Cosmetic Abdominoplasty Research Articles

The Efficacy of the Transversus Abdominis Plane Block in Abdominoplasty: A Systematic Review and Meta-Analysis.

The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. Its use in cosmetic abdominoplasty procedures is less frequently documented. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique's effectiveness in abdominoplasties. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis. The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting(OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group. The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.

Determination of Appropriate Umbilicus Position during Abdominoplasty in Male Patients.

Abdominoplasty techniques are well documented. The ideal position of the umbilicus has, however, received limited attention. Unfortunately, umbilicus position is not universally agreed upon in male cosmetic abdominoplasty. This study was conducted to determine the ideal umbilicus anthropometric measurements in young men, and the relationships between umbilical position and anterior trunk and torso reference points that may be applicable to intraoperative positioning. It is aimed also at investigating whether umbilicus position would be more accurately determined by considering nipple position instead of the abdominal crease, as recently proposed. Several anthropometric measurements of various anterior abdominal and thoracic landmarks were conducted on 60 young and middle-aged male volunteers and 30 cadavers at São Paulo city. All statistical analysis was completed using Stata software. Of all the measured reference points, a much stronger correlation (0.513) was demonstrated between umbilicus-anterior axillary fold (U-AX) and inter-nipple (N-N) distances with a constant golden number ratio relationship (N-N = U-AX × 0.618) compared with the weak correlation of 0.034 between umbilicus-xiphisternum and umbilicus-abdominal crease. In 75% of volunteers, the calculated U-AX was within ±3 cm of actual measurement, and in 33.33% within ±1 cm. U-AX = 1.618 × N-N equation is more predictive of adequate umbilicus repositioning during abdominoplasty in male patients. Chest and abdomen of men are a single aesthetic unit. Proper positioning of the nipples and umbilicus, as well as harmonious abdominal and torso proportions are critical for an optimal final aesthetic outcome.

Patient Characteristics and Spending Among Individuals Undergoing Ambulatory Panniculectomy and Abdominoplasty in the US from 2016 to 2019.

Abdominal contouring surgery can provide both functional and cosmetic benefits to patients with abdominal soft tissue laxity. Although these procedures have been studied in the inpatient setting, few studies describe abdominal contouring surgery in the ambulatory setting. The purpose of this analysis was to investigate patterns in patient demographics between functional panniculectomy and cosmetic abdominoplasty using national data from the last four years. Using the Nationwide Ambulatory Surgery Sample, we analyzed outpatient abdominal contouring procedures between 2016 and 2019. Encounters with a CPT 15830 were included. Procedures with ICD Z41.1 or CPT 15847 modifiers were defined as cases of cosmetic abdominoplasty. A weighted estimate of 95,289 encounters were included, with 66,531 (69.8%) functional panniculectomy and 28,758 (30.2%) cosmetic abdominoplasty procedures. Among patients with a history of bariatric surgery (23.8%; 95% CI, 22.3-25.4%), there was a 28.5% (4,866 in 2016 vs 6,254 in 2019) increase in panniculectomy and abdominoplasty. Compared with individuals who underwent cosmetic abdominoplasty, individuals who underwent functional panniculectomy were more racially diverse, had more comorbidities, and were more likely to be from low-income backgrounds. Rates of abdominal contouring surgery in the ambulatory setting have increased in recent years especially among individuals with previous bariatric surgery. There are important demographic and clinical differences between patients who underwent functional panniculectomy and cosmetic abdominoplasty including primary payer, comorbidities, and racial identity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Does Concomitant Umbilical Hernia Repair Increase the Risk of Complications in Abdominoplasty? A Propensity Score Matched Analysis.

