Classification for indications of Lipoabdominoplasty and its Variations
Classification for indications of Lipoabdominoplasty and its Variations
Wilson Novaes Matos Jr., M.D.
, Ricardo Cavalcanti Ribeiro, M.D.
, Rogério Porto da
Rocha, M.D., and Fernando V. Carrillo Jimenez, M.D.
Purpose
This paper proposes a new clinical – therapeutic abdomen classification, to indicate the best technique (lipoabdominoplasty) for each case (table I) (figure 1).
In 1992 Illouz accomplished the abdominoplasty without undermining after abdominal liposuction, naming it “mesh undermining” with restricted indications. In 1999 Shestak published papers in which he associated liposuction, partial removal of supra pubic skin and restricted undermining. In 1999 and 2000 Avelar proposed the overall treatment of the abdominal subcutaneous fat pad with deep liposuction, without undermining and without fat pad resection, with supra pubic and infra mammary skin partial removal for the upper abdomen treatment, without transposing the navel. In 2001, Saldanha proposed the association of liposuction with classical abdominoplasty . Since 2000 we have been using this technique to treat the abdominal region. The lipoabdominoplasty standardized and systemized the association of the Liposuction with the classic abdominoplasty. It is based on five surgical phases: 1.- Dissection and sculpturing of the subcutaneous deep layer and superficial layer through the liposuction 2.- Selective undermining and plication of the anterior recti sheath 3.- Preservation of the perforator vessels 4.- Preservation of the
Scarpa's fascia and deep fat 5.- Resection of skin and umbilical transposition.
Methods
Two hundred eleven patients were submitted to lipoabdominoplasty, lipominiabdominoplasty and classical abdominoplasty, from January of 2000 to May of 2004, aged between 28 and 69 years old, Most of them were female, and just one was male.
Concerning the surgical process, we initiate it with the clinical evaluation before the surgery, and during the patient´s physical examination we observe some skin features such as: elasticity, laxity, wrinkles, surface irregularities and presence of scars. The position of the navel, its distance in relation to the pubis and xiphoid appendix and scars in hypogastrium are initial parameters to indicate the amount of skin to be removed and the future positioning of the umbilical scar. The thickness, the amount and the disposal of the
fatty tissue are evaluated, to direct the amount of fat to be aspirated. We diagnose the presence, the degree and the localization of rectus abdominal diastasis for plication ( supraumbilical or infraumbilical localization). The body contouring lipodistrophies are studied in other areas like flanks, gluteus, sacrum and pubis.
The subcutaneous abdominal tissue is divided into two layers, separated by the Scarpa fascia, considering the areolar or the superficial layer. The Scarpa fascia is a new surgicalanatomical component to be preserved in the lower abdomen at the lipoabdominoplasty.
According to Taylor´s papers, 80% of the abdominal wall blood supply comes from the abdominal perforating branches of the lower and upper epigastric arteries.
Techniques
The technique uses the infiltration with saline solution and epinephrine, at the concentration of 1:1.000.000 . The whole abdomen is aspirated by the “scanner” technique, with the cannula holes turned to the lateral, in short circular movements into the superficial and deep layers, replacing the conventional undermining.
The variation of indication for each case originated the strategy and technique changes, depending on the need for treatment of the abdominal structures. (figure 1) (table I)
Results/Complications
We have observed good results and the patients´ satisfaction when it comes to the abdominal profile appearance. The advantages of the lipoabdominoplasty and its variations are: low rate of complications, such as epitheliosis (1,5%), seroma (1%), haematoma (0,1%), necrosis (0,1%); smaller scars, preserved sensibility at the suprapubic region, better abdominal contouring and decreased abdominal circumference due to liposuction.
The superficial and deep liposuction represents the base of the techniques of the classification.lipoabdominoplasty. In 4% we just used the cannulae without aspiration to do the undermining, once there was no indication for liposuction.
The selective undermining and flap liposuction reduce the surgical trauma, preserve the perforating arteries and decrease the useless areas, replacing the great dissection of traditional abdominoplasty and lipectomies, reducing the complications. The abdominal shape which is accomplished through liposuction and repositioning of muscle structures, prevents the need for bigger plications, as recommended by some authors . The preservation of the Scarpa fascia is important for the flap lodging in the lower abdomen avoiding loss of suprapubic sensibility and seroma, once the lymphatic system and veins
are preserved. In 5 cases in which the Scarpa fascia was completely removed, it was observed an unlevelling at the pubic region and seroma.
The treatment of fatty panniculus is a limitation of the classic abdominoplasty, demanding complementary surgery for liposuction. The use of lipoabdominoplasty in atypical cases is interesting because it shapes the fatty tissue, once the preservation of the flap nutrition brings safety to the removal of excessive skin.
Conclusion
The lipoabdominoplasty is a conservative technique that dissects the abdomen anatomically and shapes it with fewer traumas, repositioning and correcting all abdominal wall layers. Faster and less painful post-operative period. The bases of the technique are the five fundamental steps of lipoabdominoplasty that are utilized in all classification groups.
Table I: Clinic-Therapeutic Classification for Lipoabdominoplasty and Variations
Surgical Technique Sub Group Skin Muscles
Liposuction
Lipomini-abdominoplasty
III
Liposuction
Suprapubic resection
Plication
Transposition of the umbilicus
No flaccidity
I
Liposuction
Suprapubic resection
With or without lower plication
II
Liposuction
Suprapubic resection and total or infra-umbilical plication
Down ward traction of the umbilicus
Light / mild
Infra-umbilical flaccidity
Infra and supraumbilical light / mild flaccidity
With / without lower diastasis
Partial or total diastasis
Infra and supraumbilical mild flaccidity
High umbilicus
No diastasis
Partial or total diastasis
Lipoabdominoplasty
Liposuction
Total Plication
Supra-umbilical Resection
Excessive skin in the whole abdomen
Total diastasis
Excessive skin in the whole abdomen
Diastasis
Ventral hernia
Classic Abdominoplasty Dermolipectomy
Herniorrhaphy
Plication
Lipoabdominoplasty Classification
LIPOMINIABDOMINOPLASTIA I LIPOMINIABDOMINOPLASTY I
LIPOMINIABDOMINOPLASTY I I
REVERSE
LIPOABDOMINOPLASTY
VERTICAL
LIPOABDOMINOPLASTY
ANCHOR
LIPOABDOMINOPLASTY
LIPOABDOMINOPLASTY
LIPOABDOMINOPLASTY
IN OBESE PATIENTS
Lipoabdominoplasty
Anchor Lipoabdominoplasty
Lipominiabdominoplasty I
Lipoabdominoplasty II
Lipominiabdominoplasty III
Lipoabdominoplasty
Lipominiabdominoplasty I with plication
Lipoabdominoplasty in obese patients
Anchor Lipoabdominoplasty
Lipominiabdominoplasty I
Lipominiabdominoplasty III
