Reverse Abdominoplasty

Abstract

The most frequent aesthetic alterations of the epigastrium are adiposity and flaccidity. Adiposity is resolved through liposuction that may supplement traditional abdominoplasties when necessary. Moderate levels of epigastric flaccidity also benefit from approaches based on infraumbilical access. However, when the flaccidity is predominantly supraumbilical, the reverse abdominoplasty is indicated, associated or not with a transverse infraumbilical incision (Fig. 35.2).

The operation is performed under general anesthesia in a supine position, with incision in the inframammary fold. The downward undermining process follows the aponeurotic level, as in regular abdominoplasties. The rest of the procedure depends on the type of conduct selected, with or without navel detachment and with or without undermining the lower abdomen.

Once undermining has been completed, the upper flap will be split in half along the midline, as far as the planned resection location. A strong stitch placed here maintains traction and demarcates the two cutaneous-adipose segments that are normally resected, but which may also be used for breast augmentation.

With resectioning completed, suturing takes place at three levels, with the fascia superficialis stitched to the deep fascia in order to accentuate the inframammary fold. A closed aspiration drain is used (Figs. 35.4, 35.5, and 35.6).

Reverse abdominoplasty does not replace the usual technique through suprapubic incision and must be used only for cases where the deformity is located mainly in the supraumbilical segment. However, the direct approach offered by this technique results in better outcomes for this region than a traditional abdominoplasty, with these two techniques forming an excellent combination in some cases.