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B. Beltrán Redondo
Table 23.4
Technique Indications Advantages Disadvantages Side effects
Radiofrequency Treat aging skin and
Ultrasound skin
tightening
Intense pulsed
light with
radiofrequency
In my experience, the best results for lax skin tightening are obtained with microfocalized ultrasound
Summary table for lax skin tightening techniques
Collagen conformation,
scars in mild-tomoderate degrees of
severity
Developed to
achieve a signicant
stretching of the skin
Deeper layers of
skin for collagen
production: Removal
of hair and leg veins,
skin tightening, skin
rejuvenation, and
wrinkle reduction
neocollagenesis in deep
layers of the skin and
subcutaneous tissue
It can be used on any
skin types
Possible to control the
depth of the energy’s
inltration
In contrast with
high-intensity focused
ultrasound,
microfocused ultrasound
uses much lower
ultrasound energy to
treat the supercial
layers of the skin
Reduction in optical or
laser energy, which
provides greater security
and makes it suitable for
all skin types
There is no
standard procedure
to reference the
parameters used
with RF
The treatment of
laxity sometimes
requires more
invasive or
combined
treatments
Effects on skin
laxity are low and
limited
There is no
standard protocol
for abdominal
treatment
and results are
disparate
Contraindicate on
infections and open
skin lesions and the
presence of active
metallic implants
Not suitable for
darker or tanned
skin
Pain (generally low)
Reddening erythema
Edema
Swelling
Brief discomfort
during treatment
Transient erythema
Edema
Occasional bruising
Transient, mild
erythema
Mild swelling
Post-inammatory
hyperpigmentation
(resolved within
24h)
Hypertrophic
scarring
ing, post-inammatory hyperpigmentation that is
resolved within 24h post treatment, and less frequent, hypertrophic scarring [112].
In short, a summary table for lax skin tighten-
ing techniques can be found in Table23.4.
23.6 Conclusion
A wide range of technologies are currently available to improve the appearance of the abdomen
after pregnancy. Some of these are low energy
devices that use radiofrequency, light energy, or a
combination of low energy sources to improve
the appearance of the body. Although they are not
invasive, they require multiple treatments and can
only achieve relatively supercial effects. Results
obtained through these procedures can be maintained and improved by following a balanced
diet, avoiding weight gain, and exercising
regularly.
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Mini Abdominoplasty
https://t.me/medicina_free
CarlosGullónCabrero
andRamónCalderónNájera
24
Take-Home Points
• The traditional abdominoplasty does not allow
any option for correction within the given situations in which we need to correct the sequelae
that occurs after a pregnancy or obesity.
• It is crucial to identify alternative procedures,
allowing us to offer diversied solutions for
the different cases.
• Different degrees of skin laxity and muscle
aponeurotic system dene the condition for
different treatments.
• Miniabdominoplasty and modied abdominoplasty are surgical techniques that offer good
alternatives for plastic surgeons to treat
sequelae of pregnancy.
24.1 Introduction
Some plastic surgery procedures are aimed at
correcting or improving congenital situations,
and others are aimed at recovering a previous
situation that has been altered. In the second
group, there is a typical one for its frequency, the
C. G. Cabrero
SECPRE (Sociedad Española de Cirugía Plástica,
Reparadora y Estética), Madrid, Spain
R. C. Nájera (*)
AECEP (Asociación Española de Cirugía Estética),
Madrid, Spain
so-called pregnancy sequelae that fundamentally
affect the breasts and abdomen.
The problems that abdominal contour surgery
can correct include damage to lower abdominal
skin, varying amounts and locations of excess
fatty tissue, and bulging of the abdomen caused
by musculofascial accidity. The etiology of
acquired abdominal contour can be traced to the
effect of pregnancy, aging, and weight gain or
weight uctuations, lifestyle, medications, hormones, genetics, embryologic development, and
previous incisions.
The relatively rapid increase in volume that
occurs in the abdominal cavity results in dilation
of the muscle aponeurotic system, alteration in
the distribution of abdominal fatty tissue, and
dilation with associated loss of elasticity of the
abdominal skin.
