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Aesthetic Plastic Surgery 3:357-368, 1979

Aesthetic
:plastic
urgery
Torsoplasty*
Mari o Gonz~ilez-Ulloa, M. D. , F. A. C. S. , F. I . C. S. , A. R. C. M. , F. I . A. P. S.
Dalinde Medical Center, Mexico City, Mexico
Abstract. Tor sopl ast y is a series of operat i ons per f or med on the t orso, from
the arms to the thighs, to cor r ect deformities caused by obesi t y, weight re-
duction, obst et ri cal remi ssness, or congenital probl ems. The results have
been highly sat i sfact ory and the compl i cat i ons minimal.
Key words: Tor sopl ast y - - Obesi t y - - Ti ssue aging
The simple fact that the pr ocedur e descri bed in this report can be performed
opens new pat hs of possibilities for the surgeon in the management of the soft
tissues of the human body.
Tor sopl ast y is an operat i on designed to be carri ed out as a single surgical
pr ocedur e (total t orsopl ast y) when time is highly i mport ant to the pat i ent and
the pat i ent ' s general health is satisfactory. The surgical envi r onment must be
adequat e, and auxiliary t eams must be available. Ot herwi se, sect i onal torso-
pl ast y- - t hat is, one or more i nt er vent i ons- - can be performed.
Fig. 1.
*Presented at the Sixth Meeting of the I.P.R.S.-I.S.A.P.S. in Rio de Janerio, May 1979
Address reprint requests to Mario Gonzfilez-Ulloa, M.D., Tuxpan 16 10 Piso, Dalinde Medical
Center, Mexico 7DF Mexico
0364-216X/79/0003-0357 $02.40
9 1979 Springer-Verlag New York Inc.
358 M. Gonz~ilez-Ulloa
Total torsoplasty entirely reshapes the human torso, restoring normal ten-
sion to the skin and placing the tissues in an antigravitational position. The
Greek term from which the word t or s o derives means "wand" or "st em"; the
torso is that portion of the body that extends from the upper part of the arms to
the upper part of the thighs.
Torsoplasty includes 1) brachioplasty of various degrees, depending on the
deformity; 2) mammoplasty, with either diminution or augmentation of volume
and correction of the breast' s shape; 3) abdominoplasty in its various modali-
ties; 4) gluteoplasty, for either diminution or increase in volume and correction
of ptosis; 5) cruroplasty, in its various aspects of improving the thigh or in
diminishing the volume of the trocanteric region; and 6) lumboplasty in cases of
deforming adiposity in this region (fig. 1).
Torsoplasty may be sectional when only one or more of these procedures are
carried out, without comprising the entire torso. The most frequent indications
are for sectional torsoplasty, and total torsoplasty is reserved for severe dis-
figurements of the torso.
To perform this series of operations, it is indispensable that there be an ade-
quate surgical environment and that auxiliary teams are available to ensure that
the patient is maintained in proper condition.
Total torsoplasty might be indicated in the patient who, as a result of a sud-
den change in personal situation, find that their physical appearance is inade-
quate for social, economic, political status and the time element is of utmost
importance.
Methods
The tracing for an incision for torsoplasty, made prior to the operation, is circu-
lar (Fig. 2A). For the correction of the posterior lateral and anterior portion of
the thigh, including the removal of a large epitrocanteric pad, infragluteal pro-
longation of the incision allows for the introduction of the gluteal prosthesis if
gluteal hypotrophy is present (Fig. 2B and 2C).
Fig. 2
Torsoplasty 359
Fig. 3
Fig. 4
After the tracing is completed (Fig. 3A), the operation (Fig. 3B) starts with
the circular section of the umbilicus, leaving an adequate amount of adipose
tissue cover around the umbilical tube.
The large abdominal incision is now made (Fig. 4A), and wide undermining is
carried out upward to the xiphoid process (Fig. 4B, left). The aponeurosis of
the rectal muscle is sutured with stainless steel wire, No. 0 (Fig. 4B, right).
In five patients in our series we have corrected mammary hypotrophy
through the same abdominal incision (Fig. 5A). Undermining upward over the
aponeurosis of the pectoral muscle and inserting the prosthesis saves surgical
time and avoids another scar. The prosthesis is fixed with a U stitch tied over a
sponge and button (Fig. 5B). For a better result, the table is set in jacknife
position during sectioning and suturing.
Strong downward traction is exerted on the abdominal flap. The medial part
is sectioned until the lower flap is reached. The flap is pushed by an assistant.
360 M. Gonz~ilez-Ulloa
Fig. 5
Fig. 6
Here a pilot suture is placed (Fig. 6A). The excess tissue is then resected from
the abdominal wall (Fig. 6B).
An incision is continued vertically downward into the upper part of the thigh
(Fig. 7A), reaching the crural aponeurosis. Tunnel undermining is done to sepa-
rate adipose tissue from the aponeurosis in the thigh (Fig. 7B). We justified the
incision in this case because rhytidectomy of the peripheral thigh was needed.
In other cases, the epitrocanteric adipose tissue is resected as a thick layer,
without skin incision.
