Abdominal contouring is one of the most commonly performed cosmetic procedures today. In 2008, 121,653 abdominoplasties were performed in the United States. The standard abdominoplasty continues to be the mainstay of midline reshaping for patients with an obvious skin deformity; however, recent advances in liposuction and surgical technique allow for a re-adaptation of the procedure to suit individual needs. Through careful evaluation of skin, fat, and muscle quality, patients can be stratified into different treatment groups, each with a customized surgical plan.
Factors that play important roles in determining body shape and contour include aging, genetics, gender, and parity. Lifestyle and medication regimens may also contribute to varying degrees to changes in abdominal girth and firmness. While there are behavioral modifications that can significantly improve the appearance of the abdomen, surgical intervention is often warranted to achieve the desired result.
Even for patients who are not overweight, inherent weight distribution patterns may preclude a desired waistline, despite efforts with diet and exercise. Female patients in particular will often experience permanent changes in their abdominal profile after childbearing, with varying degrees of secondary skin and muscle laxity or deformity. Patients who have undergone abdominal surgery may have disfiguring scars, corresponding soft tissue folds, or resultant diastasis. Finally, some patients with minimal contour irregularities may seek less invasive methods of improvement. After careful evaluation and counseling, the appropriate surgical intervention can achieve highly satisfying results.
The anterior abdominal wall is composed of several distinct layers of soft tissue. Beneath the skin and subcutaneous fat lie Camper fascia and the more membranous Scarpa fascia. In the center of the abdomen, the next layer of tissue is the rectus abdominus muscle, bounded by the anterior and posterior rectus sheaths above the arcuate line. Beneath the arcuate line, the rectus has only an anterior sheath, making that layer weaker posteriorly.
The lateral aspects of the abdominal wall are composed of four layers: the external oblique, the internal oblique, the transversus abdominus, and the transversalis fascia. While all of the above muscles contribute to the shape and contour of the abdomen, it is the rectus abdominus that is chiefly responsible for the outline of the mid abdomen.
In performing an abdominoplasty, the skin and subcutaneous fat is dissected off of the anterior rectus sheath and the external oblique muscles. Identification of the relevant tissue planes is critical to a proper dissection, especially in the event of prior surgery (ie, cesarean section) or abdominal hernias. It is also important to distinguish between the different muscle groups, their fascia, and their orientation when performing the tissue plication.
If the muscle layers or their fascia appear particularly weak, mesh may be used to ensure the strength of the abdominal wall. Variations in intra-abdominal pressure, postoperative changes in the distribution of tension lines, and long incisions will promote the ...