Functional Benefits of Abdominoplasty

Abdominoplasty has traditionally been considered to produce a greater cosmetic benefit than a functional improvement. Like breast reduction however abdominoplasty does do more, it can improve lower back pain and stress incontinence symptoms.

Directed presurgical questioning of  abdominoplasty patients over two years revealed 63% suffered lower back pain since childbirth (63/100). 42% (42/100) complained of stress incontinence since childbirth. All back pain patients improved following the abdominoplasty, 75% with complete resolution. All stress incontinence also improved, 80% completely.

Improvement in function following abdominoplasty can be explained using the mechanical system of Tensegrity. Reconstitution of the abdominal cylinder leads to a realigning of fascial tension throughout the abdomen and the pelvic floor. Tensegrity is a different theory of biomechanics which places a greater importance on connecting fascia to the extent the skeleton is a compression structure floating in an integrated tension network of soft tissues. Imbalance in this network leads to musculoskeletal pain and dysfunction corrected by the rectus repair.

Aesthetic and functional improvements are synergistic. Increasing the muscle fascia tension by repairing the rectus diastasis restores function previously lost and also improves waist contour. Increasing subcutaneous fascial tension, above the muscle fascia, further improves the waist. This method of abdominoplasty in which the main vector of pull is down and in (High Oblique Tension) tightens the abdominal skin in a spiral fashion and it is postulated this additional tension is responsible for some of the functional improvement seen.

To assess skin laxity of the trunk, 25 patients were mapped. A grid of points 5cm apart was drawn on the hemiabdomen from the inframammary fold to the upper pubis, midline front to back. Skin excursion at each of these points was recorded in four directions. The patients were remapped 1 year after their abdominoplasty showing  significant reduction in skin laxity at all points.

To further investigate the patterns of laxity seen in the preoperated abdomen, 2 cadaver dissections were undertaken. The subcutaneous tissue was removed from the muscle fascia and a coloured pin was placed at intervals, different colours reflecting the degree of tissue adhesion. A map was obtained of subcutaneous tissue attachment.

A High Oblique Tension abdominoplasty utilizes the area of firm attachment on the lateral abdominal wall after judicious mobilization (the Velcro principle) to improve the waist and then by transference of tension through the deep subcutaneous attachment to potentiate the effects of the rectus plication without any overplication beyond anatomical. The benefits of a lowered waist and leaner contour are added to improved core strength,  resolution of back pain and stress incontinence, the aesthetic creating the functional.