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Abdominal wall
The abdominal wall is built in layers: skin, the fatty Camper fascia, the membranous Scarpa fascia, deep fat, and the rectus muscles in their sheath, joined at the midline by the linea alba. A tummy tuck removes the outer layers and tightens the sheath.
Outside to inside
The skin between the navel and the pubic hairline is the part removed in a full tummy tuck. Stretch marks improve only where they lie on that skin. In classic abdominoplasty, blood flow to the skin between the navel and the scar fell to a mean 17.2% of normal skin in 15 patients measured with indocyanine green dye.[1][2][3]
Camper fascia is the outer fatty layer, loose tissue held in fibrous walls, lying under the skin and above Scarpa fascia. It runs from the xiphoid to the inguinal ligaments. Saldanha's lipoabdominoplasty keeps a thin fatty layer with its connective tissue, lymph vessels and blood vessels.[1][2]
Scarpa fascia is a membranous layer deep to Camper fascia and superficial to the external oblique muscle. It joins the linea alba and the pubic symphysis in the midline and fuses with the fascia lata about a fingerbreadth below the inguinal ligament. In a trial of 160 women, keeping Scarpa fascia and the deep fat below the navel cut seroma by 86.7% and drain output by 65.5%.[1][2]
The rectus sheath is the fibrous compartment around the rectus abdominis and pyramidalis muscles, formed by the aponeuroses of the external oblique, internal oblique and transversus abdominis. Its layers differ between the upper two-thirds and the lower third. It carries the superior and inferior epigastric arteries and veins.[1]
Classic abdominoplasty divides the main perforating vessels from the muscles to the skin. Lockwood limited direct undermining to the area near the midline to keep perforators. Saldanha's selective undermining keeps at least 80% of the blood supply of the abdominal wall.[1][2][3]