Effect Of Abdominoplasty Research Articles

Effects of DIEP flap-based breast reconstruction on respiratory function

BackgroundBreast reconstruction (BR) is an essential part of breast cancer treatment, and the DIEP flap is considered the gold standard reconstruction technique, which uses a free abdominal flap. Concerns have been raised regarding the effects of abdominoplasty on respiratory functions. This topic has not been addressed regarding donor-site closure of DIEP flaps. Our aim is to prospectively compare preoperative and postoperative spirometry in patients undergoing DIEP flap-based BR, investigating its impact on respiratory function. Materials and methodsWe enrolled 21 patients who received BR with DIEP flap in our institution, who underwent pulmonary function assessment by spirometry 1 month preoperatively and 1 year postoperatively. We assessed Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC ratio, and Peak Expiratory Flow (PEF). Statistical analysis was performed using the paired samples test. ResultsAn improvement in the mean values of all 4 variables was found at 1 year from surgery. Namely, FEV1 improved by 0.1 L with a standard deviation (SD) of 0.39 L, FVC by 0.04 L with SD of 0.627, FEV1/FVC by 2.11 L with SD of 7.85 L, and PEF by 1.2 L with SD of 1.45 L. Only PEF was statistically significant [P = 0.001]. ConclusionOur results suggest that DIEP flap BR does not negatively impact respiratory function. Although further knowledge is required, we confirm the possibility of considering the indication for abdominoplasty and DIEP flap reconstruction in patients with altered and reduced pulmonary function.

Abdominal plasty with and without plication-effects on trunk muscles, lung function, and self-rated physical function

Background: Weight loss after obesity and pregnancy is associated with excess abdominal skin and weakness of the abdominal wall, which is assumed to cause low back pain and reduce lung function. Today, abdominoplasty is the only known method to treat excess skin, and plication is used to improve aesthetics and function alone or in addition to surgery. There is lack of evidence concerning the surgery’s effect on trunk muscles, lung function, and physical function. The aim was to evaluate the effect on trunk muscle endurance, lung function and self-rated physical function after abdominoplasty with and without muscle plication.Aim: To evaluate the effect on trunk muscle endurance, lung function, and self-rated physical function after abdominoplasty with and without muscle plication.Methods: A series of 125 people were randomised to abdominoplasty with or without rectus abdominis muscle plication. Trunk muscle endurance, lung function, and self-rated physical function (disability rating index) were measured before and 1 year after surgery.Results: There were no significant differences in any of the measured variables between the groups either before or after surgery. A significant decrease (p = .02) in back muscle endurance was seen after abdominoplasty without muscle plication. A significant positive effect (p = .04) in one of the activities (running) assessed by DRI was reported after abdominoplasty with muscle plication.Conclusions: No significant differences in trunk muscle endurance, lung function, or self-rated physical function were found after abdominoplasty with vs without plication. As the primary indication for surgery was excess skin and not diastasis of the rectus abdominis muscles, there is a need for future trials before conclusions can be drawn of effect of abdominoplasty and plication.

Commentary on: Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function.

The current article, “Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function,” studies the effects of rectus plication on intra-abdominal pressure (IAP) and pulmonary compliance in a healthy patient population.1 While several previous authors have also studied the changes that occur with IAP following abdominoplasty or TRAM flap breast reconstruction, the current paper differs from these other studies in two important ways.2-4 In this paper, the authors directly measure the effect of rectus plication on the pulmonary system by measuring pulmonary compliance, and they use the standardized recommendations of the International Conference of Experts on Intra-Abdominal Hypertension and Abdominal Compartment Syndrome to measure IAP.5 Elevated IAP and the physiological consequences of Abdominal Compartment Syndrome (ACS) have been discussed extensively in the trauma literature.6,7 Because the abdomen is a closed compartment, when the abdominal wall fails to expand due to the presence of external constriction or when the internal contents increase due to edema or bleeding, compartment syndrome can develop in the abdomen in the same manner that it develops in extremities. The physiologic consequences of ACS include: bowel dysfunction, renal dysfunction, cardiovascular compromise, and pulmonary dysfunction. Since the majority of patients with ACS are on ventilators, many will have high peak inspiratory pressures and low …

Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function.

Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation. To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty. A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature. The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant. Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes. LEVEL OF EVIDENCE 3: Therapeutic.

The Effect of Abdominoplasty and Outcome of Rectus Fascia Plication on Health-Related Quality of Life in Post-Bariatric Surgery Patients.

The authors prospectively evaluated the effect of isolated abdominoplasty with or without rectus fascia plication on the physical, functional, and psychosocial dimensions of health-related quality of life in post-bariatric surgery patients. They also evaluated whether the objectively measured amount of abdominal excess skin affects the discomfort of excess abdominal skin and changes in health-related quality of life after abdominoplasty. Ninety-four post-bariatric surgery patients answered questionnaires regarding their experience of excess skin and health-related quality of life before and 1 year after isolated abdominoplasty. An objective assessment of the amount of abdominal excess skin was also performed. All study participants were assigned randomly to either undergo or not undergo rectus fascia plication. Significant improvements were reported at the follow-up concerning physical, functional, and psychosocial dimensions of health-related quality of life. A significant decrease was observed for the general health subscale of the 36-Item Short-Form Health Survey for the nonplicated group (p = 0.039). No significant differences were observed between the plicated and nonplicated groups. A significant low correlation was identified between the change in the Short-Form physical function subscale after abdominoplasty and measured amount of excess abdominal skin (rs = 0.26, p = 0.033) or resection weight (rs = 0.20, p = 0.10). Isolated abdominoplasty in post-bariatric surgery patients seems to improve both physical and psychosocial dimensions of health-related quality of life. However, rectus fascia plication does not appear to influence health-related quality of life. In addition, the correlation between the objectively measured amount of abdominal excess skin and improvements in health-related quality of life after abdominoplasty in post-bariatric surgery patients appears to be low.

Effect of abdominoplasty in the lipid profile of patients with dyslipidemia.

Introduction. Dyslipidemia like other chronic degenerative diseases is pandemic in Latin America and around the world. A lot of patients asking for body contouring surgery can be sick without knowing it. Objective. Observe the lipid profile of patients with dyslipidemia, before and three months after an abdominoplasty. Methods. Patients candidate to an abdominoplasty without morbid obesity were followed before and three months after the surgery. We compared the lipid profile, glucose, insulin, and HOMA (cardiovascular risk marker) before and three months after the surgery. We used Student's t test to compare the results. A P value less than 0.05 was considered as significant. Results. Twenty-six patients were observed before and after the surgery. At the third month, we found only statistical differences in LDL and triglyceride values (P 0.04 and P 0.03). The rest of metabolic values did not reach statistical significance. Conclusion. In this group of patients with dyslipidemia, at the third month, only LDL and triglyceride values reached statistical significances. There is no significant change in glucose, insulin, HOMA, cholesterol, VLDL, or HDL.

Effects of Abdominoplasty on Female Sexuality: A Pilot Study

Changes in the pubic region resulting from abdominoplasty may have a psychosexual impact. Thus, it is important to study the influence of physical changes on the sexuality of patients after abdominoplasty. To evaluate the effects of the elevation of the mons pubis and consequent exposure of the clitoris in the vulvar commissure on the sexual functioning and sexual satisfaction of women who underwent abdominoplasty. Data were presented as mean±standard deviation. Nineteen women with a mean age of 35±7 years, mean body mass index of 23±2 kg/m(2) and who expressed a desire to undergo abdominoplasty were selected from consecutive patients attending the abdominal plastic surgery outpatient unit of a university hospital. Physical change (measured by the distance between the xiphoid process and vulvar commissure [xipho-vc]), sexual functioning, and sexual satisfaction (assessed with the Sexuality Assessment Scale), and body image (measured using the Body Shape Questionnaire [BSQ]) were evaluated preoperatively and 6 months after abdominoplasty. There was a significant reduction (P=0.0004; z=-3.53) in the xipho-vc distance 6 months after abdominoplasty compared with baseline (mean difference 3.63±2.79 cm), corresponding to an elevation of the mons pubis and consequent exposure of the clitoris. All patients reported a significant improvement in sexual functioning and sexual satisfaction 6 months after abdominoplasty when compared with baseline (P=0.0001; z=-3.83). BSQ scores indicated an improvement in the patients' concerns about body shape (P=0.0003; z=-3.58). Our results suggest that physical change and the new position of the clitoris may have a positive impact on sexuality.

