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Chinese Medical Journal ¦ August 5, 2018 ¦ Volume 131 ¦ Issue 15 1871
Correspondence
To the Editor: Excessive weight loss usually contributes to apparent
abdominal contour deformity. Abdominoplasty is the optimal
solution for wall laxity, excess skin, and diastasis of the rectus
abdominis.[1] Reverse abdominoplasty, a partial procedure, plays
an irreplaceable role in correcting upper epigastric skin laxity
and is usually performed after prior liposuction or conventional
abdominoplasty.[2] In cases with apparent skin laxity, residual
contour deformity of the upper abdominal wall also remains.
Herein, we report the case of a patient with apparent abdominal wall
skin laxity with a compact umbilical area 1 year after liposuction,
which was treated with combined reverse abdominoplasty and
mini‑abdominoplasty, resulting in a satisfactory esthetic outcome.
A healthy 42‑year‑old Caucasian woman complained of residual
deformity of the upper epigastrium approximately 1 year after
liposuction. She expressed concern regarding abdominal skin laxity
and asymmetry both above and below the umbilicus [Figure 1a].
Accordingly, a precise trunk‑improving procedure was proposed
when she visited our institution. We concluded that the skin within
2 cm around the umbilicus was in favorable adherence to the
underlying fascia, while the rest of the skin was not. Considering
undermining of the inherent blood supply during the prior
liposuction, full abdominoplasty may have led to excessive skin
necrosis in the distal region. Regardless, the upper trunk, which
had the most apparent deformity, was far away from the incision
and may not have resulted in satisfactory improvement. Without
repositioning the umbilicus, reverse abdominoplasty was performed
and mini‑abdominoplasty was conducted as a second‑stage
procedure 6 months later.
An incision was made along the W‑shaped line crossing the
midline, and we discontinuously undermined the skin flap
just above the fascia of the rectus abdominis. With continuous
nonabsorbable, braided, polyester sutures, the aponeurosis of the
rectus abdominis was plicated along the midline from the xiphoid
to the level of the umbilicus. With the released abdominal wall
lifted up to the inframammary fold, the excess region was then
determined [Figure 1b]. Two triangle‑shaped skin aps were
excised and multilayer closure was performed. For the remaining
lower trunk laxity, 6 months later, mini‑abdominoplasty was
performed through an incision above the pubis in the conventional
direction. After mini‑abdominoplasty, the contour of all abdominal
walls was compact and at, showing a satisfactory esthetic outcome.
The patient was content with the result and no complications were
reported during the 1‑year follow‑up [Figure 1c].
Reverse abdominoplasty plays an important role in esthetic
reconstruction of the abdomen. For patients who experience
complications from a prior conventional abdominoplasty or
liposuction, residual deformity of the upper epigastrium often
remains. Reverse abdominoplasty with or without liposuction is a
reliable method for resecting the excess skin ap of the upper trunk.
Reverse abdominoplasty has similar complications as conventional
abdominoplasty. The complications are generally rare, but can be
quite severe.[3] In this case, prior liposuction, which undermined
the inherent vessels of the upper and lower abdomen, left the
important perforating vessels around the umbilicus intact. In
contrast to conventional full abdominoplasty, partial procedures are
able to avoid the abundant periumbilical veins.[4] In utilizing two
partial abdominal operations, we were able to complete minimal
undermining, ensuring stable perfusion from the perforating
vessels of the deep inferior epigastric system and intercostal veins
in order to avoid skin ap necrosis. For the combined procedures,
the ideal patient is the one who has an apparent contour deformity
both in the upper and lower abdomen, with the area around the
umbilicus being compact, which is often reported after a previous
unsatisfactory liposuction.
