Reverse Abdomınoplasty

Reverse abdominoplasty is a useful option for abdominal contouring in patients who have primarily upper abdominal soft-tissue laxity. The advantage of reverse abdominoplasty in these patients is that the resection is in the region of the upper abdominal laxity and fullness, and therefore it is more effective in correcting it. The final scar is ideally hidden within the inframammary fold. In addition, theumbilicus rarely needs to be released and re-inset, as the upward pull generated from the reverse abdominoplasty lifts and rotates the umbilicus and periumbilical soft tissue to their original position. The procedure can be combined with breast augmentation, mastopexy/reduction, or with upper and middle back contouring procedures such as a bra-line back lift.

Patients who are good candidates for reverse abdominoplasty have skin laxity or poor skin quality in the upper half of the abdomen, or have a significant amount of soft-tissue redundancy in the upper half of the abdomen that will not be adequately addressed by a full abdominoplasty technique.

The full abdominoplasty is usually sufficient to correct both lower and upper abdominal skin and soft-tissue laxity and excess adiposity. We recommend that the staged procedure, if upper abdominal laxity persists, is performed at least 6 months between procedures.

Relative contraindications for reverse abdominoplasty

1. Excess upper abdominal adiposity without significant soft- tissue laxity
2. Significant lower or global abdominal soft-tissue laxity
3. Previous surgery with low subcostal scars that cannot be excised during the reverse abdominoplasty
4. Poor skin quality with extensive lower abdominal striae
5. History or concern of hypertrophic/keloid scars in the sternal or parasternal area
6. Umbilical shape and position that would benefit from umbilicus release and inset with a standard abdominoplasty
7. In particular, smoking, diabetes, pulmonary function, anticoagulation medications, a personal or family history of DVT/PE, and future plans for pregnancy are relative contraindications and must be discussed before proceeding with surgery.

Preoperative recommendations for reverse abdominoplasty

1. Smoking cessation/avoidance of nicotine exposure for 6 weeks prior to surgery
2. Multivitamin daily
3. Stop aspirin/other blood thinning products with primary care doctor’s permission
4. Abstain from all dietary/herbal supplements not approved by the surgeon
5. Basic laboratory work should be tailored to each patient. It may include CBC, Blood Chemistry, and PT/PTT/INR. Nutritional values, including albumin, may be warranted, especially for gastric bypass patients
6. Medical clearance if needed

Abdominoplasty Scar Positions

The desired final scar placement for Reverse Abdominoplasty, should be approximately at the level of the inframammary fold. To achieve this, the upper incision should be placed approximately 1–2 cm above the fold, anticipating some descent of the scar postoperatively.

Postoperative instructions for reverse abdominoplasty

●  Maintain a partially flexed position at the waist for the first 1–2 weeks
●  Wear the abdominal binder at all times except for showering
●  Make sure the abdominal binder is maintained low enough on the abdomen
●  Verify that there are no significant creases, folds, or drain tubes underneath the binder
●  Avoid smoking or exposure to nicotine-containing products
●  Breathe deeply and use the incentive spirometer frequently
●  Drink plenty of fluids: 8 oz/h is the goal
●  Move legs frequently while resting, and walk regularly
●  Drain care as instructed
●  Continue to take multivitamin daily. Resume medications as instructed
●  No vigorous activity or heavy lifting for 4–6 weeks