Correction of Contour Deformity Using Reverse Abdominoplasty Combined with Mini-Abdominoplasty
Abdominal contour deformities following procedures such as liposuction present unique challenges for plastic surgeons. These deformities often manifest as uneven skin laxity, residual fat deposits, or irregularities in the adherence of skin to underlying fascia. A notable case discussed in this study involves a female patient who developed a distinctive contour deformity one year after undergoing liposuction. The deformity was characterized by significant skin laxity across the abdominal wall, except for a 2 cm radius around the umbilicus, where the skin adhered tightly to the underlying fascia. This localized adherence created a compact umbilical zone surrounded by loose, redundant skin. Traditional abdominoplasty techniques risked compromising the already fragile blood supply near the umbilicus if extensive undermining were performed. To address this, the authors proposed an innovative combination of reverse abdominoplasty and mini-abdominoplasty, aiming to restore abdominal aesthetics while preserving vascular integrity.
Patient Presentation and Preoperative Evaluation
The patient, a healthy woman with no significant medical history, sought correction of her abdominal contour following unsatisfactory results from prior liposuction. Her primary concerns included excess skin laxity above the umbilicus and lateral abdominal regions, alongside a firm, compact umbilical area. Physical examination revealed preserved adherence of the periumbilical skin (within 2 cm of the umbilicus) to the fascia, contrasting with poor adherence in the surrounding regions. This created a “trampoline-like” effect, where the central abdomen remained taut, while the periphery exhibited sagging. Preoperative imaging and vascular assessment confirmed adequate perfusion in the umbilical region but highlighted the risk of devascularization if aggressive tissue undermining were pursued.
Surgical Technique
The surgical strategy combined two approaches: reverse abdominoplasty and mini-abdominoplasty. The rationale was to address upper abdominal laxity via reverse abdominoplasty while minimizing disruption to the periumbilical blood supply through a limited mini-abdominoplasty.
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Reverse Abdominoplasty:
A curvilinear incision was made along the inframammary fold, extending bilaterally toward the anterior axillary lines. Subcutaneous dissection was performed inferiorly to the level of the umbilicus, allowing excision of redundant upper abdominal skin. The superior abdominal flap was then advanced downward and secured to the chest wall fascia using interrupted sutures. This step addressed the supraumbilical skin laxity without disturbing the umbilical region. -
Mini-Abdominoplasty:
A low transverse incision was made just above the pubic hairline, similar to a traditional abdominoplasty but limited in scope. Dissection was carefully performed up to the umbilical zone, avoiding the 2 cm adherent area around the umbilicus. No umbilical transposition was required due to the preserved skin quality in this region. The inferior abdominal flap was pulled downward, excess skin and fat were excised, and layered closure was performed. Liposuction-assisted lipectomy was selectively applied to refine the lateral abdominal contours.
Key technical considerations included:
- Preservation of the deep inferior epigastric perforators to maintain blood supply to the lower abdominal flap.
- Limited undermining around the umbilicus to prevent ischemia.
- Tension-free closure to minimize scarring and ensure proper wound healing.
Postoperative Outcomes
The patient experienced an uncomplicated recovery, with drain removal on postoperative day 3 and sutures removed at 14 days. Follow-up at 6 months revealed significant improvement in abdominal contour, with smooth transitions between the umbilical zone and surrounding regions. The scar quality along the inframammary fold and suprapubic area was rated as favorable, with no evidence of necrosis, infection, or wound dehiscence. Patient satisfaction surveys indicated high scores for aesthetic improvement and functional comfort.
Discussion and Comparative Analysis
The authors emphasize that their technique represents the first documented use of combined reverse abdominoplasty and mini-abdominoplasty for this specific deformity. Prior studies, including the AMBRA (Augmentation Mammaplasty by Reverse Abdominoplasty) technique by Zienowicz and Karacaoglu, reported combining reverse abdominoplasty with full abdominoplasty in 43% of cases (16/37 patients). However, those cases focused on concurrent breast augmentation and abdominal contouring, without addressing the unique periumbilical adherence seen in this patient.
The critical distinction lies in the vascular preservation strategy. Traditional full abdominoplasty involves extensive undermining around the umbilicus, which could compromise perfusion in cases where the skin is already adherent. By avoiding umbilical transposition and limiting dissection, the authors reduced the risk of necrosis. Furthermore, the mini-abdominoplasty component allowed targeted correction of lower abdominal laxity without destabilizing the umbilical blood supply.
The authors acknowledge that previous techniques, such as fleur-de-lis abdominoplasty or circumferential lipectomy, might address similar deformities but often require longer incisions or staged procedures. Their combined approach offers a single-stage solution with minimized scarring.
Addressing Prior Literature and Criticisms
A commentary on the study noted that Zienowicz and Karacaoglu’s earlier work involved reverse abdominoplasty with full abdominoplasty, suggesting the current study’s claim of novelty might be overstated. The authors respond that their technique specifically targets a deformity not described in prior literature: localized periumbilical adherence with peripheral laxity. In such cases, traditional methods requiring umbilical detachment or wide undermining would jeopardize vascularity. The AMBRA technique, while innovative, focused on simultaneous breast augmentation and did not involve selective preservation of the umbilical zone.
Clinical Implications and Future Directions
This case highlights the importance of tailoring surgical approaches to patient-specific anatomical variations. Surgeons encountering post-liposuction deformities with irregular skin adherence should consider vascular mapping and staged undermining to prevent ischemia. The success of this combined technique suggests its potential application in patients with similar deformities, such as those resulting from weight fluctuations or prior surgeries.
Future studies could explore long-term outcomes in larger cohorts or compare complication rates between this technique and traditional methods. Additionally, integrating imaging modalities like indocyanine green angiography could further refine intraoperative perfusion assessment.
Conclusion
The combination of reverse abdominoplasty and mini-abdominoplasty offers a safe and effective solution for correcting abdominal contour deformities characterized by localized periumbilical adherence. By preserving vascular integrity and minimizing tissue disruption, this approach achieves aesthetic refinement while reducing postoperative risks. The technique underscores the value of adaptive surgical planning in complex abdominal reconstructions.
doi.org/10.1097/CM9.0000000000000045
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