9805-1685 Lickwood
Lockwood T.
Rectus muscle diastasis in males: primary indication for endoscopically assisted
abdominoplasty.
Plast Reconstr Surg. 1998 May;101(6):1685-91; discussion 1692-4. PMID: 9583506
Endoscopic techniques through umbilical and mons pubis ports have provided a
method to plicate rectus muscle diastasis without skin resection. Limited or no
skin excision is performed. Major series have included only women. The criteria
for patient selection for endoscopic abdominoplasty include a protuberant
abdomen caused by rectus muscle diastasis with minimal actual or potential skin
laxity. There should not be significant intra-abdominal obesity. Extra-abdominal
familial fat deposits may be part of the abdominal aesthetic deformity. In most
women, rectus muscle diastasis because of pregnancy, obesity, or aging is
associated with actual or potential skin laxity of the abdomen and lateral
trunk. Endoscopic abdominoplasty in these women would produce mediocre early
results and poor aging potential for the future. There are a limited number of
women who are reasonable candidates for the endoscopic approach. In contrast,
rectus muscle diastasis without skin laxity is a common finding in men older
than 30 to 40 years of age. There may be a history of weight fluctuations,
weightlifting, or full-excursion sit-up exercises, which may lead to progressive
separation of the rectus muscles over time. Other etiologic factors include
chronic or intermittent abdominal distension, advancing age, or familial
weakness of the abdominal musculofascial tissues. Endoscopically assisted
abdominoplasty was performed in four male patients with good to excellent
results at 4 to 18 months. Minor complications occurred in half the patients but
were successfully treated without re-operation. Men with prominent abdominal
contours who are diet- and exercise-resistant should be examined both for
familial fat deposits and for significant rectus muscle diastasis. Contouring of
the male abdomen may be the primary indication for endoscopically assisted
abdominoplasty.
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