Decision Making in Abdominoplasty
Abstract
Background: Improvements and variations in abdominoplasty
techniques have complicated patient and procedure
selection. The authors describe their guidelines for selecting
the ideal procedure to be used with patients by stratifying
them into treatment groups according to the presence and
location of excess skin and subcutaneous tissue, lipodystrophy,
and abdominal wall laxity.
Methods: A prospective study analyzed 151 female patients
treated for abdominal contour deformities from January
2004 to July 2005. The patients were systematically classified
into five treatment groups: mini-abdominoplasty (5%),
standard abdominoplasty (42%), abdominoplasty with
liposuction and minimal midline undermining (10%),
standard abdominoplasty with removal of deep fat (13%),
and circumferential abdominoplasty (30%).
Results: The patients had a mean age of 42 years and a
mean body mass index (BMI) of 26 kg/m2. The prevalence
of overweight (BMI, 25.029.9) was 37%, and that of
obesity (BMI > 30.0) was 19%. Comparison of pre- and
postoperative photographs included improved tension of
the entire abdominal wall, enhancement of the waistline,
and increased uniformity of the contour of the abdomen.
There was a significant difference in mean BMI between
preabdominoplasty (26 kg/m2) and postabdominoplasty
(24 kg/m2) (p = 0.01). The prevalence of overweight and
obesity decreased by 8% and 9%, respectively (p = 0.01),
and a decrease in BMI occurred within each abdominoplasty
subgroup (p = 0.01). The prevalence of complications
was 11%. Seroma (4%) and delayed wound healing (4%)
were the most common. One case of pulmonary embolus
was encountered. Although there was a positive trend in
complications with higher BMI, no statistically significant
difference was found (p = 0.74). Half of the patients had
additional procedures performed without a significant increase
in complications (p = 0.5).
Conclusions: The described algorithm for abdominoplasty
selection is safe, effective, and flexible, with long-term
improvement in abdominal contour and BMI.
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