title: "Inverted-Y": a modified vest-over-pants abdominoplasty pattern following bariatric surgery.
abstract: BACKGROUND
  The post-bariatric surgery patient presents several challenges to the surgeon. Correction of skin and subcutaneous redundancy can be difficult, particularly in massive-weight-loss patients with horizontal laxity, upper abdominal or flank laxity, and "double-roll" deformities. The aim of our study was to propose our modification of the "vest-over-pants" abdominoplasty technique to exploit all the advantages of the Planas technique in bariatric surgery patients and to solve the problem of extreme epigastric skin redundancy in difficult abdominal contour cases.
  
  
  METHODS
  Sixteen post-bariatric surgery patients (10 females and 6 males, nonsmokers) with moderate to severe epigastric skin laxity were enrolled in the study. They all had undergone a biliopancreatic diversion (BPD) by laparotomy and had undergone this body-contouring procedure from 2006 to 2010.
  
  
  RESULTS
  After the inverted-Y abdominoplasty, 12 patients (75 %) had an uneventful recovery. On the other hand, one subject (6.25 %) had a seroma and four (25 %) had wound dehiscence and delayed wound healing. No skin necrosis was reported. In one patient (6.25 %) scar revision in areas that had delayed healing was performed. The addition of a vertical incision has not led to an increased rate of postoperative complications, but the rates are in line with the satisfactory results described with the Planas technique in bariatric surgery patients. In addition, various advantages have been observed compared to traditional vertical resection patterns.
  
  
  CONCLUSIONS
  This case series has quantitative limitations and further investigations are needed. However, this study suggests that inverted-Y abdominoplasty could be a good compromise between the need to minimize complication rates and ensure an optimum aesthetic result and patient satisfaction rate in some abdominal defects in massive-weight-loss patients.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bracaglia
authors.forename: Damiano
authors.initials: D
authors.lastname: Tambasco
authors.forename: Marco
authors.initials: M
authors.lastname: D'Ettorre
authors.forename: Stefano
authors.initials: S
authors.lastname: Gentileschi
mesh_terms: D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D008297:Male