Classification for indications of lipoabdominoplasty and its variations.

BACKGROUND Lipoabdominoplasty, the combination of lipoplasty with classical abdominoplasty, presents new opportunities for the treatment of abdominal lipodystrophy. OBJECTIVE The author analyzed 211 patients who underwent lipoabdominoplasty from 2000 to 2004. METHODS After the preoperative physical examination, the patients were classified into 9 different groups according to the indications for the most appropriate technique in each case. Patient groups ranged from those presenting with mild fat panniculus and good quality skin to massive weight loss patients with a high degree of flaccidity. Techniques used in treating the various patient groups included lipoplasty alone, 3 variations of lipominiabdominoplasty, 4 variations of lipoabdominoplasty, and abdominoplasty alone. The surgical principles used in the variations of lipoabdominoplasty included dissection and sculpturing of the subcutaneous deep layer and superficial layer through lipoplasty, selective undermining and plication of the anterior rectus sheath, preservation of the perforator vessels, preservation of Scarpa's fascia and deep fat, skin resection, and umbilical transposition. RESULTS Two hundred eleven patients were treated between January 2000 and May 2004. Results were good, with high patient satisfaction regardless of variations in technique. There was no loss of sensibility in the suprapubic region in any patients. Among patients who underwent lipoabdominoplasty, there were low complication rates of epidermolysis (1.5%), seroma (1%), hematoma (1%), and necrosis (0.1%). There was no incidence of seroma, necrosis, or hematoma in the lipominiabdominoplasty subgroups I and II; in subgroup III, there was a 2% incidence of necrosis. Seroma was noted in 2% of patients who underwent reverse lipominiabdominoplasty. Similar low complication rates were observed in other groups. CONCLUSIONS The classification of lipoabdominoplasty indications offers good options for treatment of the abdominal region. Lipoplasty, selective undermining, and maintenance of Scarpa's fascia help reduce surgical trauma that is the main factor affecting hematoma and necrosis rates. The learning curve for these classifications is fast because the described procedures are already familiar to most plastic surgeons.