1967 · I. Pitanguy, P. Regnault
Full abdominoplasty
Incision and plane. Low horizontal incision, skin lifted to the ribs, navel moved, muscles plicated
The skin is lifted up to the rib margin, the muscles are repaired, and the upper skin is pulled down and trimmed. The navel is brought out through a new opening. In 278 abdominoplasties at one London center, 75% were full operations with undermining to the costal cartilage and navel repositioning.[1][2][3]
Suits. Loose skin and muscle above and below the navel.
Trade-offs. In the 278 cases, 12% had dog ears, 8% unsatisfactory scars and 24% a revision operation.
1987 · R. F. Greminger
Mini abdominoplasty
Incision and plane. Shorter low incision, lower abdomen only
Greminger described the mini-abdominoplasty for patients whose deformity lies entirely below the semicircular line, in a series of 14. Matarasso's 1991 classification placed it between liposuction alone and a modified or full abdominoplasty.[1][2][3]
Suits. Lower abdominal muscle laxity and fat when liposuction alone is not enough and a full abdominoplasty is too much.
Trade-offs. It is limited to deformity below the semicircular line. In 519 outpatient cases, complications did not differ between full and mini or floating-navel operations.
2012 · J. A. Mejia
Extended abdominoplasty
Incision and plane. Incision carried into the flanks, with liposuction of the back
The abdominoplasty is extended into the flanks and combined with liposuction of the back. Mejia placed it between abdominoplasty and circumferential abdominoplasty; 25 of 268 abdominal patients in his series had it.[1]
Suits. Abdominal laxity that extends into the flanks.
Trade-offs. Longer scar. Of 25 patients, 2 had marginal skin necrosis and 1 a wound infection.
1995 · T. Lockwood
High-lateral-tension abdominoplasty
Incision and plane. Limited central undermining, more skin removed at the sides, fascial system repaired
Direct undermining is limited to the area beside the midline, with discontinuous undermining to the ribs and flanks. More skin is removed laterally than centrally and the tightest closure is placed at the sides. The superficial fascial system is repaired with permanent sutures.[1]
Suits. Moderate to severe skin and muscle laxity, with or without fat of the trunk. Lockwood followed 50 patients for 4 to 16 months.
Trade-offs. Complication rates were equal to or lower than historical controls and did not rise with added liposuction, in a single-surgeon series.
1985 · A. L. Dellon
Fleur-de-lis abdominoplasty
Incision and plane. Vertical and horizontal skin resection
A vertical resection is added to the horizontal one to remove excess skin from the upper and lower abdomen and the mons pubis. Dellon reported 16 patients, 13 women and 3 men.[1][2]
Suits. Massive weight loss, obesity with a hanging panniculus, and loose skin above the navel, with or without multiple abdominal scars.
Trade-offs. In 55,596 abdominoplasties in the CosmetAssure database, fleur-de-lis had the highest complication rate of the 7 types.
2001 · O. R. Saldanha
Lipoabdominoplasty (Saldanha)
Incision and plane. Liposuction of the whole abdomen, selective undermining, deep tissue kept
Liposuction treats the upper abdomen and flanks, the skin below the navel is removed, and the upper skin is not lifted widely. A thin fatty layer with its vessels and lymphatics is kept. Saldanha reported 445 patients from 2000 to 2007.[1][2][3]
Suits. Fat and loose skin together. In 11,191 patients in the TOPS database, complications were 10.5% with truncal liposuction and 13.0% with abdominoplasty alone, and liposuction volume did not raise the risk.
Trade-offs. In 845 TULUA lipoabdominoplasties, a variant with no undermining, complications were 16.2%, mostly seroma (8.8%).
1979 · R. Baroudi
Reverse abdominoplasty
Incision and plane. Incision in the breast folds, upper skin pulled up
The upper abdominal skin is removed through incisions in the folds under the breasts. Baroudi combined it with breast reduction in 1979. Deos reported 18 tensioned reverse abdominoplasties with only minor complications.[1][2]
Suits. Loose skin mainly of the upper abdomen, including excess left after liposuction.
Trade-offs. The scars lie in the folds under the breasts. Deos used progressive tension sutures to keep the breast fold in place and tension off the scar.
1940 · Somalo; T. Lockwood; A. S. Aly
Circumferential abdominoplasty (lower body lift, belt lipectomy)
Incision and plane. Incision all the way around the lower trunk
Skin and fat are removed around the whole lower trunk, often with a full abdominoplasty. Lockwood's 1993 lower body lift took 5 to 6 hours, 2 nights of nursing care and 3 weeks off work.[1][2][3]
Suits. Circumferential excess of the trunk, mostly after massive weight loss, including flank and back rolls.
Trade-offs. In Aly's 32 patients, seroma occurred in 37.5% and pulmonary embolus in 9.3%. Lockwood's first 10 patients had minor complications in 50%.
2001 · F. X. Nahas
Diastasis repair (rectus plication)
Incision and plane. Anterior rectus sheath folded and sutured in the midline
The front sheath of the rectus muscles is stitched together to close the gap. Nahas's classification adds an L-shaped plication of the external oblique, rectus advancement or external oblique rotation for types B to D.[1][2][3]
Suits. Rectus diastasis after pregnancy (Nahas type A). In 12 women repaired with permanent suture, CT at 76 to 84 months showed no recurrence despite a mean 6.5 kg weight gain.
Trade-offs. With absorbable suture, 40% of 40 women had residual or recurrent diastasis at a mean 64 months, and vertical plication alone did not improve the waistline.
2000 · H. Pollock, T. A. Pollock
Progressive tension sutures, drain-free
Incision and plane. Skin flap stitched down to the muscle fascia in rows
Rows of sutures fix the flap to the underlying fascia, close the space where fluid collects and spread tension onto the superficial fascial system, so drains can be left out. In 597 consecutive cases over 12 years with no drains, local complications were 4.2% and seroma 0.1%.[1][2][3]
Suits. Seroma prevention. A meta-analysis of 1,255 patients found fewer seromas with sutures and no drains than with drains alone (odds ratio 0.36).
Trade-offs. Seroma did not differ between sutures alone and sutures with drains (odds ratio 1.03). The meta-analysis held one randomized trial and four retrospective studies.
2013 · A. Costa-Ferreira
Scarpa fascia preservation
Incision and plane. Scarpa fascia and deep fat left on the muscle below the navel
Below the navel the dissection stays above Scarpa fascia, leaving it and the deep fat on the muscle. In a randomized trial of 160 women, drains came out 3 days sooner.[1][2]
Suits. Seroma prevention. Seroma fell 86.7% in the trial, and a meta-analysis of 9 controlled studies found Scarpa preservation reduced seroma on its own.
Trade-offs. Applies below the navel only. Other complications and the aesthetic result did not differ from the classic operation.