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Bocchiotti et al. Extended abdominoplasty in massive weight loss patients

Despite the large number of benefits conferred by Table 1: Patients characteristics
bariatric surgery, the massive weight loss causes a Extended abdominoplasty Torsoplasty
persistence of a large amount of inelastic skin and Characteristics Range Average Range Average
subcutaneous tissue, which can lead toskin irritations, Age (years) 30-63 46.8 30-61 45.2
mycotic infections and secondary self-imaging Bariatric BMI 41-61 51.6 42-56 47.5
problems (potentially a worsened overall patient body- Post-bariatric BMI 26-30 28.6 25-30 27.3
image). Skin redundancy following massive weight Weight loss (kg) 28-115 69.4 35-85 61.8
loss is both an aesthetic and functional problem. BMI: body mass index

The number of patients demanding plastic surgery redundancy, circumferential lipodystrophy type VI
correction of contour abnormalities has increased with according to Mejia and Cárdenas Castellanos, [12]
the advancement in weight loss procedures. Massive unchanged weight during the last year, and age
weight-loss patients often present a circumferential between 30 and 65 years.
truncal skin and subcutaneous tissue redundancy,
which cannot be optimally corrected by common Patients were excluded if affected by diabetes or
abdominoplasty techniques. The main issue is the coagulopathies, or if they had undergone prior trunk
remaining of skin bulges in the flanks and in the dorsal reshaping procedures were excluded.
area. When glutealptosis is also present, a 360°
contouring procedure is necessary: in these cases the Patients’ characteristics are described in Table 1.
most frequent operation is torsoplasty. [7]
Planning and marking
Nevertheless, both circumferential abdominoplasty We performed the body contouring procedures after
and torsoplasty have intraoperative and postoperative twelve months of stable bodyweight. Liposuction
high risk of complications such as bleeding, anemia, wasn’t performed in any case. Photographs were
dorsal dehiscence of the surgical wound due to forced taken preoperatively and postoperatively.
supine position, infection, seroma (often posterior
ones). [8-10] Skin markings are placed preoperatively with the patient
in standing position, the day before the procedure,
As an alternative to circumferential abdominoplasty, using a method similar to that described by Mejia and
wedescribeour experience with the extended Cárdenas Castellanos. [12] The scaris positioned low
abdominoplasty technique. [11,12] This technique was enough to be easily hidden by the underwear.
first described by Mejia and Cárdenas Castellanos [12]
to treat aesthetic deformities of the abdomenin Anteriorly, a vertical supra-pubic midline is drawn. The
non-bariatric patients and it preserves the median lower point of the resection is 7-8 cm from the vulvar
dorsal area from surgical traumas. We extended the anterior commeasure or from the base of the penis.
indication to the massive weight loss patients. The Two lateral lines of 7 cm are drawn from the vertical
aim was to reduce postoperative complications and line, and are then continued to the iliac crests.
hospitalization time.
Laterally the abdominoplasty line is stretched along
METHODS the two sides keeping the iliac crest height without re-
ascending [Figure 1A]. From this line, by pinching, the
Patients upper flap of adipocutaneous excess has to be marked
Twenty-one consecutive patients underwent extended along the lateral hip profile. The abdominoplasty
abdominoplasty after bariatric surgery [body mass superior line has to be stretched until the above-
index (BMI) ≥ 40] between September 2014 and mentioned point [Figure 1B].
November 2015. Data concerning age, gender, BMI at
the time of plastic surgery, weight loss, duration of the In the dorsal area, we draw a vertical line positioned in
procedure, resected tissue weight, perioperative blood the interspinal line, and then the marking of the upper
loss, duration of hospitalization, follow-up, associated incision line is extended backwards, almost straight
procedures and complications were collected and over the gluteal crease, not exceeding it [Figure 1C].
compared with those of 21 patients who had undergone This line is then directed downwards and medially. And
a classical torsoplasty during the same period. by pinching, the inferior line has to be marked in order
to correct the glutealptosis [Figure 1D].
Patients were selected after passing the following
inclusion criteria: severe abdominal and truncal skin Lastly, vertical lines along the entire drawing have to
58 Plastic and Aesthetic Research ¦ Volume 4 ¦ April 21, 2017