Abdominal contour surgery for the massive weight loss patient: the fleur-de-lis approach

Massive weight loss patients often have significant upper midline abdominal fullness that contributes to the overall abdominal girth. This region frequently is not adequately treated with conventional abdominoplasty techniques. The author used a fleur-de-lis pattern when performing a full abdominoplasty or circumferential abdominoplasty. The technical refinements of this procedure for massive weight-loss patients are presented, as well as considerations of the technique's safety. A full abdominoplasty pattern was marked, and the inferior incision was lowered along the midline to adjust for mons pubis ptosis as necessary. The vertical component of the abdominoplasty was marked as an inverted “V” or triangle to decrease the abdominal girth, and the cephalic portion was “rounded off” to create an inverted “U.” It was important to lower the final incision of the superior margin of the original abdominal pannus resection approximately 2 to 3 cm to allow for minimal tension at the lower abdominal midline closure. The back and flanks were marked for those patients undergoing a circumferential procedure using a gull-wing type incision, joining it with the anterior abdominal marks. The mid-axillary line was marked bilaterally. Vertical reference lines were also drawn along the back to aid in aligning the upper and lower back incisions. The back was treated first for those patients undergoing a circumferential procedure, and then the patient was repositioned supine for treatment of the abdomen and flanks. Ten patients whose average weight loss was 137 pounds after gastric bypass surgery underwent abdominal contour surgery incorporating a fleur-de-lis pattern. Two men and 8 women with ages ranging from 17 to 53 years (average, 39 years) were treated. Seven underwent a circumferential procedure whereas 3 underwent an isolated abdominoplasty. The follow-up period ranged from 1 month to 26 months, with an average follow-up of 9.5 months. Five patients had a hernia repair performed in conjunction with the abdominal contour surgery. There was no flap loss or wound dehiscence at the inverted “T” closure for any patient. Use of a fleur-de-lis pattern in abdominal body contouring is a safe and effective technique for properly selected massive weight-loss patients. It is particularly appropriate for those patients with significant upper midline abdominal fullness.