Anchor / fleur-de-lys abdominoplasty

One variation of the usual abdominoplasty (tummy-tuck) is known variously as the "anchor", the "vertical" or "Fleur-de-lys" abdominoplasty. This involves removing not only the lower abdominal skin and fat, but also adding a vertically-oriented segment shaped like an inverted "V" in the upper midline. When the surgery is completed, this leaves a T-shaped or "anchor" shaped incision, but it is a very effective tightening operation for those who need it.

It's usually only performed for our patients that have lost a major amount of weight (>100 lbs), and who have obvious fullness or laxity in that upper midline zone of the abdomen. Standard abdominoplasty techniques don't correct horizontal laxity of the upper abdomen very well, so this technique may be useful for patients with that particular issue.

Also, for patients that have had a previous traditional open-style gastric bypass operation, and who have a scar there already, the fleur-de-lys approach is a reasonable option, as we are not adding any new scars, and are merely using the pre-existing midline incision to take out a little more skin there.

As is commonly the case in excisional body lifting surgery, this operation is a trade-off: more scars, but better tightening.


Advantages of the fleur-de-lys approach:
- better tightening of upper abdominal zone when obvious laxity is present
- may permit excision of previous old-fashioned gall-bladder surgery scars
- gives horizontal tightening, unlike a standard abdominoplasty

Disadvantages:
- more scars, which are not as well hidden as a standard abdominoplasty
- has potential for wound healing problems at intersection of incisions
- umbilicus shaping is more complex, prone to post-operative shape changes

Surgery after Massive Weight Loss

As gastric bypass procedures have become more common, patients who have lost a large amount of weight following gastric bypass, who now have significant laxity of their skin have also become more common in our office. As you'd expect, the areas that are commonly affected after massive weight loss (MWL) include: the abdomen and trunk, the breasts, the arms, and the inner and outer thighs.

While plastic surgeons have long had operations to fix these problem areas by removing the excess skin, we've learned through experience that the MWL patients are a little different than regular non-MWL patients when it comes to wound healing, complications and results.

For example, problems like anemia (from iron or vitamin B12 malabsorption) and certain other vitamin deficiencies are much more common in someone who has had a previous gastric bypass, compared to a non-bypass patient. Also, poor protein absorption caused by the effects of bypass surgery can result in low protein reserves and subsequent troubles with slow or impaired wound healing.

MWL patients are also more prone to have a higher rate of certain post-surgical complications. These include: wound separation, fluid accumulations under the skin known as seromas, and scars that may be more obvious in color or size compared to the non-MWL group.

Also, the MWL- patient's skin tends to stretch out more over time, due to decreased elasticity. So, even though we pull the skin as snug as we safely can, some relapse of the lifted area can occur.

Overall, this makes surgery for MWL patients more of a challenge - but the results are usually very gratifying for both surgeon and patient alike when it is completed. We'll discuss this topic in more detail in future blogs.