Simultaneous Abdominoplasty Research Articles

The Outcome of the Combined Procedure of Abdominoplasty and Repair of Umbilical Hernia

Abstract Background Umbilical hernias (UH) are common in patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularization with possible umbilical necrosis. As a result, the umbilicus maintains its only blood supply from the underlying fascial attachments via the umbilical stalk. Abdominoplasty in the setting of a hernia repair can improve patients satisfaction, particularly appearance, hygiene, self-confidence and decrease the incidence of recurrence. Objective To assess the outcome of the combined procedure of abdominoplasty and repair of umbilical hernia. Patients and Methods This study Included 26 patients (18 females and 8 males) who were selected from those who presented to the department of general surgery at EL Demerdash University Hospital and Nasr city insurance hospital during the period between april2019 and october 2019. All patients had a physical examination of the UH and diastasis. Divided into two groups, each group formed of 13 patients. First group (group A) with patients underwent herniorrphy alone and the other group (group B) with patients underwent hernioplasty with combined abdominoplasty. Results It may be concluded that (1) during an abdominoplasty, midline fascial plication and ventral hernia repair can be performed in defects <3 cm without mesh reinforcement with no increase in hernia recurrence rates, (2) in patients with defects > 3 cm, mesh reinforcement is indicated after suture hernia repair and midline plication,, yields lower recurrence of abdominal deformity and less refashioning procedures with minimal complications. Conclusion Finally, it may help to reduce the incidence of recurrence by enabling removal of a large pannus and the resultant weight on the anterior abdominal wall, though this has not been proven. Also it improves the quality of life and obtains patients satisfaction with this approach.

Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review

Different methods of simultaneous full abdominoplasty and umbilical hernia repair were proposed. To review We reviewed them and compared the results concerning the umbilical hernia repair outcomes and umbilical stalk survival. A literature research was performed until 28 December 2019. Other hernia repair and mini-abdominoplasty (without umbilical transposition) were excluded. The primary outcomes analysed were umbilical hernia recurrence, mesh infection, and umbilical necrosis rates. Six studies were included (5 retrospectives series, 1 case report). Hernia was repaired by an open approach (3 studies, 28 patients) or a laparoscopic approach (3 studies, 67 patients). Umbilical hernia repair consisted in mesh placement in intraperitoneal or retromuscular/preperitoneal plane, or suture technique in intraperitoneal plane. None hernia recurrence, mesh infection, or umbilical necrosis were described. Both open and laparoscopic approaches of simultaneous abdominoplasty and umbilical hernia repair seem to be safe regarding the umbilical stalk vascularisation, hernia recurrence and mesh infection rates. However, more well-designed studies are needed to prove this hypothesis.

The use of a vacuum aspiration system for the treatment of anterior abdominal wall purulent wounds after complicated abdominoplasty

The article presents the experience of successful complex treatment of a 55-year-old patient with morbid obesity (BMI 66.3 kg / m2) who underwent excision of a skin-fat apron with simultaneous abdominoplasty complicated by purulent surgical infection.

Multidisciplinary approach to surgical treatment of patients with superficial abdominal obesity

To analyze an effectiveness of laparoscopic surgery with simultaneous abdominoplasty in patients with superficial abdominal obesity. Laparoscopic abdominal, retroperitoneal and pelvic surgery with simultaneous abdominoplasty was performed in 25 patients with body mass index >40 kg/m2. Surgery time and intraoperative blood loss were significantly higher after simultaneous surgery (p<0.05). However, these differences did not influence postoperative period. Duration of analgesic therapy, activation of patients and length of hospital-stay, as well as overall postoperative morbidity were similar in both groups (p>0.05). Simultaneous abdominoplasty resulted significantly better quality of life according to almost all parameters (p<0.05). According to certain indications, abdominoplasty is advisable as the first stage of simultaneous surgery in patients with large subcutaneous fat apron after bariatric surgery or in those with primary superficial abdominal obesity. The positive aspects of abdominoplasty are simplification of laparoscopic stage, reduced intra-abdominal pressure in postoperative period, excellent and good aesthetic effect and improved quality of life.