Patients seeking cosmetic abdominoplasty often have umbilical hernias. Optimal management and safety of concomitant umbilical hernia repair with abdominoplasty is not well described. The goal of this study was to compare complication rates following abdominoplasty with or without umbilical hernia repair. A retrospective propensity score matched cohort study of patients who underwent an abdominoplasty at Massachusetts General Hospital was performed. Direct umbilical hernia repair was performed by making a fascial slit inferior or superior to the umbilical stalk. The fascial edges were approximated with up to three 0-Ethibond sutures (Ethicon, Raritan, NJ) from the preperitoneal or peritoneal space. Propensity score matching was used to adjust for confounding variables. The authors identified 231 patients with a mean [standard deviation] age of 46.7 [9.7] years and a mean BMI of 25.9 [4.4] kg/m2. Nine (3.9%) had diabetes, 8 (3.5%) were active smokers, and the median number of previous pregnancies was 2. In total, 223 (96%) had a traditional abdominoplasty, whereas 8 (3.5%) underwent a fleur-de-lys approach. Liposuction was performed on 90%, and 45.4% underwent simultaneous breast or body contouring surgery. The overall complication rate was 6.9%. Propensity scores matched 61 pairs in each group (n = 122) with closely aligned covariates. There was no significant difference in total complication rates between abdominoplasty alone vs abdominoplasty with hernia repair. There were no cases of skin necrosis or umbilical necrosis in either group. Performing umbilical hernia repair with abdominoplasty is safe when utilizing the technique reported in this series.

81. The Impact of Body Mass Index on Surgical and Aesthetic Outcomes in Cosmetic Abdominoplasty

81. The Impact of Body Mass Index on Surgical and Aesthetic Outcomes in Cosmetic Abdominoplasty

33. Obesity as a Risk Factor in Cosmetic Abdominoplasty: A Systematic Review and Meta-Analysis

PURPOSE: The incidence of obesity is on the rise around the globe. Outside the massive weight loss patient population, knowledge of risk factors associated with abdominoplasty is limited. This systematic review and meta-analysis assesses the impact obesity has on cosmetic abdominoplasty outcomes. METHODS: A systematic review was conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases were reviewed using syntax “obesity”, “abdominoplasty”, “panniculectomy”, and “body contouring” for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of massive weight loss. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving massive weight loss patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. RESULTS: Of 3,088 initial studies, 16 met inclusion criteria. Of which, 9 studies included patient-reported outcomes that were used for pooled and meta-analysis. Six studies utilized national databases and were excluded from our data analysis. Meta-analysis demonstrated obesity was associated with more seromas (OR 1.45, 1.06-1.98, p=0.02), hematomas (OR 2.21, 1.07-4.57, p=0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p=0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class revealed no significant increase in odds in seromas or wound dehiscence. CONCLUSION: This review demonstrates obesity increased the odds of postoperative complications following cosmetic abdominoplasty. However, risk of complications does not continue to increase with higher obesity class. Additional research in cosmetic abdominoplasty is encouraged to further assess the impact of obesity on complications.

D42. The Impact of Body Mass Index on Surgical and Aesthetic Outcomes in Cosmetic Abdominoplasty

D42. The Impact of Body Mass Index on Surgical and Aesthetic Outcomes in Cosmetic Abdominoplasty

15. Comparative Analysis of Abdominoplasty with and without Concurrent Hernia Repair: An Assessment of a Reconstructive Problem in a Cosmetic Patient Population