After both the abdominal and crural flaps have been freed, reciprocal traction
is performed to pull the skin and adipose tissue of the thigh upward while the
abdominal tissues are pulled downward. At this stage, one can measure the
amount of skin and adipose that must be resected (Fig. 8A and B).
Torsoplasty 361
Fig. 7
Fig. S
Excess tissue is excised from the external aspect of the thigh (Fig. 9A), the
segment is resected (Fig. 9B), and pilot fixation sutures are placed to distribute
the skin evenly (Fig. 9C).
The stretching of the skin after pilot suturing of the thigh and lower part of
abdomen is quite remarkable (Fig. 10A). The opposite side is similarly cor-
rected. The next step is to transpose the umbilicus at the same level at which it
emerges from the muscular portion of the abdomen. This is carried out through
asingle vertical incision 2.5 cm long. When the umbilicus has been fixed in situ,
the abdomen appears stretched and youthful and the abdominal concavity will
become obvious.
When the areas that have undergone surgery are explored to determine the
degree of stretching, the laxness of the skin of the gluteal region will be clearly
noticeable (Fig. 10B and 11). To stretch this area, a prosthesis of adequate
volume will be placed after the patient is turned to the ventral decubitus
position.
362 M. Gonz~ilez-Ulloa
Fig. 9
Fig. 10
Torsoplasty 363
Fig. 11
While the patient is still in the dorsal decubitus position, the operation is
continued in the brachial region. An axis is marked from beneath the edges of
the pectoralis major muscle to the channel in between the medial epicondyle
and the troclear of the humerus. The amount of tissue to be removed can be
appreciated clinically (Fig. 12A). The incision is always started in the posterior
border of this area. Dissection is carefully done toward both sides of the in-
cision, over the brachial aponeurosis (Fig. 12B). After this wide undermining,
the flaps are opposed. It can be appreciated (Fig. 12C) how the clinical evalua-
tion of the amount to be removed is actually far less than can be accomplished
by surgery.
Suturing is done in two layers--catgut 3-0 for the subcutaneous tissue and 5-0
Dermalon for the skin (Fig. 13A). Pilot sutures are placed to distribute the skin.
For the excess tissue located exactly on the elbow (Fig. 13B), in which the skin
is almost always plicated and callous in the elderly patient, resection is done
with the arm flexed to avoid producing an ischemic flap. The skin is then care-
fully sutured with 5-0 Dermalon (Fig. 14A and B).
The patient is now turned to the ventral decubitus position. The excess skin
of the subgluteal fold and the site for the prosthesis implant are marked. Both
apex and main axes are marked (Fig. 15A). The excess skin of the gluteal fold is
now resected (Fig. 15B). Dissection is carried out at the muscular level, under-
neath the aponeurosis, so that the Dacron patches of the prosthesis remain
adhered and allow reciprocal motion of the prosthesis in concert with the glu-
teal muscle. Undermining is done with scissors and then with the hands to
make sure that the strong adherence between the adipose tissue and the coccyx
are freed (Fig. 16A and B). The prosthesis has been specially designed* in
several sizes: Ultramacro (640 cc), Macro (405 cc), Medium (280 cc), Micro
(200 cc), Minimicro (160 cc), and Ultramicro (120 cc). Their volumetric design
is shown in Figures 17A and B.
*Dow-Corning-
364 M. Gonzfilez-Ulloa
Torsoplasty 365
Fig. 14
Fig. 15
M. Gonzal ez-Ul l oa
MACRO GLUTEAL PROSTHESIS 405 c.c.
I
.5 .5
2]m,,
2 . i cm
Fig. 17
After being soaked in saline solution, the prosthesis is introduced into the
site in which it will be placed (Fig. 18A). It is fixed with a transfixion suture that
goes through the ear of the prosthesis. The needle is drawn at the points
marked at both poles and is then passed through small sponges and tied over
buttons to keep the prosthesis immobile for a period of 8-10 days. The immedi-
ate volume replacing the empty space can be readily seen in Figure 18B. Su-
tures are done with 3-0 catgut for the adipose tissue and 5-0 Dermalon for the
skin.
Torsoplasty 367
The preoperative aspect of the buttocks (Fig. 19A) is flat, lax, and sad,
whereas the postoperative appearance is full, firm, and strong (Fig. 19B). A
close-up (Fig. 19C) show the site of the implant as well as the final suturing of
the gluteoplasty and the corrected exterior part of the thigh.
The correction of the ptotic breast is performed in the usual manner: We use
a modified Passot-Dufourmentel technique, which gives a good result with a
quite inconspicuous scar, good volume, and good position of the nipples.
368 M. Gonz,~lez-Ulloa
Re s ul t s a n d C o mme n t
Torsopl ast y has produced highly pleasing results for both the surgeon and the
patient. The satisfactory cont our creat ed by t he operation has helped to im-
prove t he outlook and attitude of t he patient.
The operation requires about 6-8 hours to perform, and t he period of con-
val escence is approximately 15-20 days, with continuing observat i on for the
possible devel opment of keloids in the ot herwi se ver y fine scars.
Complications from t he operation have been limited, consisting of minimal
fusion of adipose in two patients.
When t here is less urgency for the operation, sectional t orsopl ast y is more
frequent l y performed.