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Bocchiotti et al. Extended abdominoplasty in massive weight loss patients

time, we propose a modified approach to the
traditional circumferential torsoplasty, described by
Mejia and Cárdenas Castellanos [12] as “extended
abdominoplasty” in massive-weight-loss patients.

Compared to traditional torsoplasty the extended
abdominoplasty technique preserves the median
dorsal area from surgical trauma. This area contains
a fascial-aponeurotic tissue, rich in vessels, with skin
and subcutaneous firmness [Figure 5], which is at
higher risk of bleeding and less involved in theptosis
processes. The advantage of avoiding this area is the
reduction of intraoperative bleeding, operative time
and hospitalization days.

Despite the limited number of cases, in our experience,
the comparison between extended abdominoplasty
and torsoplasty gives encouraging results regarding
blood loss, transfusion rate, operation length and
hospitalization days. We had no cases of seroma
formation and no other major complication. We reported
5 cases of superficial cutaneous necrosis occurring
on the bisiliac suture line, which was managed with
local dressing changes for less than 3 weeks. As
Figure 5: The median dorsal area. In this anatomical district, described in the result section, data analysis supports
there is a fascial-aponeurotic tissue, rich in vessels, with skin and
subcutaneous firmness this hypothesis but the small number of patients limits
its significance.
were developed. Circumferential torsoplasty was first
described in1960 as the “beltlipectomy” by Gonzalez- This procedure allows a better distribution of loose
Ulloa. [16] His technique involved anterior and posterior tissue after removal of the excess from the flanks. It
midline vertical wedge. Baroudi [17] described a similar permits narrowing of the waistline and suspending the
technique but without the wedge resection. In 1991 skin of the gluteal area without stretching the buttock
Lockwood [18] described the superficial fascial system of crease. Compared to the traditional torsoplasty, the
the torso and extremities, and its use in high-tension- aesthetic result is better considering the shorter size of
lateral closure in the transverse flank-thigh-buttock lift. the scars. Patients happily accept the perspective of a
In 1996 Hunstad [19] described a combined technique of shorter scar.
circumferential torsoplasty and liposuction.
In conclusion, this study presents the results of the
In 2002, Pascal and Le Louarn [20] proposed a new use of the extended abdominoplasty in post-bariatric
concept in the circumferential abdominoplasty: body lift patients. According to the results, this technique
with high lateral tension, creating a dermal flap for the allows a reduction in blood loss, operative time and
suspension of the buttocks and trochanteric regions. hospitalization days, and consequently leading to less
complications and costs.
Belt lipectomy is also known as torsoplasty,
circumferential torsoplasty, circumferential lipectomy We believe that extended abdominoplasty is a viable
and panniculectomy. This body contouring procedure alternative to torsoplasty in selected patients presenting
is associated with a high rate of postoperative with a severe adipocutaneous circumferential laxity, as
complications. The literature reports a rate of occurs in post-bariatric massive weight loss patients.
complications ranging from 17% to 50%.
Authors’ contributions
Seroma is the most frequent complication. It commonly Manuscript’s concept and design: M.A. Bocchiotti, S.
occurs in the posterior region, which is a well-known Bruschi
region for seromas after back surgery. Literature search: E.A. Baglioni
Data acquisition and analysis: L. Spaziante
To minimize complications and hospitalization Manuscript preparation, editing and review: E. Ruka
62 Plastic and Aesthetic Research ¦ Volume 4 ¦ April 21, 2017