Combined abdominal contouring and mastopexy

Published on 23/05/2015 by admin

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Last modified 23/05/2015

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Chapter 9 Combined abdominal contouring and mastopexy

Introduction

The combination of abdominoplasty and mastoplasty is very common, especially for patients post pregnancy or post weight loss with abdominal laxness, striae, muscle rectus diastases, and breast ptosis. It is most commonly performed in women in the age range 30–50. Many traditional abdominoplasty and mammaplasty techniques have been published in the last 50 years with extraordinary results, but with the introduction of liposuction, described by Illouz1 in 1980, we had a new tool for body contouring surgery. This opened up a new treatment method for lipodystrophies in the epigastric, flank, dorsum, trochanteric, and buttock areas. The procedure combining abdominoplasty and liposuction was called “lipoabdominoplasty,” and since then many new techniques and modifications have been proposed.

Since abdominoplasty was first described by Callia2 and Pitanguy,3 many refinements have been published in the literature.414 In 1975, Sinder15 described the superior epigastric incision approach to estimate a safe inferior abdominal flap excision. Planas16 published a similar procedure in 1978 and Serson Neto17 and Pontes18 described the geometrical inferior flap block resection. Mammaplasty, when combined with abdominoplasty, can take the form of breast augmentation, mastopexy, or breast reduction. For breast augmentation we prefer to use silicone texturized prostheses. For breast reduction we prefer the Silveira Neto dermoglandular rotation flap, published in 197619 and subsequently improved by Uebel in 1978.20 For mastopexy we use the Pitanguy21 or Ariê22 techniques with a superior pedicle flap. There are many other techniques in the literature but these are the most used by us in body contouring surgery – very simple procedures that maintain physiological function and good esthetic results. Stemming from those techniques, we have introduced some important approaches and details to ensure consistency. This will be discussed further in this chapter.

Abdominoplasty

In this chapter we will address abdominoplasty combined with mammaplasty for patients with abdominal laxness, rectus muscle diastases, localized lipodystrophy with breast ptosis, hypomastia, or breast hypertrophy. These are very common pathologies after pregnancy and are also seen in post-bariatric surgical patients.

Preoperative Preparation

In a standing position we take pictures with a digital camera (10 megapixels) and we mark the incisions of the abdomen wall and breasts, as well as all the areas to be treated with liposuction. We estimate the amount of skin and breast tissue to be removed, and in the sitting position we estimate the amount of skin and fat to be removed from the abdominal wall (Fig. 9.1A–E).

With the patient in a sitting position, we estimate the amount of skin resection needed.23 We identify the lateral inguinal folds (Fig. 9.2A, B) and a low abdominal curved line is delineated approximately 8 cm from the labia major vertex.

FIG 9.2B APPEARS imageONLINE ONLY

With the patient in a standing position, a line drawn from the superior umbilical region is connected to both extremities and the areas to undergo liposuction are outlined (Fig. 9.3).

Surgical Technique