These phenomena present constantly after
pregnancy to a greater or lesser extent depending
on the quality of the tissues, the weight control
during pregnancy, the previous state of the patient
as to the strength of her muscle aponeurotic system, and hormonal factors that can affect to a
greater or lesser extent the cutaneous appearance
and the redistribution of fat that occurs during
pregnancy. Alterations in the pelvic oor, dilation
of the vagina, or the sagging of pelvic organs,
such as the bladder of urine, are phenomena associated with sharp increase in volume of abdominal content. Therefore, the recuperation of a
woman who has suffered injuries after successive
© Springer Nature Switzerland AG 2023
M. Gomes-Ferreira, J. Olivas-Menayo (eds.), Post-maternity Body Changes,
https://doi.org/10.1007/978-3-030-43840-1_24
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pregnancies falls within the multitude of care
specialists, including but not limited to her plastic surgeon (gynecologists, urologists, general
surgeons, and physical therapists).
After pregnancies, the abdominoplasty in a
more complete way restores the muscular system
by neurotic, adapts the fat distribution, and eliminates the cutaneous excess in the abdominoplasty.
The abdominoplasty can be carried out when
there is a marked sagging and allows us to remove
the entire skin section from the anterior aspects
of the abdomen between the navel and the pubis.
When the abdominal skin is not excessive, but
there is redundancy and an altered distribution of
fat or an alteration of the muscular aponeurotic
system that almost always consists of the diastasis of the rectus abdominis muscles, we perform
a mini abdominoplasty or a modied abdominoplasty, which will henceforth be the subject of the
development of this chapter. These surgeries,
which are variations of traditional abdominoplasty, allow us to satisfactorily treat that group
of patients who would otherwise be left without
adequate treatment. Mini abdominoplasty was
rstly described by Greminger at the end of the
1980s [1].
The separate assessments of the tissues
involved in the correction of the abdomen will
allow us to make the most correct decision in
each case and can offer a complete treatment to
each of the parties involved. We consider the
treatment of fatty tissue a very important part in
the estimation of the nal result, being exceptional that we can avoid the use of liposuction as
a fundamental step of the surgery procedure.
The preoperative conditions of the patients
must be adequate, and in this sense, we consider
it very important to avoid complications.
Abstaining from smoking 6weeks prior to surgery and the prophylaxis of deep vein thrombosis
with heparin, as well as the use of the intermittent
pneumatic compression system in the lower
extremities are some of the measures we need to
follow to avoid complications.
Key Points
When the abdominal skin is not excessive, but
there is redundancy and an altered distribution
of fat or an alteration of the muscular aponeu-
rotic system that almost always consists of the
diastasis of the rectus abdominis muscles, we
perform a mini abdominoplasty or a modied
abdominoplasty.
24.2 Patient Selection andTiming
Miniabdominoplasty is indicated for those
patients in which the traditional abdominoplasty
is not necessary, because they present a marked
supraumbilical laxity. If we are speaking about
details in the differentiation of techniques
between the miniabdominoplasty and the modied abdominoplasty, the selection of the patient
would depend on the grade of laxity and state of
the aponeurotic muscle system. Throughout this
chapter, the ideal patient for each of the individual techniques is specied, as well as a decision
tree to select the correct technique.
In respect to timing, it is important that the
patient waits at least 3months after natural childbirth to proceed with this intervention; in the case
of caesarian section, it is recommended that the
patient wait at least 6months post childbirth to
proceed with a miniabdominoplasty. It is important to note that the patient is not in a position to
have children after the intervention, so that the
results are maintained over time [2].
Key Points
Miniabdominoplasty is indicated for those
patients for whom traditional abdominoplasty is
not necessary, because they present a marked
supraumbilical laxity. It is important that the
patient waits at least 3months after natural childbirth to proceed with this intervention; in the
cases of a caesarian section, it is recommended
that the patient wait at least 6months post childbirth to proceed with miniabdominoplasty.
24.3 Discussion: Combination
ofC-Section
withMiniabdominoplasty [3]
During pregnancy, there is increase in vascularization of the muscles and abdominal skin. The
uterus multiplies in size, and there is a notable
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397
increase in the abdominal perimeter at the
expense of the uterine size. After delivery, there
is a progressive regression of the uterus that will
not be completed until the following several
weeks. The muscles and skin will also begin the
contraction process which will take several
months. In some cases, this process can take
more than 4 or 5months.