PURPOSE: The risks and benefits of performing small fat-containing ventral or umbilical hernia repair (HR) during cosmetic abdominoplasty remains a reconstructive and aesthetic challenge for plastic surgeons. This study aimed to compare clinical outcomes in patients undergoing abdominoplasty with concurrent HR and abdominoplasty alone. METHODS: Patients (2015-2021) who underwent abdominoplasty with and without a concurrent HR by a single surgeon were identified. Patients were stratified by concurrent HR. All hernia patients underwent primary fascial repair, without the use of mesh reinforcement. Demographics, surgical site occurrences (SSO) and cosmetic complications, including delayed healing and necrosis, were assessed. Risk adjusted modeling was utilized to compare HR with clinical outcomes. RESULTS: One-hundred and eleven patients underwent abdominoplasty, 67 (60.4%) had concurrent HR. No significant difference in demographics was identified between groups including mean BMI (HR=27.5 kg/m2 and No HR= 26.7 kg/m2, P=0.79), and number of previous repairs (P=0.31). After a mean follow-up of 1.4 years, hernia recurrence rate was 3% (n=2), which was exclusive to umbilical defects. After controlling for demographics, there was no difference in risk of SSO (OR 1.02 [0.31-3.36] P=0.978), cosmetic complications (OR 0.80 [0.14-4.57] P=0.805), readmissions (6.06% vs. 0%, P=0.336), reoperations (18.18% vs. 3.03%, P=0.299), or procedure length (-7.23 minutes [-29.40-14.93] P=0.522), compared to patients who underwent abdominoplasty alone. CONCLUSION: Abdominoplasty with concurrent HR can be performed safely and effectively, with no increase in adverse outcomes or cosmetic complications. The value of mesh-free HR with abdominoplasty is the ability to achieve an enhanced aesthetic and mitigate long-term abdominal morbidity.

Concurrent abdominal body contouring and hernia repair are safe choices: An analysis of the 2015–2020 ACS-NSQIP database

BackgroundConcurrent hernia repair (HR) with abdominal body contouring procedures (ABD), panniculectomy, and abdominoplasty, has been discussed as a strategy. The purpose of this study is to evaluate potential medical and surgical complications following concurrent ABD-HR, with a greater emphasis on cosmetic abdominoplasty. MethodsThe 2015–2020 ACS-NSQIP datasets were utilized to identify patients who underwent ABD or ABD-HR. Propensity score (PS) matching was used to reduce selection bias by equating groups (ABD vs. ABD-HR) based on covariates. Bivariate analyses of independent variables by our outcomes of interest were performed using the Pearson Chi-Square and Fisher’s Exact tests for categorical variables and the Wilcoxon rank-sum test for continuous variables. ResultsOf the 14,115 patients identified in the ACS-NSQIP, 13,634 had ABD, while 481 had both ABD and HR. Following PS-matching of the cohorts, ABD (n = 481) and ABD-HR (n = 481), bivariate analysis of the combination of incisional, umbilical, and epigastric hernias indicated longer operative times (mean: 209.6 min) (P < 0.001) and a longer hospital length of stay (mean: 1.9 days) (P < 0.001). The incidence rate of postoperative complications such as wound dehiscence, deep venous thromboembolism, DVT, unplanned return to the OR within 30 days, and other medical complications revealed no significant differences between the two cohorts. A sub-group analysis of wound complications found no significant difference for any wound type. Analysis was also conducted for each type of hernia separately, yielding the same results. ConclusionOur results show no increase in postoperative morbidity when combining ABD and HR compared to ABD alone, suggesting that these procedures can be safely performed concurrently and regardless of the type of hernia.

Pulmonary Embolism Risk after Cosmetic Abdominoplasty

Pulmonary Embolism Risk after Cosmetic Abdominoplasty

Safety of Concomitant Umbilical Hernia Repair during Abdominoplasty: A Propensity Score Matched Analysis

