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

CORRESPONDENCE AND COMMUNICATION An abdominoplasty incision according to fashion trends

The abdominoplasty technique has evolved from the early classic resections that were a combination of vertical midline and transverse resections to various modications in incision placement and design. Modern incisions should be dictated by the prevailing lingerie and swimsuit fashions, which currently are low-cut anteriorly and laterally high for Latin American women. Nevertheless, in patients who wear low-cut trousers or skirts, the lateral ends of the incision may be exposed. We propose a novel design for demarcation and predetermined resection in abdominoplasty that achieves a symmetrical scar with horizontal lateral endings, easily concealed according to the low-cut fashion trends. References marks for symmetrical ap excision are made in the supine position and are corroborated in the standing position. These include the midline of the abdomen and a cross on both anterior superior iliac spines (ASIS). Five segments are then described (Figure 1). Segment one (suprapubic) describes a convex curve mimicking the pattern of pubic hair implantation being 9 cm in length. Segment two (supraumbilical) is a straight line perpendicular to the midline immediately tangential to the navel, being 10 cm in length. Segment three (lateral oblique) extends from segment one toward the waistline passing 1.5 cm below the ASIS. Once segment three surpasses the vertical component of the ASIS cross in 5e6 cm, the line turns horizontally to follow the swimsuit line. This is segment four (lateral horizontal) and its length may range in average from 5 to 7 cm. Finally a lazy S, rst convex and then concave, joins segment two and segment four, being denominated segment ve. The procedure is then repeated on the contralateral side on segments three, four and ve. This conguration can change slightly to adapt to the areas of more skin laxity or tension. We advocate the predetermined resection of the abdominal ap in selected patients with adequate softtissue laxity, in order to promote a symmetrical resection and traction.1 After resection, abdominal ap closure is performed from lateral to medial, always with the upper ap pushed toward the midline. This manoeuvre allows a perfect match of the upper and lower incisions. In this way, a symmetrical system of traction and counter-traction vectors is exerted in order to achieve the desired nal symmetrical scar. From July 2006 to August 2007, twelve patients with a mean age of 42 years (range 35e52 years) underwent abdominoplasty using the proposed incision. The mean follow up was 10 months (range 6e18 months). One patient required excision of dog ears. Two patients developed seroma. Three patients had Nylon suture granulomas and one minor umbilical necrosis. Patient satisfaction was high in all cases, achieving a very good abdominal contour and high quality scars. Many of them began wearing bikini

Figure 1 Schematic drawing of the proposed incision. Five segments are described: a) segment I (suprapubic); b) segment II (supraumbilical); c) segment III (lateral oblique) passing 1.5 cm below the anterior superior iliac spine (ASIS); d) segment IV (lateral horizontal) and c) segment V (Lazy S).

1748-6815/$ - see front matter 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.06.042

e318 bathing suits and pants that they were unwilling to wear preoperatively (Figure 2). Conceptionally, this incision is similar to the bicycle handlebar technique described by Baroudi2 and it also shares technical details from the UM demolipectomy3 and from the high lateral tension technique.4 The main

Correspondence and communication difference from Baroudis techniques is the nal position of the scar. In patients who wear low-cut pants, the lateral ends of the standard bicycle handlebar incision may be exposed. Our technique also applies the principle of high lateral tension to address the abdominal ank accidity. Modication of the skin resection pattern to provide a signicant lateral resection places the highest wound closure laterally, which lifts the lax anterolateral thigh and avoids the placement of all the tension on the mons veneris and consequent pubic hair superior migration.4 The disadvantage of the high lateral tension abdominoplasty is a tendency for dog ear formation due to a quick transition from high tension in the inguinal area to the laxity of the lateral trunk that usually requires lengthening of the nal scar. We propose a pre-scheduled resection of dog ears through the lateral horizontal segment of our design that yields a well hidden lateral scar. The UM abdominoplasty technique introduces the concept of perfect matching of lower and upper incision lengths, making dog ears formation less likely. This concept is incorporated in our technique, where the addition of segments three and fours lengths should always equal segment ves length. Our technique has differences in the design pattern where the suprapubic segment is convex, whereas the supraumbilical segment is a straight line. In the UM technique, the lower incision is an open U and a lazy M in the upper incision. Whenever a surgical scar is unavoidably extensive, every effort should be made to ensure the best scar quality possible. All the aforementioned concepts were incorporated in this technique allowing the achievement of better abdominal contour and high quality scars in our hands. The design herein presented is an excellent alternative in selected patients aiming to obtain scars easily concealed according to current low-cut fashion trends in trousers and skirts.

References
1. Planas J. The vest over pants abdominoplasty. Plast Reconstr Surg 1978;61:694e700. 2. Baroudi R, Moraes M. A bicycle-handlebar type of incision for primary and secondary abdominoplasty. Aesthet Plast Surg 1995;19:307e20. 3. Ramirez OM. U-M abdominoplasty. Aesthet Surg J 1999;19: 279e86. 4. Lockwood T. High-lateral-tension abdominoplasty with supercial fascial system suspension. Plast Reconstr Surg 1995;96: 603e15.

Figure 2 A) Preoperative anteroposterior view of a 41-yearold woman with folding of skin in the lower abdomen; B) Preoperative lateral view; C)Postoperative anteroposterior view; D) Postoperative lateral view. The lateral segment of our design yields a lateral horizontal scar that is very well hidden in patients who wear low-cut pants or skirts; E) Postoperative oblique views of the patient wearing low-cut pants and bikini bathing suit, that was unwilling to wear preoperatively.

Hugo D. Loustau Horacio F. Mayer Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, School of Medicine, Gascon 450 1181, Buenos Aires, Argentina E-mail address: hugo.loustau@hospitalitaliano.org.ar