appreciated. As well as the simulation of the abdominal muscles.

Fig. 17.

Patient 4. Significant flaccidity and abdominal lipodystrophy can be seen in the lateral view.

Fig. 18.

Patient 4. Performing abdominal flap liposuction allows us to leave a completely flat abdomen despite having significant flaccidity and lipodystrophy in the abdominal region. Also improving the gluteal contour thanks to gluteal lipoinjection and lumbar liposuction.

Fig. 19.

Patient 4. In the posterior view, there is a lack of contour in the waist area and a lack of projection in the hip area.

Fig. 20.

Patient 4. The improvement of the waist contour is observed thanks to liposuction, and a significant improvement in the hip area due to lipoinjection.