THE FUNCTIONAL BENEFITS OF ABDOMINOPLASTY

I have always enjoyed performing abdominoplasties, gradually developing my technique since 1998, to produce a slimmer more contoured abdomen with a defined waist and female curve.

As a plastic surgeon, I am always looking for improved form and function, but I didn’t realise just how much function was restored until I was visited in 2011 by David Berg, from MoveHappy Physiotherapy. He told me my post-op abdominoplasty patients were being discharged from his practice as their chronic low back pain and pelvic instability was cured by an abdominoplasty.

Indeed, my patients had been saying they were better, but I hadn’t asked specific questions about back pain and incontinence. So I started asking and the results were interesting. Over half the patients I saw for abdominoplasty had suffered chronic lower back pain since pregnancy and this was often combined with stress incontinence. The back pain had a significant impact on life, it made mobility and exercise difficult. Even sitting in a chair or in the car for 2 hours was painful. The incontinence occurred on laughing and sneezing. Six months after under-going an abdominoplasty, my patients were reporting all symptoms were pretty much gone. My female patients were telling me they felt stronger, healthier and happier with the added bonus of an improved shape.

This was an important message but there was little evidence in the literature apart from case reports. If I was going to do a study, I would need numbers. Through the Australasian Society of Plastic Surgeons I recruited 8 other plastic surgeons to the study.

THE STUDY

The premise was simple. All patients presenting for abdominoplasty were asked to fill in a validated research questionnaire on back pain and another on incontinence. The questionnaire was completed at three pivotal points; before the operation and then post-operatively at 6 weeks and 6 months afterwards.

By including all patients undergoing abdominoplasty it would give an indication as to the number of women suffering with functional symptoms. There was no modification of the operation to accommodate functional symptoms, it was a study of normal surgical practice.

The study ran from September 2014 to March 2016. There were 214 patients enrolled, with an average age of 42, average birth rate of 2.5 children, and an average BMI 26.3. Pre-surgery, 9% of patients had no back pain and 27.5% had no incontinence.

THE RESULTS

The post-operative results were remarkable. The average back pain disability score pre-surgery was 21.8%, which translates to a moderate disability. By 6 months post-operatively, the average disability score was 3.2%, an 85% improvement. Pre-surgery the incontinence score was 6, post-surgery it was 1.6, a 73% improvement.

These results are statistically and clinically significant. They show conclusively, abdominoplasty is a functional reconstructive operation for the woman suffering post pregnancy chronic back pain and incontinence. Medicare, in 2016, restricted the abdominoplasty item number to only weight loss patients, citing a lack of evidence the operation was anything other than cosmetic. This large, prospective, multicentre Australian study is the evidence. Medicare should now reconsider loosening the restriction to include women with chronic back pain and incontinence so they can reduce the large out of pocket expenses and claim this procedure on their health insurance.