Симультанна абдомінопластика при лапароскопічній алопластиці вентральних гриж у пацієнтів з ожирінням

Aim. To study the results of simultaneous abdominoplasty and laparoscopic ventral hernia alloplasty in patients with obesity. Material and Methods. Simultaneous adbominoplasty and laparoscopic hernioplasty for ventral hernias were performed in 31 patients. The mean age of the patients was 53.7±6.5 (95% CI 51.3; 56.0). All patients were diagnosed as obese (body mass index more than 30 kg/m2). Incisional hernia was the main indication for surgery in the majority of patients - 20 (64,5%); in 11 (35%) cases a primary hernia of median localization was detected. Immediate and long-term results of surgical interventions were studied. Results and Discussion. In the postoperative period after drainage removal accumulations of fluid (seromas) were revealed in 9 (29%) patients using ultrasound investigation; in 2 cases they were evacuated by puncture. In one case, a marginal necrosis of the skin around the formed umbilicus occurred (healing by secondary tension); in another, lower lobe pneumonia was diagnosed (eliminated by antibiotic therapy). The average length of hospital stay was 7.3±1.4 (95% CI 6.8; 7.9) days, 6-8 days in most cases. Only two patients were hospitalized for more than 8 days due to postoperative complications. No recurrences of hernias were registered at follow-up examination 1-3 years later; good cosmetic results were achieved. Conclusions. In patients with ventral hernias with obesity and fat apron it is advisable to perform simultaneous intervention - abdominoplasty and allogernioplasty. It is advisable to perform alloplasty of ventral hernias with simultaneous abdominoplasty via laparoscopic access according to IPOM technology with the use of mesh endoprosthesis with antiadhesive coating. Simultaneous abdominoplasty causes an increase in the frequency of seromas in the postoperative period, but it does not increase the duration of hospital treatment. Simultaneous surgeries allow achieving good cosmetic results and do not increase the incidence of hernia recurrence. Keywords: obesity, fat apron, ventral hernia, abdominoplasty, laparoscopic alogernioplasty, result

Laser Doppler flowmetry in the determination and evaluation of blood flow characteristics during the correction of cosmetic defects of abdominal wall

The aim — to determine the possibility of using Laser Doppler flowmetry (LDF) for the study of blood flow in the vessels of the anterior abdominal wall in order to improve the results and develop new methods of treatment of patients with cosmetic defects of the anterior abdominal wall in patients with obesity I — II stage.Materials and methods. The study of blood flow on the anterior abdominal wall using LDF scan was performed in 132 patients, predominantly females 116 (87.9 %). The average age of patients was 43.4 ± 10.3 years. All patients had obesity of grade I or II. The average body mass index was 32.8 ± 2.7 kg/m2. The patients were divided into two groups: the main group — 64 (48.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations and liposuction (lipoabdominoplasty), and the control group — 68 (51.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations without liposuction. The mean duration of the operation in the main group was 255.3 ± 23.5 min., in the control group — 210.2 ± 21.2 min. Patients were examined in the preoperative period according to the standards of the Ministry of Health of Ukraine. LDF was performed before and during surgery and within 10 days of the postoperative period to determine the microcirculation indices (MI) of the anterior abdominal wall.Results and discussion. The study of MI in the control and main groups prior to the treatment, no statistically significant difference was found between the groups (p = 0.83). Immediately after the operation, the relationship between low‑frequency rhythms, which characterize the active mechanism of microcirculation, and high‑frequency and heart rhythms is disrupted. Normally, the amplitude of vasomotions is 20 — 25 % of the level of the LDF signal, immediately after the operation it decreases to 46 — 55 % at an oscillatiofrequency of 6 — 8 per minute. The average period of recovery of MI to the initial level is 8 days, the maximum is 11 days (for a smoker with type 2 diabetes). A decrease in the level of microcirculation within 1 — 2 days after surgery was 5.2 % bigger in the liposuction group than in the control group. There was no statistically significant difference between the groups in the dynamics of changes in MI during the study period (p = 0.767).Conclusions. The study showed that during lipoabdominoplasty there is no critical reduction in the microcirculation in the flaps compared to the classical abdominoplasty. «Ischemic crisis» in the flaps after lipoabdominoplasty is present during the first 2 days of the postoperative period. In the future, the progressive recovery of microcirculation in the flaps is noted. The safety of simultaneous abdominoplasty with liposuction has been proven. The advantage of lipoabdominoplasty is better mobilization of flaps which reduces the necessary dissection of the flap, preserves the musculo‑dermal perforants, helps to obtain better body contours and reduce the risk of repeated corrections in the postoperative period.

