복부성형술 (복부거상술) 의 역사 (abdominoplasty)

복부성형술

Abdominoplasty is one of the most commonly performed aesthetic procedures, which encompasses not only aesthetic features but also structural reconstruction of the abdominal wall. Aesthetic enhancements include improvement in abdominal wall contour, reconstruction of a natural appearing umbilicus, and optimal placement of the resulting abdominal scar. The reconstructive component includes recreation of the original fascial and muscular anatomy as well as the restoration of any other anatomical deformations that may be present.
The primary goals in abdominoplasty procedures are to achieve an optimal resection of abdominal skin and subcutaneous tissue in a three dimensional manner, with a resulting wound tension that is distant from the area of tissue resection; the purpose of keeping wound tension distant from the resection is to prevent an impairment of perfusion. In addition, the abdominal musculoaponeurotic layer should be restored to prevent abdominal hernias, diastasis, and consequent muscular imbalance of the trunk, while at the same time improving the abdominal wall contour.
Due to the number of variations and modifications of abdominoplasties, it is key to select the appropriate technique in every individual case, determining the best procedure by minimizing morbidity and postoperative disability for desirable and predictable results.

복부성형술은 가장 흔히 시행되는 미용수술 중에 하나입니다, 심미적 특징뿐만 아니라 복벽의 구조적 재구성도 포함합니다. 심미적 향상에는 복벽 윤곽 개선, 자연적으로 나타나는 배꼽의 재건, 그리고 결과적인 복부 흉터의 최적 배치가 포함됩니다. 재구성 구성 요소는 원래의 근막 및 근육 해부학의 재생뿐만 아니라 존재할 수있는 다른 해부학 적 변형의 복원을 포함한다.
복부성형술의 주요 목표는 3 차원 방식으로 복부 피부와 피하 조직의 최적 절제술을 달성하는 것이며, 결과적으로 조직 절제 영역에서 떨어진 상처 장력을 갖게됩니다. 절개로부터 상처 장력을 멀리 유지하는 목적은 관류의 손상을 방지하는 것이다. 또한, 복부 근육질 협착증 층은 복부 탈장, 이완 및 결과적으로 근육의 불균형을 방지하면서 복벽 외형을 향상시켜야합니다.

복부성형술은 다양한 방법이 있고 각각의 환자 사례에서 적절한 방법을 선택하는 것이 바람직하고 예측 가능한 결과에 대한 이환율과 수술 후 장애를 최소화하여 최상의 절차를 결정하는 것이 중요합니다.

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One of the first publications in abdominal wall surgery dates
back to 1899. Kelly attempted to correct excess abdominal skin
and fat using a large horizontal midabdominal incision,
resecting a panniculus weighing over 7000 g. In 1916, Babcock
presented a vertical midline incision.4 Since that time, numerous
variations have been suggested. Thorek (1924) was the
first to devise an abdominal procedure including the nowadays
preferred lower transverse incision that preserved the
umbilicus.

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In 1957, Vernon published a modern version of abdominoplasty,
including an umbilical transposition and plication
of the musculoaponeurotic layer.7 Pitanguy reported in 1967
on 300 abdominal lipectomies;8 Regnault published the
W-technique for abdominoplasty in 1972.9 In 1973, Grazer
described the so-called “bikini line incision”.10 The St. Tropez
bikini, fashioned in the 1960s with a very low waistline,
favored the abdominoplasty with a nearly horizontal incision.
In the mid-1980s, the French-line bikini (cut high at the lateral
aspect and low centrally) became popular, favoring the
abdominoplasty incision to be converted from a nearly horizontal
line to an incision line that accompanied the inguinal
fold.9,10 Nowadays, bikinis with very low waistlines have
gained higher popularity again. Therefore, proper adjustments
in every single technique are necessary to achieve a
tailor-made abdominoplasty.

In 1977, Grazer and Goldwyn reported the first complications
using new abdominoplasty techniques. They had noted
the ability to reduce the anterior projection of the abdominal
wall by aponeurotic suturing without decreasing the diameter
of the waist. Psillakis published, in 1978, the external belt for
extensive waist diameter reduction by suture plication of the
external oblique muscle after raising it in a belt-like fashion. 
The addition of liposuction to body contouring surgery in
the 1980s allowed a further evolution of abdominoplasty
procedures. In 1985, Dellon published the new approach to a
combined vertical and transverse resection of the abdominal
wall resulting in a fleur-de-lis pattern. In 1988, Matarasso
expanded the use of abdominal contour surgery to a classification
based on variations in patients’ anatomy, from liposuction
alone to limited and full abdominoplastic surgery. 
Ted Lockwood described the high lateral tension abdominoplasty
in 1997, differing from conventional abdominoplasty
by limited direct undermining, increased lateral skin resection
with high-tension wound closure along the lateral flanks with
reconstruction of the superficial fascial system (SFS). 
In 2001, Saldanha published a new technique combining
lipoplasty with traditional abdominoplasty without undermining
of the abdominal flap, followed by modifications of
this technique by extended undermining.
According to the American Society for Aesthetic Plastic
Surgery’s 2016 Cosmetic Surgery National Data Bank Statistics,
the number of abdominoplasty procedures performed
has increased approximately 434% since 1997. 

crucial stages, problems with any of which can lead to congenital
defects of the abdominal wall. After separation of
the umbilical cord, the abdominal wall becomes a definitive
structure.
Abdominal skin and fat tend to be distributed in the lower
abdomen with aging and pregnancy. Especially as a result of
multiple pregnancies, striae become common, resulting in a
rupture and separation of dermal collagen with consequent
skin thinning. At this time, the therapy of striae is exclusively
by surgical excision.

 

글.닥터코스트

사진.픽사베이

출처. Neligan Plastic Surgery