Optimizing Body Contour in Massive Weight Loss Patients: The Modified Vertical Abdominoplasty

Abstract

In morbid obesity, contour deformities of the abdomen are common after bariatric surgery and radical weight loss. Traditional abdominoplasty techniques often fail to maximally improve body contour in these cases because adjacent sites such as the hip rolls and flanks are not treated, leaving the patient with large lateral tissue redundancies and dog-ears. In an attempt to solve these challenging problems, the authors present the modified vertical abdominoplasty technique, a single-stage procedure that involves a combined vertical and transverse approach in which an "en bloc" resection of the redundant tissues is performed without undermining, drainage, or reinforcement of the abdominal wall. The latter is only carried out when diastasis and/or hernias are present, and Marlex mesh may be utilized when indicated. In patients with simultaneous large umbilical hernias and/or excessively long stalks, neoumbilicoplasty is recommended. A significant improvement of abdominal contour was obtained in the vast majority of patients because the resection design offers simultaneous treatment of both vertical and transverse tissue redundancies in the abdomen and neighboring regions, with more harmonic results when compared with purely vertical or transverse approaches. The modified vertical abdominoplasty technique is an easy, fast, and reliable alternative for treating these patients, with less intraoperative bleeding, reduced overall cost, and low morbidity rates. In selected cases, the technique is capable of offering excellent results in terms of contouring and maximizes the overall outcome of treatment protocols for these patients, who can then be integrated into normal life with heightened self-esteem, happiness, and productivity.

Classifying Severity of Abdominal Contour Deformities after Weight Loss to Aid in Patient Counseling

“…7 To correct these deformities, modified abdominoplasty procedures have been devised, including the fleur-de-lis operation and circumferential lower body lifts. 8,9,10,11,12 These more complex abdominal operations are usually cosmetic in nature.…”

Abdominoplasty in the Massive Weight Loss Patient: Are Aesthetic Goals and Safety Mutually Exclusive?

“…However, select MWL candidates (lower BMI, nonsmoking, nondiabetic, and dietary MWL) can probably be approached with a mindset to optimize aesthetics, as in this study the prioritization of aesthetic goals in these patients did not increase the risk of major complications as compared with postpartum controls. This mindset might include attention to aesthetic details as previously delineated as well as careful reconsideration as to whether concessions to safety such as sacrifice of the umbilicus 63 , 66 or unnatural skin patterns such as the W-plasty 61 , 67-69 are actually necessary. In the author’s opinion, the common “fleur-de-lis” pattern may sometimes, perhaps often, be avoided as well.…”

Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial

“…Patients in the study and control groups undergo a mixed-type abdominoplasty, also known as anchor-line abdominoplasty, based on a previously published procedure [ 42 ], under general anaesthesia, coordinated by the same surgeon for all the operations.…”