Anatomical Reconstruction of the Abdominal Wall Through Fat Grafting and Modified Plication Technique in the Abdominal Rectus

Background Abdominal lipectomy is considered today one of the most important and common aesthetic procedures in plastic surgery. It presents very satisfactory results, however it is not free of complications, which is why modifications are constantly being made to the conventional technique in search of more natural and safe results. Objective The objective of this study is to report our experience modifying the conventional lipectomy technique by combining it with muscle fat grafting and evaluate the effects of intramuscular pressures and BMI on fat graft retention. Methods: The study was conducted between 2022 and 2024, involving patients undergoing abdominoplasty with fat grafting into the rectus abdominis muscles. Fat graft resorption was assessed postoperatively by analyzing variables such as intramuscular pressure, BMI, and patient age. Data was collected through clinical follow-ups and imaging techniques. Results The study found that intramuscular pressures greater than 8 mmHg significantly increased fat graft reabsorption rates. Higher BMI and age also showed an association with greater reabsorption, though the impact was more pronounced under high-pressure conditions. Treatment with lower pressures (<8 mmHg) resulted in lower reabsorption Conclusions Through this new technique, an anatomical reconstruction of the abdominal wall was achieved, with an increase around 80% in muscle volume, which was evidenced in the appearance of the muscle that is evaluated during the inspection of the patient and is evident in the photographic record, giving rise to a natural appearance and better body posture in the long term with an almost decrease in possible complications described in the literature and persistence of long-term aesthetic results.