Lipoabdominoplasty

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This article describes extensive liposuction with minimal abdominoplasty, a technique developed by the author and colleagues at the Institut Vila-Rovira. The technique represents another step in the evolution of liposuction procedures. Especially for patients with a body mass index of 30 to 35, the procedure is a surgical alternative that preserves the safety of the traditional lipoabdominoplasties.

Section snippets

Material and method

Clinicians at the Institut Vila-Rovira have used the ELMA procedure to treat 48 patients between 26 and 48 years old with an average weight of 100 kg and a BMI between 30 and 35.

In all cases, liposuction of between 6 and 24 L and minimal dissection abdominoplasty was done. In cases of grave obesity, bariatric surgery was recommended, followed by postbariatric plastic surgery.

Anesthetic protocol

Before the procedure, a preoperative evaluation by an anesthesiologist is important for the selection and care of these patients. American Society of Anesthesiologists (ASA) class 1 and 2 anesthetics are acceptable with strict monitoring.

BMI should be less than 35 with preoperative laboratory tests according to the recommendations of the Confederation of Latin American Societies of Anesthesiologists.

Hematocrit and hemoglobin, glucose, liver panel, coagulation profile and serology plus

Preoperative protocol

The patient must be informed about the benefits and risks of surgery in sufficient detail to allow for true understanding. At the Institut Vila-Rovira, blood work, EKG with cardiovascular evaluation and chest radiograph, referral to the blood bank for donation of 400 mL of autologous blood 30 and 15 days before the scheduled procedure are all routine for this patient population. The autologous blood is administered to the patient after the procedure. Preoperative discussions are held to go over

Fundamentals of the technique

The technique involves extensive circumferential liposuction with plication of the rectus abdominis muscles preserving the perforators and excision of redundant abdominal skin under general anesthesia.

After evaluation by the attending anesthesiologist in the holding room, the patient is transferred to the operating room where he or she is marked for the circumferential liposuction of the lower trunk and also marked for proposed areas of open excision on the anterior abdomen. The boundary to

Postoperative protocol

These patients experience a slightly prolonged recovery period as compared with those recovering from conventional liposuctions of less than 5 L, but the careful technique used to preserve the blood vessels and nerves makes the recovery period acceptable.

The use of an elastic binder for 30 to 60 days is very important. We change dressings initially between days 2 and 7, and we prescribe 7 to 10 days of rest at home with minimal basic activities.

On day 21, we remove all stitches and cover the

Clinical cases

Fig. 1, Fig. 2, Fig. 3, Fig. 4 show preoperative and postoperative images. Globally considered, the outcomes reveal esthetic body changes, circumferential changes, and good outcome of the scars.

Complications

The well-systematized and careful procedures have resulted in a considerable reduction of complications:

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    Seromas—10% [4]

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    Small areas of skin necrosis—10% [4]

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    Hematomas—2% [1]

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    Cutaneous irregularities—20% [8]

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    Secondary miniliposuction—10% [4]

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    Scar revisions—10% [4]

Skin necroses occurred in difficult patients

Advantages

The advantages of the procedure include (1) better body-contour outcome thanks to the massive circumferential liposuction, (2) less morbidity because perforator vessels are spared and dead space eliminated, (3) a more natural result in obese patients who are difficult to treat with diets, and (4) preservation of suprapubic sensation.

Disadvantages

Disadvantages of the procedure include (1) greater morbidity due to the extensive nature of the procedure and large volume liposuction, (2) the need to have a

Summary

Obese patients present more difficult challenges than those patients who are simply overweight or those with localized adiposity. The classical techniques do not satisfy the needs of obese patients, so alternative techniques, such as the one presented here, need to be considered. With this technique, we have noticed an improvement in the psychological and body image of these patients.

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