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Modified Lipoabdominoplasty: Updating Concepts—Our Postbariatric Experience

Patoué, Audrey M.D.; Herlin, Christian M.D., Ph.D.; Carloni, Raphael M.D.; Chaput, Benoit M.D.; Watier, Eric M.D., Ph.D.; Bertheuil, Nicolas M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1021e–1022e
doi: 10.1097/PRS.0000000000003221
Letters

Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, Department of Plastic, Reconstructive, and Aesthetic Surgery, Trousseau Hospital, University of Tours, Tours, France

Department of Plastic Surgery and Burn Surgery, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France

Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, Department of Plastic, Reconstructive, and Aesthetic Surgery, Charles Nicolle Hospital, Rouen, France

STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, and, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France

Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France

Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, Toulouse, France, INSERM U917, University of Rennes 1, Rennes, France, SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France

Correspondence to Dr. Bertheuil, Department of Plastic, Reconstructive, and Aesthetic Surgery, 16 Boulevard de Bulgarie, 35200 Rennes, France, nbertheuil@gmail.com

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Sir:

We read with great interest the article entitled “Modified Lipoabdominoplasty: Updating Concepts” by Ribeiro et al.1 We would like to congratulate the authors for their work and their improvements that confirm our thoughts on monsplasty following abdominoplasty. In our daily practice, we systematically perform mons fixation without liposuction following abdominoplasty or body lift.2,3 Contrary to the authors’ experience, the majority of our patients achieved massive weight loss by means of bariatric surgery. The problem with this specific population is the poor skin tone, the flaccidity, and the great laxity of skin that may compromise the long-term result by a moderate degree of ptosis recurrence. We would like to report our experience based on 26 monsplasties performed during the last half of 2015 and discuss two points.

First, in this specific population, the problem is the opposite of that in patients treated by the authors. The goal of monsplasty is to prevent recurrent ptosis despite higher scar positioning, whereas the authors performed pubic fixation to prevent flap ascent. The aim of this operative step was to bring tension to the pubic region, ascending and flattening it.4 Briefly, preoperative markings were with an arc circle placed at 7 cm from the vulvar fork5 and distant from 5 cm on either side of the midline. During the procedure, monsplasty was performed with three separate stitches using nonabsorbable suture. The first stitch was positioned medially between the Camper fascia and rectus abdominis aponeurosis, and the two lateral stitches were positioned close to the anterior superior iliac spine to apply oblique lateral traction. In our case series, the mean patient age was 44.0 ± 10.1 years; the mean American Society of Anesthesiologists physical status was 1.7 ± 0.5; and patients had a massive weight loss with a pre–massive weight loss body mass index of 49.1 ± 8.3 kg/m2 and a mean preoperative body mass index of 28.5 ± 4.3 kg/m2 (range, 21.1 to 41.4 kg/m2). No complications occurred. Patients reported aesthetic but also functional improvement.

Second, we did not perform a mons liposuction, unlike the authors. Before April of 2015, we used the same strategy, with initial liposuction under the pubic area using a 4-mm cannula. Long-term aesthetic results were similar, but the postoperative course was marked by complications: major edema up to 3 months, bruising, and loss of sensitivity. That is why we stop the use of liposuction with satisfactory results and better patient comfort. Indeed, our technique allows us to flatten the mons, like liposuction without suspension of the pubis (Figs. 1 and 2).

Fig. 1

Fig. 1

Fig. 2

Fig. 2

In conclusion, we absolutely agree with the authors regarding the possibility offered to surgeons who perform pubic fixation following a body lift or abdominoplasty. In our opinion, the goal with the aesthetic patient is opposite that of the postbariatric patient. Monsplasty is an easy, fast, and safe step that must be performed at the same operative time as abdominoplasty or body lift.

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DISCLOSURE

The authors received no funding support for the research of this communication and declared no potential conflicts of interest with respect to the research, authorship, and/or publication.

Audrey Patoué, M.D.

Department of Plastic, Reconstructive, and

Aesthetic Surgery

South Hospital

University of Rennes 1

Rennes, France

Department of Plastic, Reconstructive, and

Aesthetic Surgery

Trousseau Hospital

University of Tours

Tours, France

Christian Herlin, M.D., Ph.D.

Department of Plastic Surgery and Burn Surgery

Lapeyronie Hospital

Montpellier University Hospital

Montpellier, France

Raphael Carloni, M.D.

Department of Plastic, Reconstructive, and

Aesthetic Surgery

South Hospital

University of Rennes 1

Rennes, France

Department of Plastic, Reconstructive, and

Aesthetic Surgery

Charles Nicolle Hospital

Rouen, France

Benoit Chaput, M.D.

STROMAlab

UMR5273 CNRS/UPS/EFS-INSERM U1031

Rangueil Hospital, and

Department of Plastic, Reconstructive, and

Aesthetic Surgery

Rangueil Hospital

Paul Sabatier University

Toulouse, France

Eric Watier, M.D., Ph.D.

Department of Plastic, Reconstructive, and

Aesthetic Surgery

South Hospital

University of Rennes 1

Rennes, France

Nicolas Bertheuil, M.D.

Department of Plastic, Reconstructive, and

Aesthetic Surgery

South Hospital

University of Rennes 1

Rennes, France

STROMAlab

UMR5273 CNRS/UPS/EFS-INSERM U1031

Rangueil Hospital

Toulouse, France

INSERM U917

University of Rennes 1

Rennes, France

SITI Laboratory

Etablissement Français du Sang Bretagne

Rennes University Hospital

Rennes, France

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REFERENCES

1. Ribeiro RC, Matos WN Jr, Cruz PFModified lipoabdominoplasty: Updating concepts. Plast Reconstr Surg. 2016;138:38e–47e.
2. Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier EThe lipo-bodylift: A new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg. 2017;139:38e–49e.
3. Bertheuil N, Carloni R, Herlin C, Chaput B, Watier ELower body lift after massive weight loss: Autoaugmentation versus no augmentation. Plast Reconstr Surg. 2016;137:476e–477e.
4. Michaels J V, Friedman T, Coon D, Rubin JPMons rejuvenation in the massive weight loss patient using superficial fascial system suspension. Plast Reconstr Surg. 2010;126:45e–46e.
5. Seitz IA, Wu C, Retzlaff K, Zachary LMeasurements and aesthetics of the mons pubis in normal weight females. Plast Reconstr Surg. 2010;126:46e–48e.
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