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Correction of Contour Deformity Using Reverse Abdominoplasty Combined with Mini-Abdominoplasty

Chinese Medical Journal ¦ August 5, 2018 ¦ Volume 131 ¦ Issue 15 1871
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
sacrice 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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Address for correspondence: Dr. Hong‑Bin Xie,
Department of Plastic Surgery, Peking University Third Hospital,
No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China
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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
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
Conflicts of interest
There are no conicts of interest.
1. Hurvitz KA, Olaya WA, Nguyen A, Wells JH. Evidence‑based
medicine: Abdominoplasty. Plast Reconstr Surg 2014;133:1214‑21.
doi: 10.1097/PRS.0000000000000088.
2. Halbesma GJ, van der Lei B. The reverse abdominoplasty:
A report of seven cases and a review of English‑language
literature. Ann Plast Surg 2008;61:133‑7. doi: 10.1097/
3. Winocour J, Gupta V, Ramirez R, Shack RB, Grotting JC, Higdon K.
Abdominoplasty: Risk factors, complication rates and safety of
combined procedures. Plast Reconstr Surg 2015;136:99‑100. doi:
4. Pacico MD, Mahendru S, Teixeira RP, Southwick G, Ritz M.
Rening 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.
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Full-text available
To date, the reverse abdominoplasty has been reported infrequently as a procedure to improve the upper abdominal wall contour. In this report, we report on our experience with the reverse abdominoplasty and on a review of the English-language literature by using PubMed to draw conclusions regarding optimal indication for this procedure, results, and complications. Over a 3-year period, we have performed the reverse abdominoplasty in 7 patients that were all dissatisfied with their upper abdominal contour after previous abdominal wall contouring procedures. Five patients had preexisting submammary scars. The mean follow-up was 20 months (range 9-29 months). In all but one patient there was a significant improvement of the upper abdominal wall contour. The esthetic result as measured with the Strasser grading system was good in 4 cases, mediocre in 2 cases, and poor in 1 case. The mean patient's satisfaction was 6.3 (range 1-10) as measured on a Visual Analog Scale. In 3 patients there were complications: in 2 patients a minor complication (wound dehiscence and a small seroma) and in 1 patient a more severe complication (wound dehiscence with ultimately sagging of scars and submammary sulcus) with a poor esthetic final result. In the English-language literature the reverse abdominoplasty procedure has been reported infrequently both for purely esthetic reasons and for reconstructive reasons with good results and few complications. Based upon our results and those as reported in the English-language literature, we conclude that there is a clear though limited indication for the reverse abdominoplasty procedure in a selected group of patients: redundant upper abdominal wall tissue after a previous abdominoplasty or liposuction, preferably with preexistent submammary scars.
After studying this article, the participant should be able to: 1. Develop a surgical plan for improving the contour of the abdominal region by means of abdominoplasty surgery. 2. Describe the current modalities for preventing and managing perioperative pain associated with abdominoplasty surgery. 3. Discuss proper techniques for safely performing simultaneous abdominal wall liposuction and abdominoplasty surgery. 4. Determine the means of decreasing seroma formation and drain duration in abdominoplasty patients. 5. Apply current concepts in preventing and minimizing perioperative complications in abdominoplasty patients. Abdominoplasty continues to be one of the most popular cosmetic surgeries performed by plastic surgeons throughout the world. Advancements in the area continue to surface which can help improve outcomes. We present an extensive review of the most current literature on this topic. This article offers readers an up-to-date and organized approach to abdominoplasty surgery.
The reverse abdominoplasty is an effective technique for selected patients seeking treatment for upper abdominal tissue excess and laxity. Specifically, the procedure is particularly effective in patients who have previously undergone conventional abdominoplasty or liposuction and have residual upper abdominal contour problems. It is a versatile technique that may be combined with a number of adjunctive procedures, notably autologous breast augmentation with the excess upper abdominal tissue. The authors reviewed their experience with the reverse abdominoplasty in a series of 14 consecutive patients who underwent surgery over a five-year period. Patient case notes, as well as and pre- and postoperative clinical photographs, were analyzed. Furthermore, patients were directly questioned to assess their surgical result. The mean age of the cohort was 56.6 years and the majority of patients had undergone previous abdominal or breast aesthetic surgery. A mean of 6 cm of upper abdominal tissue was excised, weighing a mean of 326 g. There were no major complications and only three patients had to undergo minor revisional surgery postoperatively. The authors present their surgical outcomes and discuss the indications, benefits, and lessons they have learned from their experience with this useful technique in relation to the published literature. The ideal candidate for this procedure appears to be a patient who is older, presents with excess upper abdominal skin, has had a previous conventional abdominoplasty, and who has existing inframammary scars.
The purpose of this article is to describe a novel technique of providing autologous tissues for breast augmentation and simultaneously rejuvenating the abdomen. Thirty-seven patients underwent augmentation mammaplasty by reverse abdominoplasty (AMBRA) between 1997 and 2006. The upper abdominal pannus present in women whose lower abdomen was typically less aesthetically compromised was harvested as deepithelialized adipofascial flaps, maintaining their connection to and thus blood supply from the attached breast parenchyma. These flaps are transposed subglandularly, creating autologous tissue breast implants, and reverse abdominoplasty accomplishes donor-site closure and aesthetic improvement. If previous surgery or inadequate inframammary fold tissue thickness renders the superior circulation unfavorable, the upper abdominal tissues can be used as advancement flaps vascularly supplied by their attachment to the abdominal skin apron. Twenty-three patients (62 percent) had simultaneous mastopexy and 16 (43 percent) had simultaneous panniculectomy. Complications in the superior pedicle group were minimal. In the inferior pedicle group, complications were more extensive because of the premorbidity of this group of patients and the limitations of this technique, where the resuspension of the abdominal wall apron is less facile and generally weaker than closure with superiorly based flaps. Augmentation mammaplasty by reverse abdominoplasty is a versatile procedure that in the carefully selected patient can successfully address two aesthetic concerns simultaneously, providing durable autologous tissue that can obviate or enhance the outcome provided by prosthetic implants and rejuvenating the abdomen. It also shows promise as a significant adjunct to the techniques available to the breast reconstructive surgeon.
The reverse abdominoplasty: A report of seven cases and a review of English-language literature
  • Halbesma
Halbesma GJ, van der Lei B. The reverse abdominoplasty: A report of seven cases and a review of English-language literature. Ann Plast Surg 2008;61:133-7. doi: 10.1097/ SAP.0b013e31815f6fb9.
Abdominoplasty: Risk factors, complication rates and safety of combined procedures
  • Winocour