Anatomical and technical refinements for abdominoplasty

Several important details pertinent to the classic transversal low-incision abdominoplasty, commonly underestimated, are pointed out. Metameric sensitivity distribution is focused in the normal individual and then transformed by abdominoplasty. Emphasis is also given to the vascularization, lymphatic drainage, and treatment of the muscle-aponeurotic plane and femoral cutaneous nerve under effects of abdominoplasty. Attention is called to how effectively they can help to obtain symmetric postoperative results and how important it is to have a normal-looking, aesthetically pleasing navel. First introduced as a corrective procedure for abdomens grossly deformed by lipodystrophies or greatly compromised by hernias or problems related to multiple surgeries, abdominoplasty is no longer merely a reconstructive procedure. In the last 10 years, requests for abdominoplasty for aesthetic improvement of lax skin, "striae," and scars of even "good quality" situated in the infraumbilical area have increased in indirect proportion to the size of today's bathing suits.The great number of cosmetic abdominal surgeries calls for a better solution to problems such as the placement and quality of scars, the positioning of the umbilicus, and the resulting waistline. An increasing number of demands are made regarding minute details of asymmetry, sensibility, edema, and pain. Like the young surgeon in training, we had to search our anatomy books to find explanations and ways to avoid problems justifiable in earlier days but unacceptable today.