Dr Kelly was the first surgeon that tried and succeeded in correcting excess abdominal fat and skin. He used a transverse incision and was able to collect 7450 g panniculus that measured 90 x 31 x 7 cm and since then, there have been a numerous types of surgery suggested leading to the Thorek model, the fist ever doctor to develop an intervention that will also preserve the umbilicus.
The problem that would lead to such an operation would be an abdominal deformity that is cause by excess subcutaneous tissue and skin and the laxity of the abdominal musculature wall.
One of the most common cause that will lead to such an intervention would be a pregnancy or several pregnancies and at the same time former obese men or women that were left after exercising and dieting still with excessive skin and fat. A pregnancy will stretch the skin far more then its biomechanical capability to have a back spring and also will stretch the musculoaponerotic structures that the abdominal wall will have resulting in a thinning and stretching of diastasis of the rectus muscle and of these structures. A contributing factor will also be postpartum weight loss but if skin retraction did not occur within six months after the birth it will most probably will never occur thus leaving that person with excessive skin and fat on their abdomen.
Also, as earlier stated, a massive weight loss can have its tool on the muscles of the abdomen, whether from a gastric bypass surgery or from dieting and will also play a significant role in having excessive laxity and skin on the abdominal wall. This kind of deformity has two folds that will include the excessive subcutaneous tissue and skin and the laxity of the abdominal wall musculature. The area that will be most significantly affected will be the below and around the umbilicus.
The fat deposits where classified in 1972 by Katras and Georgiade into upper medial or lower medial, solely based on the umbilicus and patients will be divided into there main categories: those with massive weight loss, those who have mild to moderate obesity and the ones that have a normal weight.
This type of procedure should be used as a final solution to the many other options that are out there and not to be taken lightly taking into account that there are cases of pure laziness and bad eating life styles that could lead here.
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