Alberto Di Giuseppe and Melvin A. Shiffman (eds.)Aesthetic Plastic Surgery of the Abdomen10.1007/978-3-319-20004-0_16

16. Abdominoplasty Combined with Cesarean Section: Discussion of the Evidence

Teri E. Benn¹ and Carlos E. Spera²

(1)

Department of Obstetrics and Gynecology, Femcare OB-GYN c/o Teri Benn, 7800 SW 87th Ave., Suite A-120, Miami, FL 33173, USA

(2)

Department of Surgery, Nova Southeastern University, Fort Lauderdale, FL 33314, USA

Teri E. Benn (Corresponding author)

Email: teribennmd@gmail.com

Carlos E. Spera

Email: carspera@bellsouth.net

Reprinted with permission, Am J Cosm Surg. 2014;31(4):260–3.

16.1 Introduction

In clinical practice, many women request abdominoplasty at the time of cesarean section in order to remove excess skin and stretch marks that develop during pregnancy. In addition, many obstetrician gynecologists are learning to do cosmetic procedures, such as abdominoplasty.

As the most common surgical procedure, cesarean section is delivery of a fetus through a hysterotomy and accounts for more than one million major operations in the United States annually [1, 2]. It can be either a primary or repeat cesarean section. The most common indications for cesarean section are fetal distress, labor dystocia, malpresentation, and multiple gestation [3, 4]. Three percent of cesarean sections are done for maternal request [5]. Unless an emergency situation, cesarean delivery is done under spinal or epidural anesthesia [3, 4].

Abdominoplasty is a cosmetic procedure designed to undermine and remove excess abdominal skin and fat and tighten the abdominal musculature. With a full abdominoplasty, the anterior rectus fascia is plicated from the pubic symphysis to the xiphoid to correct the rectus muscle diastasis and resolve abdominal wall laxity resulting in a flat and toned appearance [6, 7].

According to the American Society of Plastic Surgery, in 2012 in the United States and Canada, there were 106,628 abdominoplasties performed, making it the sixth most common cosmetic procedure [8]. Frequently, abdominoplasty is done after women complete childbearing [7]. Most surgeons recommend that women wait until after they are done having children before having abdominoplasty, and some even suggest that weight should be stable for at least 3 months preoperatively for optimal results [7].

With the popularity of both of these procedures, the question was raised as to the possible complications of combining the procedures of cesarean section with abdominoplasty. Combining abdominoplasty with gynecologic procedures seems to have an acceptable safety profile which could translate to combination with cesarean section [6, 9–13]. Therefore, a review of the literature was performed to assess the safety and aesthetic results of combining abdominoplasty and cesarean section.

16.2 Research

A literature search was done using PubMed, EBSCO, and the Cochrane database. The search was not restricted by time period, but was limited to English language publications. The search was done with combinations of keywords “abdominoplasty,” “cesarean section,” “tummy tuck,” “c section,” “liposuction,” “aesthetic surgery,” “lipoabdominoplasty,” “gynecology,” “gynecologic surgery,” “lipectomy,” “dermolipectomy,” “panniculectomy,” and “abdominal wall reconstruction.” The literature search was done by one researcher.

16.2.1 Results

There was one clinical trial done comparing patients who had abdominoplasty cesarean section with patients who had abdominoplasty alone to investigate the safety and efficacy of combining the procedures [14]. When this study was performed, in 2011, the authors stated that in their search of the literature, there were no published articles about this topic [14]. Similarly, there were no other articles, reviews, or case reports found investigating this specific topic during this literature review.

In a study in 2011 by Ali and Essam [14], 50 pregnant women from 2008 to 2009 had abdominoplasty and limited liposuction combined with cesarean section in Kuwait. These cases were compared to 80 cases of abdominoplasty alone during the same time period. During the follow-up 6 months, there were significantly more wound infections, wound dehiscences, and cases of distal skin necrosis in the combined procedure group than in abdominoplasty alone group. In terms of aesthetics, the researchers noted that marking the pregnant abdomen was more difficult than the nonpregnant abdomen. The most common unaesthetically pleasing results in the combined procedure group were as follows: 32 % of patients reported bulging of the abdomen, 24 % reported a bulging umbilicus, and 12 % reported recurrent abdominal skin redundancy. This was significantly more common in the combined group than in the abdominoplasty alone group at 9 %, 5 %, and 4 %, respectively (p < 0.05). Only 48 % of women were satisfied with the overall results after combining abdominoplasty with cesarean section. They did not indicate in this study the type of anesthesia that was used or the circumstances of the cesarean section.

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