PURPOSE: Over 97,000 abdominoplasties were performed in 2020 in the United States alone. Patients seeking a cosmetic abdominoplasty often have concurrent umbilical hernias stemming from shared risk factors for fascial and skin laxity. Optimum management and the safety of performing umbilical hernia repair during the same operation as an abdominoplasty is not well described. In this context, we compared the complication rates of performing an abdominoplasty with an umbilical hernia with abdominoplasty alone. Further we share our technique for umbilical hernia repair. METHOD: We performed a retrospective propensity score-matched cohort study of patients (n=271) who underwent an abdominoplasty at Massachusetts General Hospital between January 2014 and December 2020 by the senior author. Patients with panniculectomy were excluded to give a more homogenous population. Patients who underwent repair of an umbilical hernia at the time of the abdominoplasty were identified. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in patient baseline covariates. The primary outcome was any post-operative complication. Secondary outcomes included umbilical necrosis, skin flap necrosis, hematoma, venous thromboembolism, seroma, infection, and hernia recurrence. RESULTS: One-to-one propensity-score matching yielded 63 patients in each exposure group (126 patients total) with the distribution of observed baseline covariates closely aligned. If an umbilical hernia was present, a fascial slit was made inferior or superior to the umbilicus, the hernia contents were reduced if needed, and the fascial edges were approximated with one to three 0-Ethibond sutures from underneath. Within the matched cohort, there was no significant difference in total complication rates (abdominoplasty alone 8% (n=5) vs. abdominoplasty with hernia repair 6% (n=4) p=1.00). Similarly, there were no significant differences in any of the secondary outcomes (p>0.05). Specifically, there were no cases of abdominal skin necrosis or umbilical necrosis in either group. CONCLUSION: Performing umbilical hernia repair during the same operation as an abdominoplasty is safe without significantly increasing risk to the patient. Avoiding the dissection of or through the umbilical stalk may help provide adequate blood supply for survival. Future prospective studies are needed to evaluate patient-reported and long-term outcomes. REFERENCES: 1. ASPS Plastic Surgery Statistics Report 2020. Accessed 3/1/2022. 2. Person H, Mojallal A, Braye F, Shipkov H. Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review. Aesthet Surg J. Jun 14 2021;41(7):NP831-NP839. doi:10.1093/asj/sjab094 3. van Schalkwyk CP, Dusseldorp JR, Liang DG, Keshava A, Gilmore AJ, Merten S. Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair. Aesthet Surg J. Nov 12 2018;38(12):NP196-NP204. doi:10.1093/asj/sjy100

An Algorithmic Approach to Umbilical Inset during DIEP Flap Reconstruction.

An aesthetically pleasing umbilicus is a critical component to the overall cosmesis and resultant patient satisfaction after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Because of variables in body habitus, comorbidities, and technical aspects of the procedure, patients undergoing DIEP flap breast reconstruction are at a higher risk of umbilical complications and poor aesthetic appearance of the neoumbilicus compared with those undergoing cosmetic abdominoplasty. To minimize these potential problems and maximize the overall aesthetic appearance of the abdomen, the authors propose an algorithmic approach to umbilical inset after DIEP flap harvest that takes into account several critical factors: the thickness of the subcutaneous tissue of the abdominal flap, the length of the umbilical stalk, and the depth of the umbilical bowl. This simple algorithmic approach is a useful tool that will assist surgeons in minimizing umbilical complications and delivering a superior cosmetic appearance to the abdominal donor site in DIEP flap reconstruction.

Pulmonary Embolism Risk After Cosmetic Abdominoplasty and Functional Panniculectomy.

Tighter abdominal wall reconstruction may increase intra-abdominal pressure, which can decrease lower extremity venous return. Decreased venous return through the inferior vena cava has been demonstrated to increase risk of deep vein thrombosis. Tighter abdominal wall plication during cosmetic abdominoplasty compared with functional panniculectomy may increase these risks. The purpose of this study was to determine whether cosmetic abdominoplasty increases risk for thromboembolic events compared with functional panniculectomy. Retrospective cohort study was conducted using the National Surgical Quality Improvement Program database for excision of excessive subcutaneous infraumbilical skin and soft tissue at participating hospitals between 2015 and 2019. Procedures performed for cosmetic abdominoplasty versus functional panniculectomy were compared for occurrences of postoperative pulmonary embolism (PE). During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty ( P < 0.001). The risk for postoperative PE was independently associated with cosmetic abdominoplasty ( P < 0.001), elevated body mass index ( P = 0.001), preoperative recent weight loss ( P = 0.006), and concurrent hernia repair ( P = 0.049). Most PE events occurred outpatient after discharge (87.2%), and the average postoperative time from surgery until PE was 10.5 ± 6.7 days. Cosmetic abdominoplasty has greater than 4 times the risk of postoperative PE than functional panniculectomy. Risk of PE is further increased by concurrent hernia repair, elevated body mass index, and rapid weight loss in the immediate preoperative period. It may be advisable to caution patients to delay abdominal excisional body contouring procedures until their weight has plateaued.

