RESUMEN
BACKGROUND: Deformities of the upper portion of the abdominal wall can be difficult to solve, as in many cases abdominoplasties or mini-abdominoplasties lead to unsatisfactory results. Direct approaches to this region through inframammary incisions can be a good therapeutic option, once adequate patient selection has been performed and certain surgical principles are followed. METHODS: This technique should be primarily indicated for patients complaining of skin laxity predominantly in the upper abdomen and for patients who will have such excess after liposuction. In patients who require resection of a large amount of tissue, a single, broad, U-shaped dissection should be used, associated with midline fascia plication, when required (group 1). In patients with a smaller amount of tissue to be resected, two oblique tunnels can be made toward the navel, with no incision unification at the midline, to provide less evident scars (group 2). RESULTS: Eighteen procedures were performed: 12 in group 1 and six in group 2. Patients and surgeons were satisfied with the results. Only minor complications occurred, and they did not result in definitive sequelae. CONCLUSIONS: The principle of progressive tension suture, previously utilized in conventional abdominoplasties, is now originally employed in reverse abdominoplasties as a continuous suture, enabling proper flap positioning, keeping the inframammary sulcus at its original position, and preventing tension on the resulting scar. Tensioned reverse abdominoplasty is an easily applicable technique that provides good results and should be considered in cases of abdominal laxity predominantly in the upper abdomen.