Abdominoplasty with Customized Transverse Musculoaponeurotic Plications

The standard abdominoplasty technique uses a wide, vertically oriented plication of the rectus sheath to narrow the waistline. However, this plication is not always enough to achieve good cosmetic and functional results. This is also the case with other plication techniques. To strengthen the abdominal wall at the points of greatest weakness in each particular patient, the authors have developed a personal technique consisting of customized transverse plications at the points of maximum protrusion in the musculoaponeurotic layer, in addition to the classic vertical plication.

Ninety-eight women were divided randomly into two groups: the control group (group A) comprised 44 patients (44.9 percent) who underwent classic vertical plication; the experimental group (group B) comprised 54 patients (55.1 percent) in whom vertical plication was associated with one or more customized horizontal plications. Results were rated on a scale of 0 to 10 by external observers and the patients. Complications and recurrences were recorded.

In group A, the mean global rating scores were 8.5 of 10 for external raters and 8.3 of 10 for patients. In group B, they were 9.5 of 10 and 9.8 of 10, respectively. In group B, there were no recurrences of prominences, whereas three were recorded in group A. Five cases of seroma were registered in each group and resolved by closed suction.

In some cases, vertical plication with customized transverse plications produces results that are aesthetically superior to those of the classic approach, achieves long-lasting effects, and does not increase the rate of recurrences or the risk of complications.