Optimizing Nonopioid Analgesia and Different Pain Management Options following Abdominoplasty: A Systematic Literature Review.

Introduction:Postoperative pain remains a significant challenge with the growing number of abdominoplasties every year. Opioids are currently considered the mainstay modality for controlling postoperative pain. However, opioid-related side effects raise the need for a safer and more effective approach. In this study, we aimed to investigate these alternative evidence-based postoperative pain relief modalities following abdominoplasty.Methods:This systematic review was designed and conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature was systematically searched in December 2021 using the following databases: MEDLINE, Cochrane, and EMBASE. The MeSH terms used to aid the search were the following: abdominoplasty, postoperative pain management, postoperative analgesia, pain control, analgesia, and pain.Results:Reviewing the literature resulted in a total of 851 publications. After implementing our criteria, only 13 articles were included in this study, with 990 patients. A continuous infusion pump was the most commonly used method of analgesia (n = 3), followed by a transversus abdominis plane block (n = 2). The postoperative pain assessment scale was mentioned in nine out of the 13. Compared to controls, all interventions resulted in considerably lower pain levels in all the patients. Patient satisfaction was reported in three studies, and all studies reported higher satisfaction rates than the control groups.Conclusions:The authors performed a systematic review of the existing database of high-quality research on pain management after cosmetic abdominoplasty to determine the best pain management options currently available. However, future studies are recommended to assess the optimum dosing and administration methods.

Functional panniculectomy vs cosmetic abdominoplasty: Multicenter analysis of risk factors and complications

Amidst the rising trend of bariatric surgical procedures being performed across the country and around the world, patients seeking functional panniculectomy after massive weight loss represent a different population than those seeking cosmetic abdominoplasty. The purpose of this study was to determine whether certain complications are more likely to occur in patients undergoing functional panniculectomy, as well as identify risk factors that are implicated in the occurrence of adverse events. Retrospective cohort study was conducted of patients undergoing cosmetic abdominoplasty and functional panniculectomy in North America between 2015 and 2019 using the National Surgical Quality Improvement Program database sponsored by the American College of Surgeons. Comorbidities and postoperative complications between these two cohorts were analyzed with appropriate statistics. During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n=6397) patients undergoing functional panniculectomy and 42.6% (n=4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (p<.001). Overall adverse events (p<.001), medical complications (p=.047), surgical complications (p<.001), related readmission (p<.001), and related reoperation (p<.001) were significantly higher in patients undergoing functional panniculectomy. Surgical complications significantly higher in functional panniculectomy included superficial incisional infection (p<.001), deep incisional infection (p<.001), organ/space infection (p<.001), dehiscence (p=.003), and bleeding requiring transfusion (p=.003). Patients undergoing functional panniculectomy are significantly more likely to have comorbidities and experience postoperative wound infection, dehiscence, sepsis, bleeding, related readmission, and related reoperation.

A Case Report of Cosmetic Abdominoplasty in a Patient With Colostomy Appliance

Our patient presents with a unique case of both functional and cosmetic concerns following colectomy for the treatment of Crohn’s disease with subsequent massive weight loss following bariatric surgery. She desires abdominoplasty to address these concerns. Thorough preoperative planning and work up set the ground work for a successful procedure. We’ve shared our intraoperative approach, which has never before been published in the literature. Following her procedure, the patient had a mostly uneventful postoperative course. Her functional and cosmetic concerns were addressed with the procedure. The surgical outcome exceeded her expectations. Patients seeking body contouring surgery following bariatric surgery can be expected to increase. We suspect there may be other patients similar to ours that are experiencing similar functional and cosmetic concerns that can be addressed with cosmetic surgery. Due to the extremely unique nature of this case, we’ve shared our approach in hopes that our success can serve as a resource to other surgeons with similar patients.