Abdominal Wall Strength: A Matched-Pair Analysis Comparing Muscle-Sparing TRAM Flap Donor-Site Morbidity with the Effects of Abdominoplasty

Microsurgical autologous breast reconstruction has evolved significantly over the last three decades. The muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), deep inferior epigastric artery perforator, and superficial inferior epigastric artery flaps have been developed to minimize abdominal donor-site morbidity. Assuming that harvest of the superficial inferior epigastric artery flap has the same impact on abdominal wall morbidity as performing an abdominoplasty, the authors designed a matched-pair analysis comparing patients' abdominal wall strength after muscle-sparing TRAM flap reconstruction with that after abdominoplasty. A total of 104 patients were included in the study. Fifty-two TRAM flap patients were matched with 52 abdominoplasty patients for age and body mass index. Outcome measures included postoperative complications, particularly hernia and abdominal bulge formation. Two surveys were used to assess patient satisfaction as well as the impact of the procedure on everyday life. Both study groups were similar with regard to age, body mass index, past medical history, and postoperative complication rate, including hernia and abdominal bulge formation. Results were similar between the study groups, with the exception of a higher rate of satisfaction with the appearance of the abdominal scar among TRAM flap patients (p=0.03) as well a lower likelihood of TRAM flap patients to engaging in sporting activities postoperatively (p=0.01). In the present study, the muscle-sparing TRAM flap did not result in a higher rate of postoperative complications related to abdominal wall morbidity. Differences observed regarding the postoperative level of activity are unlikely to be related to the surgical insult to the abdominal wall.

The Effect of Abdominoplasty on Urinary Incontinence in Women

Sir: Urinary incontinence has a significant psychosocial, economic, and health impact on the Australian community.1 In 2006, the prevalence of incontinence in Australian women was estimated to be as high as 37 percent1 and in 1998 was thought to cost the community $710 million in treatment and personal costs.2 Current treatments for female incontinence include pelvic floor exercises, medication, and surgery. The current literature on the effect of abdominoplasty on urinary incontinence consists of three case reports.3–5 These were all single case reports of middle-aged female patients who subjectively reported improved urologic function postoperatively. The proposed mechanism in all cases was an increase in intraabdominal pressure and muscle stabilization by plicating the rectus sheath, which facilitated improved bladder emptying. We hypothesized that women with urinary incontinence symptoms may have improvement following abdominoplasty. We performed a retrospective postal questionnaire–based study of a population of women who had undergone abdominoplasty at either Flinders Medical Centre or the private rooms of the senior author (R.G.M.) between January of 2005 and March of 2009. Any patient that had undergone previous urologic surgery was excluded. Data were also collected from the medical records. As no previously validated questionnaire existed for such a retrospective study, one was devised by the study group (Fig. 1). The questionnaire consisted of a series of questions asking the patient to grade her symptoms using a Likert scale. These questions were designed to assess symptoms of urinary incontinence before and after abdominoplasty. Results were tested for significance using the unpaired t test and the chi-square test. Patients were grouped together for the purposes of analysis.Fig. 1.: Questionnaire used in the study to assess symptoms of urinary incontinence.In our population of 100 patients who underwent abdominoplasty, the median age was 42.7 years (range, 14.2 to 77.5 years), with a mean weight of 76.0 kg (range, 40 to 120 kg) and a mean body mass index of 28.9 (range, 20.5 to 42.9). The main indication for abdominoplasty was localized adiposity (82.8 percent). The group reporting incontinence symptoms had undergone fewer cesarean deliveries (p = 0.005, t test). None of the other variables was significant. Forty-six patients replied to the questionnaire, of which 59.0 percent reported incontinence symptoms preoperatively. Of these patients, 25.9 percent reported improvement of symptoms, 3.7 percent reported worsening of symptoms, and the rest reported no change during the 6 months postoperatively (Fig. 2).Fig. 2.: Change in symptoms of urinary incontinence during the first 6 months postoperatively.This study was conducted in a population of middle-aged women with medium to high body mass indexes who underwent abdominoplasty for mainly aesthetic reasons. The majority of these patients had previously had children, and a number had undergone significant weight loss. This is a population already known to have a high rate of urinary incontinence. The key finding of our study was that 25.9 percent of patients undergoing abdominoplasty who had symptoms of urinary incontinence reported an improvement in these symptoms postoperatively. The strength of this study is affected by several drawbacks, which include the use of a nonvalidated questionnaire, a small population size, and the retrospective nature of the study. However, despite this, it still indicates that abdominoplasty may have a beneficial effect on the symptoms of urinary incontinence in this population, and it is a field worthy of further prospective study. DISCLOSURE The authors have no conflicts of interest to disclose. Nicholas S. Solanki, B.M.B.S., B.Sc. Jaime A. Duffield, Ph.D., B.Sc.(Hons.) Nicola R. Dean, F.R.C.S.(Eng.), Ph.D. R. Gwyn Morgan, F.R.C.S., F.A.C.S. Department of Plastic and Reconstructive Surgery Flinders Medical Centre Bedford Park, South Australia, Australia

