From the Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine.
Plast Reconstr Surg. 2019 Aug;144(2):197e-204e. doi: 10.1097/PRS.0000000000005862.
Abdominoplasty is one of the top five most commonly performed cosmetic procedures. Whereas widening of the linea alba is a well-accepted consequence of pregnancy, the changes to the rectus abdominis muscles are less well known and thus unappreciated and undertreated.
After institutional review board approval, the Northwestern Enterprise Data Warehouse identified nulliparous and multiparous women, aged 18 to 45 years, who underwent abdominal computed tomography between 2000 and the present. Measurements included the width and cross-sectional area of each rectus muscle, width of the linea alba, and circumference of the abdominal cavity at the level of the L3 vertebra. In addition, two case reports addressing these anatomical changes with muscle modification and mesh reinforcement are presented.
Sixty women were identified that met our inclusion criteria: 15 nulliparous, 15 after one pregnancy (para 1), 15 after two pregnancies (para 2), and 15 after three or more pregnancies (para ≥ 3). The linea alba was significantly widened after one pregnancy from 1.14 cm to 2.29 cm, but did not significantly widen further with each subsequent pregnancy. The width of each rectus muscle was significantly widened from 6.00 ± 0.60 cm in nulliparous to 6.61 ± 0.58 cm in para 1, significantly widened again to 7.03 ± 0.46 cm in para 2, but not significantly widened after that (6.97 ± 1.00 cm in para 3).
In addition to widening of the linea alba, pregnancy alters the shape of the rectus abdominis muscle. Correction of muscle width during abdominoplasty may be a necessary adjunct to achieve the proper tension in both primary and revision procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
腹部整形术是最常进行的五大美容手术之一。虽然腹白线增宽是妊娠的公认后果，但腹直肌的变化却鲜为人知，因此也未得到充分认识和治疗。
在获得机构审查委员会批准后，西北企业数据仓库确定了 18 至 45 岁之间在 2000 年至现在期间接受腹部计算机断层扫描的未产妇和经产妇。测量包括每块腹直肌的宽度和横截面积、腹白线的宽度以及第 3 腰椎水平腹部的周长。此外，还介绍了两个涉及这些解剖结构变化的病例报告，包括肌肉修饰和网片加固。
共确定了 60 名符合我们纳入标准的女性：15 名未产妇、15 名经产妇（1 次妊娠）、15 名经产妇（2 次妊娠）和 15 名经产妇（3 次或以上妊娠）。一次妊娠后白线显著增宽，从 1.14cm 增至 2.29cm，但随后每次妊娠均未进一步增宽。每块腹直肌的宽度从未产妇的 6.00 ± 0.60cm 显著增宽至经产妇（1 次妊娠）的 6.61 ± 0.58cm，再次显著增宽至经产妇（2 次妊娠）的 7.03 ± 0.46cm，但随后不再增宽（经产妇（3 次妊娠）的 6.97 ± 1.00cm）。
除了白线增宽外，妊娠还会改变腹直肌的形状。在腹部整形术中纠正肌肉宽度可能是实现原发性和修复性手术适当张力的必要辅助手段。
临床问题/证据水平：治疗性，V。
