Purpose:

We report a unique method of truncal body contouring in a 30 year-old gravida 4 para 2 female who underwent a living-related liver transplant for sclerosing cholangitis and cirrhosis, leaving her with a Chevron scar. Truncal body contouring was staged with liposuction first followed by a discontinuous upper and lower abdominoplasty in order to decrease wound healing complications.

Background:

Traditional truncal body contouring has evolved into a spectrum of surgical options ranging from liposuction to abdominoplasty and a combination of both. Full abdominoplasty can eliminate the redundant tissues in the upper and lower abdomen as well as tighten the abdominal fascia.

In the patient who has a scarred abdomen, full abdominoplasty represents a challenge. Huger's Zone 1 of the abdomen (xiphoid to pubis) receives blood primarily from an arcade formed between the superior and inferior epigastric arteries. In patients with upper abdominal scars, there is increased risk of wound complications or skin/tissue necrosis secondary to interruption of blood supply to Zone 1. Other authors report successful “anchor-line” abdominoplasty in patients with supraumbilical or paramedian scars.

Methods:

In the first stage, a VASER ultrasound liposuction machine was used on the entire abdomen, flanks, and lateral breast areas. We avoided deep liposuctioning in the area of the previous liver transplant scar. A compression garment was worn during the post-op period prior to abdominoplasty.

4 1/2 months later, the patient returned to the operating room for a discontinuous upper and lower abdominoplasty. The Chevron scar was excised and elevation of the lower side of the flap was performed at the level of the anterior rectus fascia down toward the umbilicus. The lower side of the flap was advanced superiorly and the excess was cut off. We then used the Doppler ultrasound to identify periumbilical perforators in Zone 1 bilaterally. A lower abdominoplasty was then performed by undermining the upper flap to the level of the umbilicus while preserving at least three perforators on each side. The incision used was an ellipse, extending from one anterior iliac spine to the other.

Results:

At 2 weeks post-abdominoplasty and 5 months post-liposuction, there is aesthetic improvement in the abdominal contour with elimination of lower abdominal roll, reduction in upper abdominal, and lower abdominal fat. Patient satisfaction is excellent. There was no wound healing complication or tissue necrosis.

Conclusion:

This case report demonstrates the successful use of a unique method of truncal body contouring using staged liposuction and discontinuous upper and lower abdominoplasty in an immunosuppressed liver transplant patient. Thus, Chevron and bilateral subcostal incisions can be managed in this manner. As transplant surgery advances in surgical technique and immunology, patients will live longer and may require body contouring especially when certain immunosuppressant medications cause excessive weight gain. This method of truncal body contouring is a safe option with good aesthetic results for these patients.