Abstract: Abdominoplasty with Lymphatic Microsurgery for Patients with Lower Extremity Lymphedema

INTRODUCTION: Patients with secondary lower extremity lymphedema (LEL) often develop suprapubic lymphedema. A majority of the cases have midline abdominal scars, with ventral herniation also observed. We developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of LEL. METHODS: A skin incision in a fleur-de-lis pattern was performed for horizontal and vertical abdominal skin and fat resection1. A caudal-based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, in cases with a ventral hernia, the hernial orifice was repaired directly and a monofilament polypropylene mesh. Thereafter, lymphaticovenular anastomosis (LVA) between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer (LNT) to the groin region was performed to restore lymphatic flow. LVA and LNT were also performed at the lower extremities to improve LEL. Perioperative change in limb volume was evaluated using the LEL index, and lymphatic function was evaluated by lymphoscintigraphy. RESULTS: Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The LEL index improved perioperatively, with a significant difference (p < 0.01). In eight patients who underwent lymphoscintigraphy before and after surgery, the lymphatic function was found to have not deteriorated in any limb. CONCLUSION: When simultaneous lymphatic microsurgeries and careful observation for complications were performed, abdominoplasty resulted in good outcomes in patients with LEL and suprapubic lymphedema without worsening of lymphedema.

Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years.

Abdominoplasty patients are frequently candidates for breast rejuvenation as well. Transabdominal breast augmentation permits insertion of breast implants through the abdominoplasty incision. This combined procedure is preferentially performed in an outpatient setting under monitored anesthesia care and nerve blocks. This study was a 14-year retrospective review of a single surgeon's technique and outcomes using transabdominal breast augmentation through a low transverse abdominoplasty incision in select patients requesting simultaneous abdominoplasty and bilateral breast augmentation. Patients had minimal ptosis, smoking cessation a minimum of 4 weeks before surgery and indefinitely thereafter, and a lack of superior abdominal or significant breast surgery. The study's 114 patients had a mean follow-up of 19.2 months. The procedure was performed under monitored anesthesia care with intercostal nerve blocks for most patients [n = 107 (93.9 percent)] and general anesthesia [n = 7 (6.1 percent)] for a few. Seventy-nine patients [n = 74 (64.9 percent)] underwent additional procedures, with most (n = 48) undergoing suction-assisted lipectomy. Many patients underwent multiple procedures. Most complications occurred predictably along the central distal abdominoplasty flap and were minor (small wound breakdown, seroma, and mild skin infection). Major complications [n = 8 (7.0 percent)] included two patients with implant malposition requiring revision and one patient with a Baker grade III capsule; notably, this patient was a half-pack-per-day smoker with a body mass index of 27 kg/m. Transabdominal breast augmentation is a safe, reliable procedure in the appropriately selected, healthy patient and may be used in minimally to moderately ptotic patients who request concurrent breast augmentation and abdominoplasty. Morbidity compares favorably to reported abdominoplasty series in the appropriately selected patient. Therapeutic, IV.

Abdominoplasty with Lymphatic Microsurgery for Patients with Secondary Lower Extremity Lymphedema.

Patients with secondary lower extremity lymphedema often develop suprapubic lymphedema. The authors developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of lower extremity lymphedema. A fleur-de-lis skin incision pattern was performed for horizontal and vertical abdominal skin and fat resection. A caudally based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, a lymphaticovenular anastomosis between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer to the groin region was performed to restore lymphatic flow. Lymphaticovenular anastomosis and lymph node transfer were also performed at the lower extremities to improve lower extremity lymphedema. Perioperative change in limb volume was evaluated using the lower extremity lymphedema index, and lymphatic function was evaluated by lymphoscintigraphy. Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The lower extremity lymphedema index improved perioperatively, with a significant difference (p < 0.01). In eight patients who underwent lymphoscintigraphy before and after surgery, the lymphatic function was found to have not deteriorated in any limb. When simultaneous lymphatic microsurgical procedures and careful observation for complications were performed, abdominoplasty resulted in good outcomes in patients with lower extremity lymphedema and suprapubic lymphedema without worsening of lymphedema. Therapeutic, V.

Simultaneous Abdominoplasty and Umbilical Hernia Repair via Laparoscopy: a Preliminary Report.

