Laxity of the abdominal wall in women after
delivery, or women with a pendulous abdomen, is one of the defects which
frequently require plastic surgery intervention. While in women after delivery
the main complaint is flaccid and wrinkled skin of the anterior abdomen,
extensive striae in the area of the navel and lower abdomen may also be found,
along with diasthasis recti in patients with a pendulous abdomen,
persistent eczema under the overhanging skin, and various orthopedic, vascular
and other complications.
However, in clinical practice we frequently
see abdomen that do not require radical mobilization of the whole abdominal
wall from mons pubis and inguinal area to subcostal area, involving postpartum
status or status after weight loss (1, 2). In such cases the laxity of the
abdominal wall is localized only to the lower or upper abdomen, while the
epigastrium or hypogastrium is in a relatively very good condition and
does not require correction. Frequently we find changes in the lower half of
the abdomen, such as excess tissue to the abdominal pannus, while the upper
half is firm and stretched. Both cases can be solved individually with what may
be termed a miniabdominoplasty, which is classified depending on location
as an upper or lower abdominoplasty (3).
constitutes an operative method of partial abdominal wall correction (Fig. 1).
It is an alternative to the classic abdominoplasty. In lower abdominoplasty
the cut is horizontal above the mons pubis and the groin area of the abdominal
pannus, mobilizing the dermis and hypodermis to the navel and laterally to the
sides of the mesogastrium. After the loose skin has been pulled caudally we
reduce the excess tissue. Then we thin the whole area of hypodermis under the
elevated flap all the way to the scarpa’s fascia and fix the flap with several
stitches to the abdominal wall. Prior to skin suture we insert Redon’s drain
and leave it in for 24 hours (Fig. 2–7).
frequent indication for miniabdominoplasty is loose skin in the area above the
navel, while the lower part of the abdomen does not require correction. The upper
abdominoplasty requires more time and is more technical. We use the
original surgical method according to Longacre (4), where a decorticated
flap of the abdominal wall is used for the augmentation of hypoplastic breasts.
In upper miniabdominoplasty the decorticated flap is used for fixation of the
mobilized wall to the ribs. Similar principles are used in extensively
mobilized abdominal epigastric wall, the basis for some reconstructive methods
The surgery itself
consists of flap decortications in the shape of a half-moon under the
breast fold, followed by caudal skin and hypodermis release almost to the
navel. After the upper edge and external lower edge of the decorticated flap
are detached we fix the flaps under tension to the rib periosteum externally
and cranially above the level of the breast fold, so the lower flap edge
corresponds with this fold. It is beneficial to insert a few stitches to stabilize
the mobilized and cranially moved protruded abdominal wall. After upper
miniabdominoplasty a drain is not usually used, because the released wall
is fixed by strips of adhesive plaster, and an elastic bandage is added.
Sometimes, if the mesogastrium is not damaged, we can perform upper and lower
miniabdominoplasty at the same time, which efficiently corrects a flaccid
abdominal wall throughout its entire extent without leaving a noticeable
vertical scar along the whole wall and changing the naval shape (Fig. 8–16).
In the postoperative
course we remove the intradermal stitches between day 14 and 17. Elastic
underwear should be worn after a lower abdominoplasty for 3–4 weeks and
after an upper abdominoplasty for 4–6 weeks. Physical stress is possible 4 to 6
weeks after surgery.
the cases indicated, the advantages of partial abdominoplasty are indisputable.
Lower miniabdominoplasty in particular takes less time and demands a lower
level of technical skills compared to the traditional abdominoplasty, while
also allowing for early rehabilitation and recondition. Upper
miniabdominoplasty corrects laxity of the upper abdomen with less pronounced
scars placed in the breast folds compared to the vertical scars in the epigastrium
resulting from traditional abdominoplasty, if these are necessary for abdominal
correction. The fact that the navel remains in situ, often without significant
circular scarring, can be considered a further point in favor of partial
Prof. Jan Měšťák, PhD.
Hospital Na Bulovce
00 Prague 8
1. Měšťák J., Víšek V., Čakrtová M., Červený J. Dermolipectomy of the abdominal wall. Acta Chir. Plast., 30, 1988, p. 182-191.
2. Regnault P. Abdominoplasty by the W technigue. Plast. Reconstr. Surg., 55, 1975, stránky p. 265-274.
3. Vasconez LO., Torre JI. Abdominoplasty. In Mathes J. (ed.) Plastic Surgery, 2nd ed. Saunders, 2006, p. 158-165.
4. Longacre JJ. Correction of the hypoplastic breast with special reference to reconstruction of the “nipple type breast with local dermo-fat pedicle flaps. Plast. Reconstr. Surg., 14, 1954, p. 431-441.