Abdominal Body Contouring: Does Body Mass Index Affect Clinical and Patient Reported Outcomes?

Obese individuals are thought to be higher risk for complications after excisional abdominal body contouring (EAC) due to co-morbidities and significant tissue resection. We comparatively analyzed EAC patients with Body Mass Index (BMI) ≥35kg/m2 and BMI <35kg/m2 to highlight key differences in clinical and patient-reported-outcomes (PROs). Patients ≥18 years-old undergoing EAC by a single surgeon from 01/2018-01/2020 were identified and separated into cohorts based on BMI (<35 and ≥35kg/m2). Patients were excluded if they had a cosmetic abdominoplasty without history of bariatric surgery or massive weight loss, or if they had <1000 gs of tissue resected. Clinical outcomes and PROs using the BODY-Q were comparatively analyzed. 70 total patients with median BMIs of 30[26-32] and 41[37-45] kg/m2 in each cohort, were identified. Patients with BMI ≥35kg/m2 were more likely to have higher ASA (P<0.01) and use of incisional negative pressure wound devices (P=0.042). Alternatively, they were less likely to have had concurrent liposuction (P=0.05). There were no differences in development of an SSO, SSI or SSOpi (P>0.05) between cohorts. Multivariate logistic regression showed that BMI ≥35kg/m2, iNPWD and liposuction were not associated with the development of complications. PROs demonstrated improvement in multiple domains despite BMI. There was no association with BMI ≥35kg/m2 and the development of complications within our cohort. We encourage preoperative weight loss when possible, however these procedures can be performed safely with acceptable outcomes even in individuals who are obese and/or require extensive tissue removal.

Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction

The aesthetic and functional outcomes of the donor site following abdominal-based free flap breast reconstruction have been suboptimal. The objective of this study is to evaluate a modified liposuction-assisted abdominoplasty technique combined with rectus plication (LPARSP) adopted from cosmetic abdominoplasty practice. All abdominal-based free flap breast reconstructions from 01/2017 to 03/2019 were reviewed. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and body mass index with patients who underwent conventional abdominoplasty (CA group). Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed. A total of 28 patients were included. Groups were similar in demographics. The mean amount of lipoaspirate in the LPARSP group was 1054±613.5ml. The postoperative course was similar in both groups. The LPARSP technique resulted in a lower positioned horizontal scar (p = 0.03). The aesthetic outcome was superior in the LPARSP group (p < 0.0001). Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). In addition, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups. Lipoabdominoplasty with rectus plication represents a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Superior functional and aesthetic results paired with improved abdominal wall sensation are achieved compared to CA. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics

Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.

Abdominoplasty: My Preferred Techniques.

Abdominoplasty has been evolving since the 1960s with many technical innovations throughout the years. It has become one of the most frequent and common procedures done in aesthetic plastic surgery, with the ultimate goal of not only to remove the excess tissue in the abdominal area but also to achieve an aesthetic trunk silhouette. The prime objective of this article was to describe our preferred approach for a full cosmetic abdominoplasty. We summarized all the key technical aspects from our shared surgical approach for abdominoplasty. The article describes collective experiences from authors performing the surgery in South America, North America, and Asia. The key technical aspects identified were conservative muscle plication, customized excess tissue resection, and ultrasound-assisted liposuction to improve definition in the abdominal lines and body curves, combined with lipofilling. The aesthetic results are presented. Abdominoplasty should be customized to every patient's anatomy and desired cosmetic outcome, taking into consideration all the anatomical areas surrounding the abdominal wall.