In the last decade, body contour surgery has advanced substantially. Abdominoplasty is the most frequent procedure in body contour aesthetic surgery. The surgeon who performs body rejuvenation procedures needs knowledge of anatomic, technical, and artistic concepts to assess and resolve the full spectrum of trunk deformities. The anatomical variations in abdomen types and the diversity of deformities make necessary a clear understanding so the surgeon can arrive at an accurate diagnosis and apply advanced techniques.
In the last decade, body contour surgery has advanced substantially. Abdominoplasty is the most frequent procedure in body contour aesthetic surgery, and a high percentage of patients are women who have had one or more pregnancies. Deformities in the trunk due to overweight are also very common, as are the after-effects of weight loss. The surgeon who performs body rejuvenation procedures needs knowledge of anatomic, technical, and artistic concepts to assess and resolve the full spectrum of trunk deformities. The anatomical variations in abdomen types and the diversity of deformities make necessary a clear understanding so the surgeon can arrive at an accurate diagnosis and apply advanced techniques.
In daily practice it has become increasingly more frequent to see patients who have undergone abdominoplasty to treat abdominal flaccidity. Traditional techniques that consist of removing a skin ellipse between the pubis and umbilicus may lead to some drawbacks and sometimes require revision surgery. The author and colleagues find that many of these problems arise from over-resection centrally based on the surgeon’s desire to eliminate the umbilical defect in the abdominal flap. These drawbacks include a high horizontal scar that maybe distorted, sometimes in a W fashion, giving a bizarre appearance to the pubis. Also the distance between the horizontal scar, which defines the new superior limit of the pubis, and the umbilicus may be too short (ie, <10 cm). By contrast, the distance between vulvar commissure and pubic scar may be too long (ie, more than 8 cm). The excessive tension can lead to hypertrophy of scars. Other frequently seen problems include lateral flaccidity and dog ears, because the lateral scar ends abruptly instead of continuing farther laterally. Sometimes fat accumulations remain in various areas of the lower trunk, while in other patients, incomplete diastasis repair at the original procedure can lead to epigastric or generalized bulging.
Classification of anatomic abdomen types
The author and colleagues have proposed a classification of three anatomical types of abdomen based on measurement of the anatomical position of the umbilicus from the superior limit of the pubis, based on measurements made by the author in 368 abdominoplasties performed between 1998 to 2008. This system is useful for planning and predicting postoperative results. It is an aesthetic priority to guarantee the ideal umbilicus position in abdominoplasty, so conservative skin resection must be done to avoid the consequences of excessive skin resection.
The three types of abdomen described in the author’s system, which are outlined below, depend on preoperative measurement of the distance between the superior limit of the pubis and the umbilicus, or the distance, on the hairless pubis, between the vulvar commissure and the umbilicus:
Type 1. Abdomen with low-positioned umbilicus. The distance established in this group is 12 to 14 cm between pubis and umbilicus or 19 to 21 cm from vulvar commissure to umbilicus.
Type 2. Abdomen with intermediate umbilicus. The distance established in this group is 15 to 16 cm from pubis to umbilicus or 22 to 23 cm from vulvar commissure to umbilicus.
Type 3. Abdomen with high umbilicus. The distance established in this group is 17 cm or more from pubis to umbilicus or 24 cm or more from vulvar commissure to umbilicus.
In our preoperative findings, the proportion of patients in each group was 56% for group 1, 31% for group 2, and 13% for group 3.
Based on these observations, in the surgical planning one can predict, depending on the existing flaccidity, whether the skin resection will cause a vertical midline scar resulting from umbilical transposition. In the author’s experience, more than 50% of primary abdominoplasties needed a vertical scar to maintain the natural distance of umbilicus, which is 11 to 14 cm from the superior limit of the pubis, which is determined by the abdominoplasty scar or 18 to 21 cm from the vulvar commissure, in the hairless pubis. These patients, who belong to groups 2 and 3, with intermediate and high umbilicus, respectively, as well as 85% of the author’s secondaries, required a vertical scar.
The treatment of these problems
In secondary abdominoplasty, the author and colleagues try to reverse all of the sequelae discussed in the previous section. Patients are not happy when aesthetic goals are not obtained after the primary procedure. After surgery, the abdomen must be harmonious, attractive, and natural even when nude. As is the case in other surgeries, abdominoplasty leaves a scar. But a well-positioned scar is well tolerated if there is no deformity.
The basic principles in secondary abdominoplasty are the same as in primary abdominoplasty. If one does not target primarily the diagnosis of the deformity and there is not an adequate result, a secondary problem arises.
As mentioned previously, in most secondary cases, the author and colleagues find a low umbilicus (<10 cm). One needs to measure the distance in each case and evaluate the skin excess to predict the skin resection. The author and colleagues apply the concept of anatomical abdominal types based on measurement of the distance of the vulvar commissure to the umbilicus or the superior limit of pubis (determined by the scar) to umbilicus, as described earlier in this article.
The treatment of these problems
In secondary abdominoplasty, the author and colleagues try to reverse all of the sequelae discussed in the previous section. Patients are not happy when aesthetic goals are not obtained after the primary procedure. After surgery, the abdomen must be harmonious, attractive, and natural even when nude. As is the case in other surgeries, abdominoplasty leaves a scar. But a well-positioned scar is well tolerated if there is no deformity.
The basic principles in secondary abdominoplasty are the same as in primary abdominoplasty. If one does not target primarily the diagnosis of the deformity and there is not an adequate result, a secondary problem arises.
As mentioned previously, in most secondary cases, the author and colleagues find a low umbilicus (<10 cm). One needs to measure the distance in each case and evaluate the skin excess to predict the skin resection. The author and colleagues apply the concept of anatomical abdominal types based on measurement of the distance of the vulvar commissure to the umbilicus or the superior limit of pubis (determined by the scar) to umbilicus, as described earlier in this article.
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Editorial Comment on “ SAFECircumferential Liposuction with Abdominoplasty”
No-Drain Abdominoplasty with Progressive Tension Sutures
Editorial Comment on “Concepts on Correction of the Musculoaponeurotic Layer in Abdominoplasty”
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