Abdominoplasty Combined with Cesarean Delivery: Evaluation of the Practice

Abstract

Abdominoplasty is an aesthetic surgical procedure that restores abdominal contouring. Repeated pregnancy usually leads to lower abdominal skin redundancy and excess fat accumulation. Delivery via Cesarean section adds weakness to the lower abdominal wall muscles and yields a lower transverse Cesarean scar. Recently and in some cultures, abdominoplasty is requested at the same time of Cesarean delivery. Those women usually want to get the benefit of undergoing the abdominoplasty combined with Cesarean delivery in the same setting, thus avoiding a future surgery. This study was designed to evaluate the aesthetic outcome of combined abdominoplasty with Cesarean delivery. The study included 50 pregnant women from February 2008 to December 2009 with an average follow up period of 6 months. Nine patients (18%) developed wound infection; three of them (9%) developed wound dehiscence. Six patients (12%) developed lower abdominal skin necrosis; three of them (6%) were treated conservatively and healed by secondary intention, while surgical debridement and secondary sutures were needed in the other three patients (6%). Residual abdominal skin redundancy in 9 patients (18%), outward bulging of the abdomen and lack of waist definition in 16 patients (32%), and outward bulging of the umbilicus in 12 patients (24%) were the reported unaesthetic results. The results were compared with results of 80 abdominoplasties in nonpregnant women. The study concluded that abdominoplasty combined with Cesarean delivery carries a higher incidence of complications and does not give the desired aesthetic outcome. The authors do not recommend this practice.

Combined Breast Surgery and Abdominoplasty

“…It has proven feasible to combine breast surgery with abdominoplasty provided that operating room time is minimized and appropriate logistical precautions are taken. This conclusion is consistent with the vast majority of literature on the topic of combining abdominoplasty with additional procedures (Table 1), 2,[6][7][8][12][13][14][19][20][21][22][23]65,72 including recent American Association for Accreditation of Ambulatory Surgery Facilities data 34 demonstrating that abdominoplasty plus one additional procedure is performed slightly more frequently than abdominoplasty alone (187,847 versus 176,092 cases, respectively), but abdominoplasty plus one, two, or three procedures is performed over 1.5 times more frequently than abdominoplasty alone (286,742 versus 176,092 cases, respectively). Critical elements in avoiding pitfalls include careful patient selection, meticulous but efficient operative planning and technique, a well-thought-out operative sequence accounting for necessary changes in patient position, close attention to fluid management, and a well-thought-out postoperative care plan that includes early ambulation.…”

“…In Ali's series, for example, combining abdominoplasty with cesarean section led to higher complication rates and inferior aesthetic results secondary to distorted local anatomy and compromised healing because of contamination. 8 Fortunately, local problems that may arise during adjacent combined procedures, such as wound contamination and excess tension, are fairly straightforward to conceptualize and therefore avoid. Coon et al report that in the massive weight loss population, performing multiple procedures in the same operative setting increases the total number of complications for a given number of trips to the operating room, but the absolute number of complications is no greater than would be expected if all procedures had been performed individually.…”

Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

“…Some groups believe that the combined procedure results in increased complications, particularly in an increased incidence of pulmonary embolus [2][3][4]. One study discouraged ABP combined with cesarean delivery due to increased complications and unsatisfactory aesthetic outcomes [17]. More recently, most groups believe that a combined ABP-HYS is safe and does not have any increase in complication rates when compared to ABP and HYS on separate dates [1,[6][7][8][9][10].…”

Hysterectomy with Concurrent Panniculectomy

“…Moreover, in their study, wound dehiscence trended toward higher frequency in the combined procedure group. 30 Over the past 20 years, widespread adoption of prophylactic measures has contributed to the improved safety of combined procedures. 1 On morbidly obese patients, the pannus will remain an obstacle during gynecologic surgery, which requires additional instrumentation or personnel to help retract it, to obtain proper exposure.…”