Improving esthetics and safety in abdominoplasty with broad lateral subcostal perforator preservation and contouring with liposuction

Annals of Plastic Surgery
Adam R Kolker

Abstract

Suction-assisted lipectomy (SAL) in association with abdominoplasty has been regarded with trepidation, with ischemia of the apron flap, skin loss, and open wounds among the potential dire consequences. Leaving midabdominal and epigastric fatty excess, however, confers suboptimal contour and often a mediocre cosmetic result. In this study, a theoretical and technical approach that improves esthetics and safety in anterior and circumferential abdominoplasty with contouring using SAL is described and evaluated. Forty-two patients were treated with follow-up ranging from 5 to 40 months (mean follow-up 19 months). Through a low-transverse incision, the upper flap is elevated widely to the umbilical horizontal. The umbilicus is circumcised. The dissection then proceeds in a narrow column above the rectus sheaths to the xiphoid. Judicious subcostal undermining is performed, maintaining an intact bilateral subcostal "perforator zone" of 4 to 6 cm. Diastasis repair and anterior sheath plication are performed, and the umbilicus is anchored to the fascia. Excess skin and fat are excised from the inferior aspect of the flap, and the flap is inset. Wetting solution is instilled, and SAL of the entire flap, particularly in the midline and i...Continue Reading

References

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Citations

May 13, 2009·Aesthetic Plastic Surgery·Luiz Haroldo Pereira, Aris Sterodimas
Jan 15, 2010·Plastic and Reconstructive Surgery·António Costa-FerreiraJose Amarante
May 29, 2012·Plastic and Reconstructive Surgery·Michele A Shermak
Feb 4, 2009·International Archives of Medicine·Youssef SalehAlaa A Abd-Elsayed
Feb 15, 2019·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·S GiordanoI Koskivuo
May 18, 2016·Annals of Plastic Surgery·António Costa-FerreiraJosé Amarante
Feb 13, 2015·Plastic and Reconstructive Surgery. Global Open·Rita Valença-FilipeAntónio Costa-Ferreira

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