Abdominoplastia En Obesos

Obesity Surgery, 13, 95-100

Circumferential Abdominoplasty for Sequential Treatment after Morbid Obesity
Miguel Modolin, MD1; Wilson Cintra Jr, MD2; Celeste Imaculada C. Gobbi3; Marcus Castro Ferreira, MD4
1

Atending Plastic Surgeon, 2Plastic Surgeon, 3Psychologist, 4Chief of Plastic Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, BrazilBackground: The severely obese patient, after considerable loss of weight, has large remaining skin folds. Classic transverse abdominoplasties leave bulges in the flanks. This article presents an alternative procedure, circumferential abdominoplasty, which involves the perimeter of the abdomen. Methods: Average age of the patients was 39.5 years, consisting of 10 females and two males. Incisions were madelike those of the classic transverse abdominoplasty, but were extended dorsally without tension on the suture-line. Results: Pre and postoperative aspects revealed the huge impact achieved after resection of the excess panniculus, with improvement of body contour, posture, ambulation, social and psychological integration, hygiene and sexual performance. In some patients, seromas, partialdehiscences, flap infection and atelectasis were immediate complications. Hyperthopric scars and some remaining skin folds were late complications. Conclusion: The major disadvantage of the circumferential abdominoplast y is the resulting scar. However, this procedure should be taken into consideration as an option to achieve a more harmonious body contour. Complications are not enough to contraindicatethe surgery, because the patients preferred better social and professional integration, as well as behavioral improvement due to enhancement in their self-confidence.

Key words: Circumferential abdominoplasty, morbid obesity, obesity, sequential treatrment, plastic surgery

Introduction
Morbid obesity is a disease which has reached epidemic status in countries with a high gross nationalReprint requests to: Miguel Modolin, MD, R. Canadá, 89, São Paulo, SP CEP: 01436-000, Brazil. E-mail: miguelmodolin@uol.com.br © FD-Communications Inc.

product.1-3 Severe repercussions on different systems of the body are related to this illness, as well as a peculiar body image, frequently grotesque, due to a heterogeneous distribution of excessive fat. Therefore, in order to lose weight, andimprove health conditions, the obese person goes on diets or undergoes surgeries to reduce gastric volume. Considerable weight loss leaves additional skin folds irregularly distributed among limbs, abdomen and breasts, increasing the occurrence of skin infections such as intertrigo. Obese people stand in a defective posture because of the uncommon increment of body volume, with or without the presenceof osteopathy. Thus, with sedentary habits, there are important consequences on locomotion such as difficulty ambulating. This situation may persist after weight loss, due to the volume of remaining skin folds. Sexuality is compromised, because of redundant tissue that accumulates on the abdominal wall, covering the genitalia. In addition to that, there are flaccid ptotic breasts and annoyingredundant skin remaining on the thighs and arms. Once the patient has lost weight and the obesityrelated diseases are under control, the search for ways to achieve a better body image, that may improve quality of life, takes place. Skin has lost elasticity and folds accumulate in a non-balanced and even distorted distribution in the body segments. Once weight is stable, the patient may undergo surgeryto remove redundant skin. Abdominal dermolipectomy with the classic incisions may give poor final results, because of skin bulges remaining in the flanks. Thus, some authors have proposed an extension of the transverse inferior abdominal incisions to the flanks and dorsal area.4-7 We present our experience with this techObesity Surgery, 13, 2003

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