Many patients are daunted by reverse abdominoplasty due to an
apparent scar. This procedure can begin with either a W‑shaped
curvilinear incision crossing the midline of the epigastrium or
with two separate crescentic incisions along the inframammary
line. Compared with the W‑shaped incision, the separate incisions
sacrice correction of the skin laxity of the midline in order to
avoid an apparent scar.[4] In this case, the patient accepted the
W‑shaped curvilinear incision across the midline with consideration
of her apparent contour deformity of the upper epigastrium. In our
Correction of Contour Deformity Using Reverse
Abdominoplasty Combined with Mini‑Abdominoplasty
Xiao Yang, Guan‑Huier Wang, Jing Wang, Hong‑Bin Xie
Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China
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DOI:
10.4103/0366‑6999.237402
Address for correspondence: Dr. Hong‑Bin Xie,
Department of Plastic Surgery, Peking University Third Hospital,
No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China
E‑Mail: cs4811@aliyun.com
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© 2018 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
Received: 31‑03‑2018 Edited by: Ning‑Ning Wang
How to cite this article: Yang X, Wang GH, Wang J, Xie HB. Correction
of Contour Deformity Using Reverse Abdominoplasty Combined with
Mini‑Abdominoplasty. Chin Med J 2018;131:1871‑2.
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Chinese Medical Journal ¦ August 5, 2018 ¦ Volume 131 ¦ Issue 15
1872
previous experience, the scar is not as noticeable in Caucasian
individuals, which may neutralize the defect of the intact incision.
In the present case, the surgical outcomes proved to be dramatic
and favorable, and to date, the original deformity has not recurred.
Frequently, upper torso laxity coincides with mammary ptosis to
a certain extent. In these circumstances, reverse abdominoplasty
is combined with mastopexy or reduction/augmentation
mammaplasty, which can be conducted in a single stage using the
same incision.[5] In general, because the breasts expand and become
oversized after massive weight loss, patients prefer reduction
mammaplasty to modify the breast deformity. Hurvitz et al. rst
suggested simultaneous reverse abdominoplasty and mammary
augmentation and investigated the possibility of utilizing silicone
and a spiral ap in the mammary augmentation surgery. Utilizing
the waste skin ap to correct the breast deformity, the spiral ap
resulted in an excellent esthetic outcome and was deemed a more
reasonable alternative. In the present case, the breasts remained
in an approximately normal projection; therefore, mastopexy or
reduction/augmentation mammaplasty was not indicated.
This case had limitations. Although the surgery achieved
satisfactory postoperative outcomes, the case lacked pre‑ and
postoperative weight and abdominal girth measurements, limiting
the objective measurements that could verify the esthetic effect.
Furthermore, this was a single case whose results should be taken
with caution. A future study involving more patients may help
validate this procedure.
In conclusion, to our knowledge, this is the rst report of combined
reverse abdominoplasty and mini‑abdominoplasty for the treatment
of a characteristic deformity. In contrast to conventional full
abdominoplasty, the combined partial procedures guaranteed that
the blood supply avoided necrosis of the skin ap. In this way,
the procedure can minimize repeat undermining of the abdomen,
particularly the blood supply, and ultimately result in a long‑term
satisfactory outcome.
Declaration of patient consent
The manuscript was approved by the Ethics Committee of Peking
University Third Hospital. The authors certify that they have
obtained all appropriate patient consent forms. In the form, the
patient has given her consent for her images and other clinical
information to be reported in the article. The patient understands
that her name and initials will not be published and due efforts
will be made to conceal the identity of the patient, but anonymity
cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
RefeRences
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2. Halbesma GJ, van der Lei B. The reverse abdominoplasty:
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SAP.0b013e31815f6fb9.
3. Winocour J, Gupta V, Ramirez R, Shack RB, Grotting JC, Higdon K.
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10.1097/PRS.0000000000001700.
4. Pacico MD, Mahendru S, Teixeira RP, Southwick G, Ritz M.
Rening trunk contouring with reverse abdominoplasty. Aesthet Surg
J 2010;30:225‑34. doi: 10.1177/1090820x10369690.
5. Zienowicz RJ, Karacaoglu E. Augmentation mammaplasty by reverse
abdominoplasty (AMBRA). Plast Reconstr Surg 2009;124:1662‑72.
doi: 10.1097/PRS.0b013e3181babd02.
Figure 1: Surgical course of the patient. (a) Preoperative contour
deformity of both the upper and lower abdomen, with a tight and
flat umbilical area. (b) W‑shaped curvilinear incision during reverse
bdominoplasty. (c) Postoperative outcome showing a symmetric and
smooth abdominal contour.
c
b
a
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