Elizabeth B. Odom & Terence M. Myckatyn
A 39-year-old woman with two previous pregnancies and a 40-lb weight loss has excess abdominal skin and subcutaneous tissue and multiple striae.


  • Excess skin and subcutaneous tissue of the central abdomen.

  • Laxity of the abdominal wall musculature (consistent with weight loss and pregnancies).

  • Residual localized adiposity of both flanks.



  • Assess patient suitability for the procedure and general anesthesia, as well as risk factors for deep venous thrombosis (DVT) and wound-healing problems.

  • Previous abdominal surgery (including laparoscopic surgery).

  • History of pregnancies and their effect on the abdomen. Possibility of future pregnancies.

  • History of weight changes: Weight should be stable and within 10 lb of final desired weight for ~ 3 months before surgery.

  • Heart disease, peripheral vascular disease, diabetes, steroid use, connective tissue disease.

  • Smoking history: Must stop smoking 6 weeks before surgery.

  • History of DVT or pulmonary emboli (PE).

Physical examination

  • Examine excess skin and soft tissue with the patient in the standing, sitting, and supine positions.

  • Document any hernias, diastasis recti, or asymmetries.

  • Note and document the location and size of all abdominal scars.

    • A thorough understanding of the abdominal blood supply is essential.

Pertinent imaging or diagnostic studies

  • Complete blood cell count (CBC), basic metabolic panel, prothrombin time (PT)/international normalized ratio (INR), activated partial thromboplastin time (aPTT) may be considered.

  • Urine β-human chorionic gonadotropin level to confirm absence of pregnancy.

  • Albumin/prealbumin level to assess nutritional status (especially in patients with weight loss).

  • Urine cotinine level to gauge patient compliance with smoking cessation (if indicated).


  • If an abdominal wall defect or hernia is encountered on examination, a general surgery consultation may be made for intraoperative assistance.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Abdominoplasty
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