Abdominoplasties: Classification (Bozola and Psillakis) and Concepts of Treatment Strategies

Abstract

In general, miniabdominoplasties are considered as minor surgery when compared with classical abdominoplasty or with liposuction-abdominoplasty done with the resection of all the infraumbilical skin and transposition of the umbilicus. The classification “miniabdominoplasty” does not indicate the real complexity and the extent of this surgery. Nothing is “mini.” Sometimes this surgery is equal to or greater than a classical abdominoplasty. As has been said, this classification could make sense if it is made by observation of the suprapubic scar extension, when the skin excess is small. It is a classification that is simpler than the reality. However, the present author regards the miniabdominoplasty as inappropriate.

However, in accordance with the following factors: (1) excess skin, (2) excess subcutaneous fat, (3) laxity or not of the musculoaponeurotic layer, and (4) the position of implantation of the umbilicus, and dividing the abdomen into two segments, inferior and superior, it is possible, as shown below, to classify abdomen types into five groups and to treat each type correctly, obtaining good final results.

• Group I (G I): No excess skin. Fat excess in the abdomen, flanks, and lumbar region. No muscle aponeurotic diastasis. Umbilicus in normal position, near the metric relation of 1/1.5 to 1/1.6 between the infra- and supraumbilical segments. Treatment: infiltrative vibroliposuction.

• Group II: Infraumbilical skin excess. Fascia superficialis sectioned (cesarian section) and not sutured. Fat excess similar to that in G I. A good muscle-aponeurotic layer. Umbilicus implantation near the ratio of 1/1.5 to 1/1.6 between the infra- and supraumbilical segments (normal). Treatment: infiltrative vibroliposuction. Resection of the transverse suprapubic spindle-shaped skin excess. Low curvilinear scar, no cutting the lyre’s bottom, 1–1.5 cm above the inguinal pleats.

• Group III: Infraumbilical skin excess . Fascia superficialis sectioned. Fat excess similar to that in G I. Oblique muscle diastasis. Umbilicus implantation with normal proportion (1/1.5 to 1/1.6) between infra- and supraumbilical segments. Treatment: Infiltrative vibroliposuction similar to that in G I. Resection of the spindle-shaped skin excess similar to that in G II. Plication of the oblique muscle aponeurosis through two lateral tunnels from the iliac drainage to the latero-costal margins; there are no important perforator vessels.

• Group IV: Little or medium skin excess in the supra- and infraumbilical segments. Umbilicus with high implantation. Relation greater than 1/1.4 between the infra- and supraumbilical segments. Fat similar to that in G I. Diastasis of the rectus muscles. Treatment: Infiltrative vibroliposuction. Spindle-shaped skin resection similar to that in G II and G III. Plication of the rectus muscle diastasis through a medial tunnel up to the xiphoid appendix detaching the umbilicus implantation and reattaching with a bolster stitch 2–4 cm below (proportion up to 1/1.6 between the infra- and supraumbilical segments).

• Group V: Skin excess in the infra- and supraumbilical segments. Umbilicus with low implantation; proportion 1/1.6 or more for the infra- and supraumbilical segments (this is a long segment). Fat excess similar to that in G I, II, III, and IV. Diastasis of the rectus and/or oblique muscles. Treatment: Infiltrative vibroliposuction. Transverse spindle-shaped skin resection from the pubis to the umbilicus. Plication of the rectus muscle aponeurosis through the medial tunnel and plication of the oblique muscles with a lateral tunnel when necessary. Umbilicus transposition and omphaloplasty.