Umbilical hernias (UH) are common in postpartum patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularisation with possible umbilical necrosis. To minimize this risk we associated abdominoplasty with laparoscopic UH repair. The aim of this study was to present the technique of simultaneous abdominoplasty and UH repair and the first results. Simultaneous abdominoplasty and laparoscopic mesh UH repair was analysed in the first 10 cases. The intervention was performed by a plastic surgeon and a general surgeon. It begins as a standard abdominoplasty with flap elevation, umbilicus detachment and diastasis repair, if indicated. The second stage is the UH repair via laparoscopy using an intraperitoneal mesh. The third stage consists of umbilical transposition and closure of the abdominoplasty incision. We had no complications at the umbilicus or the hernia mesh. In all cases, umbilical vascularisation was preserved and no hernia recurrence was noted. Our first results suggest that the simultaneous UH repair with abdominoplasty is safe, minimizing the risk to the umbilicus blood supply. These first results encourage us to recommend this approach and perform a more detailed analysis of the whole series since our first case.

Sleeve Gastrectomy with Concomitant Abdominoplasty: A Novel Procedure

Background: Obesity is a major health problem and bariatric surgery has been shown to be the most effective approach in the management of obesity. Abdominoplasty is a common aesthetic procedure for divarication recti with abdominal apron and it has a wide appeal. The aim of this study is to determine the usefulness of laparoscopic sleeve gastrectomy with concomitant abdominoplasty.Subjects/methods: This is a retrospective study over a 7 - year period from 2009 to 2015, conducted on 82 patients who underwent sleeve gastrectomy and simultaneous abdominoplasty at Sunrise Group of Hospitals, Kochi and Dubai. A classical Pfannenstiel incision was made and the skin flap raised, laparoscopic sleeve gastrectomy carried out with the usual port placement directly on the sheath. Ventral hernia (if present) repaired, neoumbilicus created, redundant skin and fat excised and the flap sutured in layers over suction drains. Patients were followed up indefinitely.Results: Eighty two patients underwent combined laparoscopic bariatric surgery and abdominoplasty. Of these, 68 (82.93%) had ventral hernia repair carried out and 14 (17.07%) underwent abdominoplasty alone. The median length of stay was 4 days. 6 patients developed postoperative seroma, and 1 patient had surgical site cellulitis; whereas 3 patients developed surgical site infection. To date, one patient required a revision abdominoplasty.Conclusion: Considering the advantages, comparable hospital stay and the low rate of complications, it would be safe to conclude that LSG with concomitant abdominoplasty is a beneficial procedure in patients of obesity and abdominal apron.

Boomerang pattern correction of gynecomastia.

After excess skin and fat are removed, a body-lift suture advances skin and suspends ptotic breasts, the mons pubis, and buttocks. For women, the lift includes sculpturing adiposity. While some excess fat may need removal, muscular men should receive a deliberate effort to achieve generalized tight skin closure to reveal superficial muscular bulk. For skin to be tightly bound to muscle, the excess needs to be removed both horizontally and vertically. To aesthetically accomplish that goal, a series of oblique elliptical excisions have been designed. Twenty-four consecutive patients received boomerang pattern correction of gynecomastia. In the last 12 patients, a J torsoplasty extension replaced the transverse upper body lift. Indirect undermining and the opposing force of a simultaneous abdominoplasty obliterate the inframammary fold. To complete effacement of the entire torso in 11 patients, an abdominoplasty was extended by oblique excisions over bulging flanks. Satisfactory improvement was observed in all 24 boomerang cases. A disgruntled patient was displeased with distorted nipples after revision surgery. Scar maturation in the chest is lengthy, with scars taking years to flatten and fade. Complications were limited and no major revisions were needed. In selected patients, comprehensive body contouring surgery consists of a boomerang correction of gynecomastia. J torsoplasty with an abdominoplasty and oblique excisions of the flanks has proven to be a practical means to achieve aesthetic goals. Gender-specific body lift surgery that goes far beyond the treatment of gynecomastia best serves the muscular male patient after massive weight loss. Therapeutic, IV.

Panniculectomy and Abdominoplasty in Patients Undergoing Gynecologic Surgery

The current obesity epidemic poses significant challenges to surgical specialists striving to safely and effectively deliver medical care. In the United States, approximately 33.3% of men and 35.3% of women are classified as obese. Pelvic surgery, especially in patients with gynecological malignancies and those who require complex surgical procedures carries additional risk because of the increased technical difficulty posed by excess abdominal wall tissues and increased difficulty in providing and maintaining exposure of the appropriate pelvic anatomy. Simultaneous panniculectomy or abdominoplasty in selected patients may provide better access and visualization of the surgical field, reduce operative difficulty, and decrease perioperative morbidity. We retrospectively reviewed our experience in 15 patients undergoing panniculectomy or abdominoplasty in conjunction with gynecologic surgery. This review was conducted after approval by the local institutional review board. Complications were analyzed, and 2 (13%) of the 15 patients were found to have major complications. The only statistically significant finding for prediction of a negative outcome was an association of hypertension and advanced age with increased risk of postoperative transfusion (P < 0.02).