Performing miniabdominoplasty under these
conditions can lead to very unsatisfactory outcome. The size of the uterus will prevent the correct plication. Muscle dilation and lack of skin
contraction will severely increase the difculty in
estimating the amount of tissue to be resected.
Not a few women experience alterations in
fatty deposits, a situation that can vary in the
months following childbirth. This fact introduces
a further confounding variable when deciding on
the correct surgical treatment.
Occasionally, births or caesarean sections can
involve a signicant blood loss, compromising
the viability of the abdominal ap and even putting the patient’s health at risk. Also, the rate of
infections of a tummy tuck is higher in the context of a delivery or caesarean section.
Almost one-third of the patients present a
residual bulge of the abdomen without denition
of the waist, a situation that only happens in 9%
of the patients submitted to an abdominoplasty
without delivery or cesarean section.
Likewise, the umbilical herniation rate is
increased by 15% and the skin excess by 14% in
cases of abdominoplasty associated with caesarean section or delivery. In the same way that we
would not do a breast reduction in the case of a
nursing woman, because the breasts are in a temporary situation of volume increase and glandular activation, it seems appropriate to dismiss the
option of abdominoplasty after caesarean section
or delivery.
Pearls and Pitfalls
In conclusion, we can say that the degree of satisfaction is low, the aesthetic results are worse, and
the complication rate is higher.
24.4 Approaches totheTreatment
ofAbdominal Sequelae After
Pregnancy
Combining traditional liposuction and abdominoplasty technique gives surgeons different treatment options. For those patients in whom
liposuction will not sufciently correct their
lower abdomen, but for whom a complete abdominoplasty is an unfeasible treatment due to low
supra umbilical laxity, there are procedures such
as mini abdominoplasty or modied abdominoplasty. In mini abdominoplasty procedures, we
focus our attention on correcting lower abdomen
defects with direct access to the muscles of this
region. Modied abdominoplasty, an intermediate procedure between mini abdominoplasty and
full or traditional abdominoplasty, thus allows
the treatment of moderate accidity of the upper
musculofascial system.
Within modied abdominoplasty, there are
three possible variants in terms of surgical technique. We will choose the most appropriate to
correct the patient’s abdominal defects.
The two main variables that condition us in
choosing the most appropriate technique of
abdominoplasty surgery are the laxity of the
abdominal skin and the state of the Aponeurotic
Muscle System.
Laxity of the Abdominal Skin: when there is no
supraumbilical skin accidity or it is minimal, we
will think about alternative treatment options to
those of traditional abdominoplasty.
Aponeurotic Muscle System: infraumbilical
muscle aponeurotic accidity can be treated in all
modalities of abdominoplasty. We employ different options of alternative procedures when there
is associated supraumbilical musculofascial
accidity.
Once we have evaluated the patient’s condition with respect to both variables, we can choose
between the following (Table24.1):
– Type I: Mini abdominoplasty
– Type II: Modied adbominoplasty
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C. G. Cabrero and R. C. Nájera
Table 24.1
muscle aponeurotic system
Type Skin Aponeurotic Muscle System Treatment
I Minimum supraumbilical laxity Infraumbilical diastasis Mini abdominoplasty
II Minimum supraumbilical laxity Infraumbilical and supraumbilical
III Minimum supraumbilical laxity Infraumbilical and supraumbilical
IV Medium supraumbilical laxity Infraumbilical and supraumbilical
V Marked supraumbilical laxity Infraumbilical and supraumbilical
– Type III: Modied abdominoplasty with
Classication of the abdominoplasty technique depending on the state of the abdominal skin and of the
diastasis <3cm
diastasis > or =3cm
diastasis > or =3cm
diastasis > or =3cm
Modied adbominoplasty
Modied abdominoplasty with
supraumbilical scar
Modied abdominoplasty with
infraumbilical middle scar
Abdominoplasty
24.5.2 Surgical Technique
supraumbilical scar
– Type IV: Modied abdominoplasty with
infraumbilical middle scar
– Type V: Traditional abdominoplasty
We carve a ap of skin and the supra-aponeurotic
fat to the level of the navel. This gives us access
to the underlying muscular plane that we will
correct by approximating the rectus abdominis
muscles (Fig. 24.1). We chose non-absorbable
Key Points
In mini abdominoplasty procedures, we focus our
attention on correcting lower abdomen defects
with direct access to the muscles of this region.
