MINIMAL-ACCESS VARIATIONS IN ABDOMINOPLASTY

The use of liposuction began a trend toward less invasive abdominal co ntour surgery and resulted in a variety of techniques based on individ ual anatomy. An analysis of 170 patients was undertaken to determine w hich patients benefited from even less invasive techniques that evolve d from these concepts. The selection criteria used were based on the p hysical examination of the skin, fat and muscle layers, and patients' goals, willingness to accept incisions, and tolerance for the recovery period. The options used for this new category of treatment were subt ypes of the abdominolipoplasty system (type 1, suction-assisted lipect omy; type 2, miniabdominoplasty; type 3, modified abdominoplasty; type 4, full abdominoplasty) and included extended liposuction (type 1a); ''open'' miniabdominoplasty (type 2a); and endoscopically assisted or muscle access abdominoplasty (type 3a). Also included in this series w ere patients whose procedures were downstaged to a less extensive alte rnative and cases during which the abdominoplasty incision was used fo r access for another operation. All procedures resulted in smaller or fewer incisions. Results suggested that the current period (1991-prese nt) is marked by less invasive treatment options, characterized by a p reponderance of ''closed'' techniques (60% vs. 40%: 1986-1991). With t he availability of technology to treat muscle and adipose tissue throu gh inconspicuous incisions, judgment regarding the capability of the s kin to recontour becomes the overriding physical factor in the decisio n-making process. The outcomes support the conclusion that minimal-acc ess variations in abdominoplasty are appropriate alternatives, reflect ing a philosophical alteration in the approach to patients.