The Repair of Incisional Hernia Following Roux-en-Y Gastric Bypass—With or Without Concomitant Abdominoplasty?

Incisional hernia, found in up to 25% of patients, is a typical complication of open bariatric surgery. Open Roux-en-Y gastric bypass (RYGB) was performed in 204 patients. They have been followed-up for at least 6 months. Thirty-two patients in whom incisional hernia was diagnosed were divided into two groups-they were scheduled for hernia repair or hernia repair with abdominoplasty. The surgery was performed, on average, 20 months after RYGB operation. Fourteen patients [mean body mass 86.4 kg, mean body mass index (BMI) 30.0 kg/m(2)] have had hernias repaired. The mean duration of hospital stay was 7.2 days. Hernia repair along with abdominoplasty was performed in 18 patients with mean body mass 89.4 kg and BMI 31.5 kg/m(2). The mean duration of hospital stay was 8.7 days. Both examined groups were similar in body mass, BMI, age, and duration of hospital stay (p > 0.05), as well as gender distribution. The wound infection was diagnosed in six patients. The simultaneous abdominoplasty does not prolong the time of hospital stay of the patients undergoing incisional hernia repair. Infection is the most frequent complication of incisional hernia repair.

Excisional lipectomy for HIV-associated cervicodorsal lipodystrophy

The development of effective antiretroviral therapy for the treatment of human immunodeficiency virus (HIV) has allowed for prolonged and healthier lives for affected patients. However, significant side effects from the drugs have been well documented, including syndromes of abnormal fat distribution. Cervicodorsal lipodystrophy, or "buffalo hump" deformity, is a common presentation of lipodystrophy syndrome and can cause significant disfigurement to the patient. Surgical correction has been the mainstay of treatment. The authors report on the use of excisional lipectomy to correct cervicodorsal lipodystrophy. Six male patients and one female patient (mean age, 47.2 years) underwent excisional lipectomy for buffalo hump deformity caused by HIV protease inhibitor use. Common complaints on presentation included disfigurement, neck pain, and difficulty sleeping. Deformity had first been observed an average of 4.75 years before presentation (range 2 to 7 years). At the time of consultation all patients were on antiretroviral regimens that included protease inhibitors. Excisional lipectomy of the hypertrophied cervicodorsal fat pad was performed on all patients, with suction-assisted lipoplasty (SAL) additionally to optimally contour the nondystrophic fat at the periphery of the resection. One patient also underwent simultaneous abdominoplasty, another underwent rhytidectomy with autologous fat transfer, and one patient received malar autologous fat injections. The average operative time for all procedures was 2.7 hours (range 1.0 to 5.8 hours). Complications included seroma in three cases and wound dehiscence in one patient, none of which required reoperation. At an average of 26.6 months of follow-up, all patients report satisfaction with their results, and there have been no recurrences. Cervicodorsal lipodystrophy is a well-described complication of extended use of HIV protease inhibitor therapy. Patients may seek consultation with plastic and reconstructive surgeons for correction of the aesthetic and functional morbidity associated with the deformity. Because of the fibrous nature of the hypertrophied cervicodorsal fat and the high rate of recurrence after SAL alone, an approach with excisional lipectomy (with or without SAL) may provide improved results and superior long-term outcomes.

Risk of Seroma with Simultaneous Liposuction and Abdominoplasty and the Role of Progressive Tension Sutures

This study aimed to evaluate the true risk of seroma with simultaneous abdominoplasty and liposuction and to assess the role of progressive tension suture in preventing it. A retrospective chart review of 235 consecutive abdominoplasties performed by a single surgeon was conducted. Matarasso classification was used, and 146 patients with type 4 abdominoplasty were selected. These patients were divided into two groups. The 96 patients in group A had no progressive tension sutures. This group was further subdivided into subgroup A1 (43 patients), which had abdominoplasty alone, and subgroup A2 (53 patients), which had abdominoplasty with liposuction. The 50 patients in group B had progressive tension sutures. This group was further subdivided into subgroup B1 (26 patients), which had abdominoplasty alone, and subgroup B2 (24 patients), which had abdominoplasty with liposuction. The two groups were similar in terms of body mass index, age, and smoking status. The incidence of seroma formation was 26% (n = 25) in group A, as compared with 4% (n = 2) in group B (p = 0.001). Group B showed 0% seroma formation when abdominoplasty alone was performed, as compared with 7.7% when liposuction was performed at the same time (p = 0.08, no statistical difference). Also, no statistical difference was seen when similar subgroups were compared in group A (p = 0.87). The findings of this retrospective study show that the application of progressive tension sutures in abdominoplasty significantly reduces the incidence of seroma, and that simultaneous abdominoplasty with liposuction does not contribute to this complication.

