The reverse abdominal reduction and the “waistcoating” procedure for the correction of the fixated pfannenstiel incision

Abstract The principles of a standard abdominal reduction are well understood and as a technique it has been used for many years. There are occasions, however, where, for example, an abdominal reduction has already been carried out but continued weight loss has led to skin redundancy on the upper abdomen or in cases where the upper abdomen needs correction but similarly the patient requires a mastopexy or breast reduction at the same time where a reverse abdominal reduction may be considered. The latter procedure is rarely mentioned in the medical texts but can prove successful, and although the scar across the lower sternum has often been considered to be unsatisfactory, often it does not prove to be so. In the correct circumstance it can prove a very successful procedure. Secondly the Pfannenstiel incision, if not satisfactorily repaired in the first instance, can become fixated to the abdominal wall with the inevitable migration of skin and fat at its cephalic edge which causes a rather displeasing contour defect when wearing tight fitting swimwear. The principle of the waistcoating procedure is essentially to chamfer the fat cephalically and use it to disconnect the Pfannenstiel scar from the abdominal wall. The principle is simple and effective and can be used elsewhere where there is a fixated scar. These two aforementioned principles are not commonly used but can prove particularly effective in suitable cases when they arise. We illustrate the principles.