The postpartum abdomen: psychology, surgery and quality of life

Effect of Compression Garments on Post-Abdominoplasty Outcomes: A systematic Review of the current Evidence

Introduction

It is commonly believed that using abdominal binders or compression garments (CGs) after an abdominoplasty could encourage fluid to drain, which would prevent fluid from building up at the surgical site and reduce the risk of seroma and other similar problems.

Objective

To evaluate the effect of the use of abdominal binders or CG on the post-operative outcomes following abdominoplasty.

Design

Systematic review.

Method

Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to select relevant studies from 2004 to 2024. Data from the included studies were extracted to assess the quality and risk of bias using a modified Jadaad score.

Main outcome

Post-operative seroma formation.

Secondary outcome

Ventilatory function, intra-abdominal pressure (IAP), and subcutaneous edema were the outcomes of interest.

Results

Only 5 trials totaling 130 patients were included in this review. Utilizing post-operative CG following abdominoplasty showed a non-significant tendency to decrease seroma development, ventilatory function, and subcutaneous edema. The limited evidence available also suggested that using post-operative CG increases IAP.

Conclusion

Weak evidence supports the beneficial use of abdominal binders following abdominoplasty.

Limitations

Low-quality scientific evidence available from the scant data and low caliber of the literature support the use of CG post-abdominoplasty. Therefore, unified outcome reporting and rigid randomized clinical trials are necessary to obtain valid data.

Exploring the Potential of ChatGPT-4 in Responding to Common Questions About Abdominoplasty: An AI-Based Case Study of a Plastic Surgery Consultation

BACKGROUND

With the increasing integration of artificial intelligence (AI) in health care, AI chatbots like ChatGPT-4 are being used to deliver health information.

OBJECTIVES

This study aimed to assess the capability of ChatGPT-4 in answering common questions related to abdominoplasty, evaluating its potential as an adjunctive tool in patient education and preoperative consultation.

METHODS

A variety of common questions about abdominoplasty were submitted to ChatGPT-4. These questions were sourced from a question list provided by the American Society of Plastic Surgery to ensure their relevance and comprehensiveness. An experienced plastic surgeon meticulously evaluated the responses generated by ChatGPT-4 in terms of informational depth, response articulation, and competency to determine the proficiency of the AI in providing patient-centered information.

RESULTS

The study showed that ChatGPT-4 can give clear answers, making it useful for answering common queries. However, it struggled with personalized advice and sometimes provided incorrect or outdated references. Overall, ChatGPT-4 can effectively share abdominoplasty information, which may help patients better understand the procedure. Despite these positive findings, the AI needs more refinement, especially in providing personalized and accurate information, to fully meet patient education needs in plastic surgery.

CONCLUSIONS

Although ChatGPT-4 shows promise as a resource for patient education, continuous improvements and rigorous checks are essential for its beneficial integration into healthcare settings. The study emphasizes the need for further research, particularly focused on improving the personalization and accuracy of AI responses.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combined Surgery (Mommy-Makeover) Compared to Single Procedure (Abdominoplasty) in After-Pregnancy Women: A Prospective Study on Risks and Benefits

BACKGROUND

Mommy-makeover is becoming very popular to help them reshaping their own bodies and restoring self-perception, hardly stressed by childbearing-related changes. However, debate exists in the literature concerning safety and aesthetic outcome in patients undergoing combined procedures. The study aims to shed a light on advantages and disadvantages in mommy-makeover technique compared to conventional abdominoplasty with a particular attention to psychological aspects.

MATERIALS AND METHODS

In total, 37 women were enrolled at Campus Bio-Medico Hospital in Rome between October 2019 and January 2022. All of the patients were eligible for both abdominoplasty only and mommy-makeover. We proposed to the patients both procedures explaining risks and benefits; then, based on the preference of the single patient, we performed either mommy-makeover (Group A) or abdominoplasty alone (Group B). In order to evaluate patients' satisfaction and safety, multiple questionnaires were administered 9-month postoperatively (BUT, POSAS, visual perception, etc.).

RESULTS

The sample analyzed was composed of 37 patients (treatment group = 18, control group = 19). In the pre-post comparisons of BUT-A performed, there were statistically significant differences recorded in both groups and for all observed variables. The significance values were all less than 1% (p < 0.01).

CONCLUSIONS

Combined surgery proved not to be inferior in terms of patient safety. At the same time, the effectiveness in improving diastasis-related symptoms is fully comparable with single surgery. Treatment group showcases a considerable superiority in terms of body-image perception improvement and overall patient satisfaction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intra-abdominal and perineal pressures during abdominal exercises: A cross sectional study in postpartum women

AIMS

Low intra-abdominal pressure (IAP) and high perineal pressure (PP) are safe conditions for pelvic floor. This study aims to measure IAP and PP in Beninese post-partum women during abdominal exercises and determine what exercise presents less risk for pelvic floor after delivery.

METHODS

IAP and PP were measured at rest and during exercises performed in random order: Cough, pelvic floor contraction (PFC), Curl-up, diaphragmatic aspiration (DA), Drawing-in, DA + Curl-up and Drawing-in+Curl-up, using a Micro-Full biofeedback PHENIX-Vivaltis with dual-channel probe. Results were presented as change from rest (maximal value during exercise minus value at rest) and expressed in percentage of this change for the reference exercise, Cough for IAP and PFC for PP. The ANOVA repeated measures test was used to compare pressures between exercises.

RESULTS

Seventeen postpartum women participated to this study. The maximal IAP and PP change were the highest (100%), respectively, during cough and PFC. During DA, IAP was the lowest (-7%) and PP was 51%. During Curl-up, IAP was moderate (43%) and significantly higher than during PFC (33%), Drawing-in (16%) and DA. PP was low (29%) and similar to that during Drawing-in (23%). Compared to Curl-up, Drawing-in+Curl-up increased PP (50%) but did not decrease IAP (40%). DA + Curl-up increased PP (58%) and decreased IAP (31%) compared to Curl-up but not compared to DA.

CONCLUSION

DA is safe and Curl-up presents little risk for the pelvic floor. According to interindividual variations observed in IAP and PP, intrinsic factors should be considered in future studies.

Association Between Inter-Recti Distance and Impaired Abdominal Core Function in Post-Partum Women With Diastasis Recti Abdominis

Background and Aim: The definition and management of Diastasis Recti Abdominis (DRA) is under debate. This study aimed to understand the correlation between the post-partum inter-recti distance (IRD) and functional impairments associated with core instability, with the hypothesis that IRD could serve as a proxy for core instability symptoms and constitute a tool in decision-making for DRA treatment. Material and Methods: A cohort of post-partum women with abdominal core instability symptoms combined with DRA were studied. The size of IRD was measured with ultrasonography and cross-sectionally analysed against functional impairments registered with the self-report Disability Rating Index (DRI), which grades the ability to perform 12 different daily activities. Results: A total of 224 women were included in the study. In univariable analysis, IRD was associated with impairment of the activities running (p = 0.007), heavy work (p = 0.036) and exercise/sports (p = 0.047), but not with dressing, walking, sitting for long periods, standing bent over a sink, carrying a suitcase, making a bed, light manual labour or heavy lifting. No significant correlations were seen in the multivariable analysis when adjustments were made for BMI and parity. Conclusion: IRD and post-partum functional impairments had no significant correlation in multivariable analysis. The post-partum core instability condition is complex and probably associated with more factors than solely the IRD. The IRD alone does not seem to be a sufficient proxy for decision-making regarding optimal treatment. A more complete instrument to assess the post-partum abdominal core is warranted.