Initial examination of patients for abdominoplasty

Anamnesis. A carefully collected anamnesis allows one to understand the reasons for the development of pathological changes in the anterior abdominal wall. To do this, the surgeon finds out the presence of previous pregnancies, changes in body weight and the impact of each pregnancy on the condition of the anterior abdominal wall.

Motivation. Stretch marks on the relaxed skin of the abdomen are a cosmetic defect and prevent many women from appearing on the beach in an open swimsuit. The presence of a fold on the abdomen is emphasized by tight clothing. The existence of an "apron" of soft tissues disrupts the sexual attractiveness of a woman and can cause disharmony in family relationships.

Medical examination. Patients are examined naked in a standing position and then lying down. During the examination, the presence of scars on the anterior abdominal wall, the number, distribution and type of stretch marks, the degree of obesity, and the presence of hernial protrusions are noted. The tone of the anterior abdominal wall and the edges of the muscles are determined. Excess skin is assessed by taking it in a fold and moving this fold to the level of the inguinal. This test allows one to determine the type and location of the proposed incision. Ultimately, the surgeon selects the final method of correcting the deformity in a given patient and informs him of the content of the operation.

Indications and contraindications. The main indications for abdominoplasty are:

• the presence of stretch marks on the skin, located mainly in the hypogastric region, in combination with flabbiness of the skin;
• the presence of a skin-fat "apron" in the lower abdomen;
• significant divergence of the rectus abdominis muscles;
• loose skin combined with umbilical hernia;
• extensive postoperative scars.

Many patients, especially those with excess weight, want to create a waist and generally improve their figure "immediately and as much as possible" without dooming themselves to physical exercise and dieting. It is understandable that for some patients this intervention seems to be a "simple and reliable measure" that can solve their problems. In these cases, it is advisable to recommend that patients reduce their body weight, after consulting a nutritionist.

In the presence of obesity with significant deposits of fatty tissue on the anterior abdominal wall, surgical methods are often considered as a last resort after unsuccessful shaping and dieting. In these cases, the question of surgery must be decided differentially depending on specific conditions.

The most common general contraindications include:

• the presence of scars on the anterior abdominal wall located above the navel (for example, after cholecystectomy), with the possibility of their significant impact on the blood supply to the flaps cut out during the operation;
• excessive thickness of the subcutaneous fat layer on the anterior abdominal wall, which increases the likelihood of developing postoperative complications.

Common factors that make abdominoplasty inappropriate or premature include:

• the patient's intention to subsequently lose weight, which will worsen the outcome of the operation;
• possible pregnancy, which will lead to the loss of the achieved result;
• the presence of general diseases (diabetes, heart disease, etc.).

Preoperative preparation. Patients should not take medications containing acetylsalicylic acid for 2 weeks before surgery. During the last two days before surgery, the patient is put on a "water diet". A cleansing enema is given in the evening before surgery and in the morning of the day of the intervention.

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