Irritable bowel syndrome and abdominoplasty.

Irritable bowel syndrome is a chronic disease involving pain or discomfort relieved by defecation and associated with a change in frequency or consistency of the stools. The effect of abdominoplasty on patients with irritable bowel syndrome has not been elucidated, so advising patients with irritable bowel syndrome about the effects of surgery on their disease was difficult. One hundred female patients from a pool of 120 patients responded to a questionnaire relating to abdominoplasty surgery. Follow-up ranged from 6 months to 2 years. Patients completed questionnaires formulated on the basis of Rome II Diagnostic Criteria. Of the 100 patients, nine had true irritable bowel syndrome, nine had moderate symptoms and were receiving medication (not true irritable bowel syndrome), 16 had mild symptoms on occasional medication, and 66 had no symptoms of irritable bowel syndrome before surgery. Of the true irritable bowel syndrome patients, all had symptomatic improvement with decreased medication, eight of the nine patients with moderate symptoms improved markedly, and five of the 16 patients with mild symptoms improved significantly. No patient had any initiation or deterioration of symptoms. It is thus concluded that the symptoms of irritable bowel syndrome are certainly not worsened, in the short term, by surgery, and may be alleviated or improved in most significant cases.

Anatomical and technical refinements for abdominoplasty

Several important details pertinent to the classic transversal low-incision abdominoplasty, commonly underestimated, are pointed out. Metameric sensitivity distribution is focused in the normal individual and then transformed by abdominoplasty. Emphasis is also given to the vascularization, lymphatic drainage, and treatment of the muscle-aponeurotic plane and femoral cutaneous nerve under effects of abdominoplasty. Attention is called to how effectively they can help to obtain symmetric postoperative results and how important it is to have a normal-looking, aesthetically pleasing navel. First introduced as a corrective procedure for abdomens grossly deformed by lipodystrophies or greatly compromised by hernias or problems related to multiple surgeries, abdominoplasty is no longer merely a reconstructive procedure. In the last 10 years, requests for abdominoplasty for aesthetic improvement of lax skin, "striae," and scars of even "good quality" situated in the infraumbilical area have increased in indirect proportion to the size of today's bathing suits.The great number of cosmetic abdominal surgeries calls for a better solution to problems such as the placement and quality of scars, the positioning of the umbilicus, and the resulting waistline. An increasing number of demands are made regarding minute details of asymmetry, sensibility, edema, and pain. Like the young surgeon in training, we had to search our anatomy books to find explanations and ways to avoid problems justifiable in earlier days but unacceptable today.