Abstract
Background
Patients requiring surgical skin excision after massive weight loss are challenging and require an individualized approach. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars from open gastric bypass surgery in the upper abdomen, which compromise blood supply of the abdominal skin.
Methods
We propose four different surgical techniques for safe abdominal body contouring in the presence of such scars: (1) a limited abdominoplasty of the lower abdomen is performed, and then contouring is completed by a reversed abdominoplasty with scar positioning in the submammary folds; (2) a one-stage procedure characterized by skin resection in the upper and lower abdomen, in which blood supply of the skin island between the submammary and suprapubic incisions is ensured by periumbilical perforators; (3) a perforator-sparing abdominoplasty with selective dissection of periumbilical abdominal wall perforators to secure flap blood supply and allow complete flap undermining up to the xyphoid process; (4) for patients with extensive excess skin, a modified Fleur-de-Lys abdominoplasty performed in such a way that the old transverse scar is transformed into a vertical scar.
Results
The treatment of four exemplary patients is described. All techniques yielded good esthetic and functional results through preservation of abdominal blood supply.
Conclusion
Through an individualized approach, adequate abdominal body contouring can be performed safely, even in the presence of transverse surgical scars in the upper abdomen.
Similar content being viewed by others
References
Alvarez-Cordero R, Aragon-Viruette E. Incisions for obesity surgery: a brief report. Obes Surg. 1991;1:409–11.
Jones KBJ. The superiority of the left subcostal incision compared to mid-line incisions in surgery for morbid obesity. Obes Surg. 1993;3:201–5.
Jones KBJ. The left subcostal incision revisited. Obes Surg. 1998;8:225–8.
de Castro CC, Aboudib JJ, Salema R, Gradel J, Braga L. How to deal with abdominoplasty in an abdomen with a scar. Aesthet Plast Surg. 1993;17:67–71.
Huger WEJ. The anatomic rationale for abdominal lipectomy. Am Surg. 1979;45:612–7.
Rieger UM, Aschwanden M, Schmid D, Kalbermatten DF, Pierer G, Haug M. Perforator-sparing abdominoplasty technique in the presence of bilateral subcostal scars after gastric bypass. Obes Surg. 2007;17:63–7.
Chang BW, Luethke R, Berg WA, Hamper UM, Manson PN. Two-dimensional color doppler imaging for precision preoperative mapping and size determination of TRAM flap perforators. Plast Reconstr Surg. 1994;93:197–200.
Rand RP, Cramer MM, Strandness DEJ. Color-flow duplex scanning in the preoperative assessment of TRAM flap perforators: a report of 32 consecutive patients. Plast Reconstr Surg. 1994;93:453–9.
Dellon AL. Fleur-de-Lis abdominoplasty. Aesthet Plast Surg. 1985;9:27–32.
Ramsey-Stewart G. Radical “Fleur-de-Lis” abdominal after bariatric surgery. Obes Surg. 1993;3:410–4.
Duff CG, Aslam S, Griffiths RW. Fleur-de-Lys abdominoplasty—a consecutive case series. Br J Plast Surg. 2003;56:557–66.
Mayr M, Holm C, Hofter E, Becker A, Pfeiffer U, Muhlbauer W. Effects of aesthetic abdominoplasty on abdominal wall perfusion: a quantitative evaluation. Plast Reconstr Surg. 2004;114(6):1586–94.
Grazer FM, Goldwyn RM. Abdominoplasty assessed by survey, with emphasis on complications. Plast Reconstr Surg. 1977;59:513–7.
Taylor J, Shermak M. Body contouring following massive weight loss. Obes Surg. 2004;14(8):1080–5.
Matarasso A. Liposuction as an adjunct to a full abdominoplasty revisited. Plast Reconstr Surg. 2000;106:1197–202.
Saldanha OR, Souza Pinto EB, Mattos WN Jr, Pazetti CE, Lopes Bello EM, Rojas Y, et al. Lipoabdominoplasty with selective and safe undermining. Aesthet Plast Surg. 2003;27:322–7.
Graf R, de Araujo LR, Rippel R, Neto LG, Pace DT, Cruz GA. Lipoabdominoplasty: liposuction with reduced undermining and traditional abdominal skin flap resection. Aesthet Plast Surg. 2006;30:1–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rieger, U.M., Erba, P., Kalbermatten, D.F. et al. An Individualized Approach to Abdominoplasty in the Presence of Bilateral Subcostal Scars after Open Gastric Bypass. OBES SURG 18, 863–869 (2008). https://doi.org/10.1007/s11695-007-9414-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9414-6