INTRODUCTION Mini-abdominoplasty Combined with Liposuction in Bangalore
Mini-abdominoplasty Combined with Liposuction in Bangalore is a procedure far less often performed than traditional abdominoplasty because it is applicable to a limited population. It combines the benefits of liposuction with suprapubic tightening and a shortened scar.
Mini-abdominoplasty is a great procedure for patients with limited skin excess or an unsatisfactory suprapubic scar who desire skin tightening. The ideal candidate is someone who already has a suprapubic horizontal scar, such as for caesarean section, and who is young and fit except for some lower abdominal muscle weakness. Umbilical hernias are also well treated with this technique . The umbilicus is not transposed on the skin in this procedure, so if ﬂoated downward, the umbilical descent should not be too great leading to a distorted, aberrantly low position. Liposuction may be performed liberally because of the limited undermining.Mini-abdominoplasty Combined with Liposuction in Bangalore
The patient is marked in the standing position, and a contour map is drawn with concentric circles, the central-most circle indicating the thickest subcutaneous fat layer. Most of the liposuction will be performed in the upper abdomen between the umbilicus and the costal margin, particularly over the linea alba and the flank areas (Figure 33-1). The marks for lower abdominal excision resemble a trapezoid, and the patient needs to clearly understand the scar length, as these patients are typically not interested in the longer scar associated with traditional abdominoplasty. A ruler or grid is helpful in ensuring symmetry of marks and ultimate closure, although preoperative asymmetry must be taken into consideration. for Mini-abdominoplasty Combined with Liposuction in Bangalore
DETAILS OF PROCEDURE- Mini-abdominoplasty Combined with Liposuction in Bangalore
The patient is brought into the operating room and anesthesia is induced. Positioning includes arms at no greater than 90 degrees from the body and placement in supination on egg crate to avoid nerve compression. A urine catheter may be considered. The knees are placed on a pillow to encourage ﬂexion, and antiembolism support stockings and sequential compression devices are initiated prior to anesthesia (Figure 33-2). The abdomen is prepared and draped in sterile fashion, placing an upper or lower body-warming blanket throughout the surgery to avoid hypothermia Mini-abdominoplasty Combined with Liposuction in Bangalore. Tumescent solution is infiltrated for hemostasis and anesthetic benefit. This solution includes 30 cc of 1% lidocaine and 1 cc of 1:1000 epinephrine per liter of Lactated Ringers. If only the abdomen will be addressed, 50 cc of 1% lidocaine may be used in the tumescent solution recipe. The solution must be allowed to permeate within the tissues for at least 8 minutes for the full epinephrine effect to reduce blood loss. The tissue is inﬂated until ﬂaccid. Liposuction (suction-assisted lipectomy, power-assisted liposuction, or ultrasound-assisted liposuction) is then performed in the areas designated (Figure 33-3). After liposuction is complete, incision is made in the suprapubic marking. Dissection is taken through subcutaneous fat to the abdominal wall and then superior dissection elevating the skin ﬂap up to the umbilicus is performed (Figure 33-4). For patients with significant diastasis, the umbilicus may be disconnected from the abdominal wall, and a midline plication is performed using interrupted #1 braided permanent figure-of-eight suture (Figure 33-5). Plication may be performed over a pain pump catheter for postoperative analgesia. Umbilical hernias are also easily corrected. The umbilicus is then sutured back down to the abdominal wall, adjusting placement depending on skin excision (Figure 33-6). The skin is excised and temporary closure is performed with staples. A 10-mm closed drain is placed in the subcutaneous space and sutured into position. The Scarpa’s fascia is then approximated with interrupted #2-0 braided absorbable suture or a running barbed suture of that caliber. The dermis is approximated with interrupted, buried, absorbable #3-0 monofilament suture, followed by a running intracuticular #4-0 absorbable monofilament suture (Figure 33-7). Tissue glue may be placed on the incision. Absorbent pads are placed over the incision and foam compression with a sil- icone layer against the skin is placed on the abdomen, under an abdominal binder which is snug. The pain catheter is attached to a pump with 0.25% bupivacaine.
Mini-abdominoplasty may be performed as an outpatient. Before leaving the recovery room, the patient must be able to urinate, ambulate, and take adequate oral ﬂuids.
Arnica montana herbal pills may be taken immediately preoperatively and then postoperatively to reduce edema and bruising. After initial recovery, topical ointment or gel may be massaged into the skin while also taking the oral medication.
Physical limitations within the abdomen last for a month. Patients may shower several days after the procedure, and foam pads and binder are recommended for the first week. The drain is typically removed after a week.
Overzealous repair of a diastasis rectus can lead to irregular bunching of the overlying skin. This may require further lateral undermining, but caution is encouraged if significant liposuction has been performed as well. Vascular compromise is possible.
Plication needs to be performed up to the xiphoid notch. The mistake often seen is incomplete or inadequate diastasis repair, particularly as the distance increases from the suprapubic access incision.
It is critical to replace the umbilicus in the midline, and this should be definitively checked. Midline staple can be placed when draping to assist in placement. In some cases, patients may not have a completely centralized umbilicus preoperatively, and this should be noted and brought to the patient’s attention.
Patients can get into trouble with seromas if their activity level is too great within weeks of the operation. Compression assists with protecting against this problem.
Liposuction should not be performed prior to hernia repair if there is a hernia. Blind liposuction runs the risk of injuring intra-abdominal contents.
Pick your patients carefully. Skin removal here is limited, and patients seeking this technique are looking for short scars. They must be informed of the limitations of this technique with minimal skin removal allowed with a minimal scar.
Mini-abdominoplasty Combined with Liposuction in Bangalore & Cost.
Cost is approximately 60.000- INR
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