Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, e317ee318

CORRESPONDENCE AND COMMUNICATION

An abdominoplasty incisionaccording to fashion trends

Figure 1 Schematic drawing of the proposed incision. Fivesegments are described: a) segment I (suprapubic); b) segmentII (supraumbilical); c) segment III (lateral oblique) passing1.5 cm below the anterior superior iliac spine (ASIS);d) segment IV (lateral horizontal) and c) segment V (Lazy S).

The abdominoplasty technique has evolved from the earlyclassic resections that were a combination of verticalmidline and transverse resections to various modificationsin incision placement and design. Modern incisions shouldbe dictated by the prevailing lingerie and swimsuit fash-ions, which currently are low-cut anteriorly and laterallyhigh for Latin American women. Nevertheless, in patientswho wear low-cut trousers or skirts, the lateral ends of theincision may be exposed.

We propose a novel design for demarcation and pre-determined resection in abdominoplasty that achievesa symmetrical scar with horizontal lateral endings, easilyconcealed according to the low-cut fashion trends. Refer-ences marks for symmetrical flap excision are made in thesupine position and are corroborated in the standing posi-tion. These include the midline of the abdomen and a crosson both anterior superior iliac spines (ASIS). Five segmentsare then described (Figure 1). Segment one (suprapubic)describes a convex curve mimicking the pattern of pubichair implantation being 9 cm in length. Segment two(supraumbilical) is a straight line perpendicular to themidline immediately tangential to the navel, being 10 cm inlength. Segment three (lateral oblique) extends fromsegment one toward the waistline passing 1.5 cm below theASIS. Once segment three surpasses the vertical componentof the ASIS cross in 5e6 cm, the line turns horizontally tofollow the swimsuit line. This is segment four (lateralhorizontal) and its length may range in average from 5 to7 cm. Finally a lazy S, first convex and then concave, joinssegment two and segment four, being denominatedsegment five. The procedure is then repeated on thecontralateral side on segments three, four and five. Thisconfiguration can change slightly to adapt to the areas ofmore skin laxity or tension.

We advocate the predetermined resection of theabdominal flap in selected patients with adequate soft-tissue laxity, in order to promote a symmetrical resectionand traction.1 After resection, abdominal flap closure isperformed from lateral to medial, always with the upperflap pushed toward the midline. This manoeuvre allows

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a perfect match of the upper and lower incisions. In thisway, a symmetrical system of traction and counter-tractionvectors is exerted in order to achieve the desired finalsymmetrical scar.

From July 2006 to August 2007, twelve patients witha mean age of 42 years (range 35e52 years) underwentabdominoplasty using the proposed incision. The meanfollow up was 10 months (range 6e18 months). One patientrequired excision of dog ears. Two patients developedseroma. Three patients had Nylon suture granulomas andone minor umbilical necrosis. Patient satisfaction was highin all cases, achieving a very good abdominal contour andhigh quality scars. Many of them began wearing bikini

tiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.

e318 Correspondence and communication

bathing suits and pants that they were unwilling to wearpreoperatively (Figure 2).

Conceptionally, this incision is similar to the bicyclehandlebar technique described by Baroudi2 and it alsoshares technical details from the UM demolipectomy3 andfrom the high lateral tension technique.4 The main

Figure 2 A) Preoperative anteroposterior view of a 41-year-old woman with folding of skin in the lower abdomen;B) Preoperative lateral view; C)Postoperative anteroposteriorview; D) Postoperative lateral view. The lateral segment of ourdesign yields a lateral horizontal scar that is very well hidden inpatients who wear low-cut pants or skirts; E) Postoperativeoblique views of the patient wearing low-cut pants and bikinibathing suit, that was unwilling to wear preoperatively.

difference from Baroudi’s techniques is the final position ofthe scar. In patients who wear low-cut pants, the lateralends of the standard bicycle handlebar incision may beexposed.

Our technique also applies the principle of high lateraltension to address the abdominal flank flaccidity. Modifi-cation of the skin resection pattern to provide a significantlateral resection places the highest wound closure laterally,which lifts the lax anterolateral thigh and avoids theplacement of all the tension on the mons veneris andconsequent pubic hair superior migration.4 The disadvan-tage of the high lateral tension abdominoplasty isa tendency for dog ear formation due to a quick transitionfrom high tension in the inguinal area to the laxity of thelateral trunk that usually requires lengthening of the finalscar. We propose a pre-scheduled resection of dog earsthrough the lateral horizontal segment of our design thatyields a well hidden lateral scar.

The UM abdominoplasty technique introduces theconcept of perfect matching of lower and upper incisionlengths, making dog ears formation less likely. This conceptis incorporated in our technique, where the addition ofsegments three and four’s lengths should always equalsegment five’s length. Our technique has differences in thedesign pattern where the suprapubic segment is convex,whereas the supraumbilical segment is a straight line. Inthe UM technique, the lower incision is an open U and a lazyM in the upper incision.

Whenever a surgical scar is unavoidably extensive, everyeffort should be made to ensure the best scar qualitypossible. All the aforementioned concepts were incorpo-rated in this technique allowing the achievement of betterabdominal contour and high quality scars in our hands. Thedesign herein presented is an excellent alternative inselected patients aiming to obtain scars easily concealedaccording to current low-cut fashion trends in trousersand skirts.

References

1. Planas J. The ‘‘vest over pants’’ abdominoplasty. Plast ReconstrSurg 1978;61:694e700.

2. Baroudi R, Moraes M. A ‘‘bicycle-handlebar’’ type of incision forprimary and secondary abdominoplasty. Aesthet Plast Surg1995;19:307e20.

3. Ramirez OM. U-M abdominoplasty. Aesthet Surg J 1999;19:279e86.

4. Lockwood T. High-lateral-tension abdominoplasty with superfi-cial fascial system suspension. Plast Reconstr Surg 1995;96:603e15.

Hugo D. LoustauHoracio F. Mayer

Department of Plastic Surgery,Hospital Italiano de Buenos Aires,

University of Buenos Aires,School of Medicine, Gascon 450 1181,

Buenos Aires, ArgentinaE-mail address: hugo.loustau@hospitalitaliano.org.ar