Modied abdominoplasty, an intermediate procedure between mini abdominoplasty and full or
traditional abdominoplasty, thus allows the treatment of moderate accidity of the upper musculofascial system.
poly lament sutures of zero or two for this
approximation to ensure consistency of the closure. Ideally, we will give two layers of the
sutures that will give greater rmness and
security.
After exing the operating table between 20
and 30°, we estimate the amount of skin to excise.
It is advisable to avoid leaving dead spaces when
approaching the ap on the muscular plane. In
this sense, we can suture the ap to the supraaponeurotic plane causing obliteration of the cav-
24.5 Miniabdominoplasty
ity and associate a vacuum drain. Both measures
will signicantly prevent the appearance of a
24.5.1 The Ideal Candidate
seroma [4].
After nishing the procedure, we will place a
The ideal candidate for miniabdominoplasty has
suffered alterations at the level of the lower abdomen, without distortion of the upper abdo- men.
The treatment for the accumulation of fat varies
and must be adapted in each case by associated
liposuction techniques. Also, the excision of
suprapubic skin with variable extension to the
anks should be adapted to the existing
accidity.
compression bandage and a sash during the
4–6 weeks that will contribute to the union of
both layers of tissue. In patients whom we have
performed muscle repair, it is advisable to avoid
exercise to that specic area during the rst
12weeks. This ensures perfect consolidation of
the muscular plane repaired in the surgery. We
avoid excessive compression of the area that
could compromise the vascular supply.
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399
Table 24.2 Graduation of the level of abdominal skin
laxity and the disorder of the muscular aponeurotic system
Diastasis of
the rectus
abdominis
muscles
+/+++
++/+++
Modied
adbominoplasty
Modied
abdominoplasty with
supraumbilical scar
Modied
abdominoplasty with
infraumbilical
middle scar
Supraumbilical
cutaneous
laxitude
− or +/+++
− or +/+++
++/+++ ++/+++
because there are many patients with failure in
the abdominal aponeurotic muscular system who
have had a good skin recovery after childbirth
and have no marked laxity at the supraumbilical
skin.
As we said above in this chapter, the modied
abdominoplasty technique has three possible
variants (Table24.2):
Fig. 24.1 Miniabdominoplasty technique. The green line
represents the delimitation of the area of undermining. The
solid red line represents the skin incision and the interior
area, symbolized by the red dots, represents the excision.
The middle zone with the transverse black lines is the plication. The blue arrows represent the liposuction zones
24.6 Modied Abdominoplasty
andIts Variants
Modied abdominoplasty is an intermediate procedure between mini abdominoplasty and complete or traditional abdominoplasty. It is the most
appropriate technique when a mini abdominoplasty is not suitable because there is diastasis of
the rectus abdominis muscles above the navel,
but the patient also does not require a complete
abdominoplasty, mainly because the laxity of his
skin in the supraumbilical area is not marked.
In cases of pregnancy sequelae, modied
abdominoplasty is a useful surgical procedure
1. Modied adbominoplasty: patients who
presents minimum supraumbilical laxity and
infraumbilical and supraumbilical diastasis
less than 3cm wide.
2. Modied abdominoplasty with supraum-
bilical scar: when the patient concurs minimum supraumbilical laxity and infraumbilical
and supraumbilical diastasis bigger than 3cm
wide.
3. Modied abdominoplasty with infraumbil-
ical middle scar: patients with medium
supraumbilical laxity and infraumbilical and
supraumbilical diastasis wider than 3cm.
In Fig.24.2 you can see the decision process
of the most appropriate modied abdominoplasty
technique.
Key Points
In cases of pregnancy sequelae, modied abdominoplasty is a useful surgical procedure because
there are many patients with failed results in the
abdominal aponeurotic muscular system who
have had good skin recovery after childbirth and
have no marked laxity at the supraumbilical skin.
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