Simultaneous Abdominoplasty and Umbilical Reconstruction Using a Modified C-V Flap Technique

Simultaneous Abdominoplasty and Umbilical Reconstruction Using a Modified C-V Flap Technique

Body Lift: An Account of 200 Consecutive Cases in the Massive Weight Loss Patient

The epidemic of obesity in the United States has led to a rapid increase in the number of bariatric procedures performed over the past several years. The dramatic changes to the torso following massive weight loss are only partially addressed by routine procedures such as abdominoplasty and liposuction. Circumferential body lifts or simultaneous abdominoplasty, thigh, and buttock lifts are becoming the method of choice for treating the postbariatric condition. In this article, the authors review the senior author's experience of 200 body lifts with massive weight loss individuals. The charts of 200 consecutive body lift patients were reviewed for complications and other variables. The preoperative markings, current surgical technique, and postoperative care are described. The patients were classified into three types according to their body mass index at the time of surgery. Type I individuals had a body mass index less than 28, type II individuals had a body mass index between 28 and 32, and type III individuals had a body mass index greater than 32. Type I and II patients in many instances achieved a nearly ideal body contour. Type II and III individuals also had a significant functional and aesthetic improvement but were more likely to have complications. The overall complication rate was 50.0 percent. The most frequent complications were skin dehiscence and seroma formation at 32.5 percent and 16.5 percent, respectively. The body lift very effectively addresses the functional and aesthetic concerns of the massive weight loss patient. Careful patient selection and education are essential to a good outcome.

Does lipoplasty really add morbidity to abdominoplasty? Revisiting the controversy with a series of 406 cases

The popularity of plastic surgery "makeover" television programs has increased interest among the public and the medical community in both the positive and negative aspects of combined surgery procedures. In particular, the safety of combining abdominoplasty with lipoplasty became a matter of concern following multiple deaths in Florida and the consequent moratorium on simultaneous abdominoplasty and lipoplasty enacted by the Florida Board of Medicine. The goal of this study was to evaluate the morbidity of abdominoplasty combined with suction-assisted lipoplasty (SAL) compared to the morbidity of abdominoplasty alone. A retrospective review of 406 consecutive abdominoplasty procedures performed by the senior author (W.G.S.) at a single outpatient surgery center was conducted. Cases were sorted into 2 groups: those that had abdominoplasty only and those that had abdominoplasty with SAL. The SAL group was further subdivided into 4 groups based on the volumes of aspirate removed. The primary groups and subgroups were compared with regard to morbidity. In addition, the location of SAL, age, body mass index (BMI) and surgery time of each patient were evaluated as contributing factors to morbidity. No statistically significant differences in complication rates were found when comparing abdominoplasty with SAL to abdominoplasty alone. Additionally, the amount and location of lipoplasty, age, BMI and surgery times did not significantly affect patient morbidity. The prevalence of morbidity in all groups compared favorably to parameters established in previous studies of abdominoplasty and SAL. This extensive retrospective study provides further evidence that combining abdominoplasty with SAL does not increase patient morbidity compared to abdominoplasty alone.

Comprehensive surgical treatment of prune belly syndrome: 17 years' experience with 32 patients

Objectives To describe the results of comprehensive surgical management of prune belly syndrome. Methods Thirty-two patients were evaluated and treated for abdominal and genitourinary abnormalities. The surgical procedure, including simultaneous abdominoplasty, bilateral orchiopexy, and urinary tract reconstruction, was performed according to individual needs. At follow-up, the urinary tract, abdominal, and genital anatomy and function were evaluated. Results The upper urinary tract anatomy and function were stabilized in 30 patients, and no vesicoureteral reflux was found postoperatively. The bladder drainage was adequate in 29 patients, and 4 presented with recurrent bacteriuria. Abdominoplasty improved flaccidity in 29 patients. Adequate testicular position and consistency were obtained in 54 testes. Complications included acute tubular necrosis (1 patient) and ureterovesical obstruction (3 patients). Conclusions Individualized comprehensive surgical management of prune belly syndrome is effective, with an acceptable incidence of complications and excellent long-term results.