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Journal of General Surgery

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Research Article

The Impact of Monsplasty on Sexual Function

Salim Al Lahham, Ruba Sada, Saif Badran, Rehan Zahid, Ahmed Mofeed Mokhalalati, Magdi Himada, Sohail Quazi, Shiyas Mohammedali, Mutaz Abuelgasim, Ahmed Al Qahtani and Atalla Hammouda

Correspondence Address :

Salim Al Lahham
PLASTIC SURGEON
HAMAD MEDICAL CORPORATION,Doha,Qatar
Fellowship in hand, Reconstructive microsurgery Ganga hospital, India
DAFPRS Dutch facial plastic surgery fellowship
Netherland
Tel:+97430197754
Email: sal_lah@hotmail.com

Received on: July 01, 2019, Accepted on: July 26, 2019, Published on: August 01, 2019

Citation: Salim Al Lahham, Ruba Sada, Saif Badran, Mutaz abuelgasim ,Rehan Zahid, Shiyas Mohammedali, Magdi Himada, Sohail Quazi, Ahmed Al Qahtani and Atalla Hammouda (2019). The Impact of Monsplasty on sexual function

Copyright: 2019 Salim Al Lahham et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract
The mons pubis is the soft mound of fatty tissue covering the pubic bone above the vulvar area and is considered one of the important aesthetic features of a feminine physique. With normal aging, this region enlarges and laxity in this region due to obesity or weight loss can cause the mons pubis to excessively sag, affecting functionality and selfconfidence during intimacy. It is important to have a good self-esteem and a good body image in order to have a healthy sexual relationship. Therefore, laxity of the mons pubis can be considered an important factor of dissatisfaction in a sexual relationship.
We hypothesize that the addition of monsplasty to the standard abdominoplasty surgery will improve the appearance of the mons pubis as well as enhance the patient's sexual satisfaction. We performed a prospective study to evaluate the sexual satisfaction of 46 patients who underwent abdominoplasty combined with monsplasty. It was found that all participants had a significant improvement in their sexual relationships, compared to, an improvement in only 44% of the 34 patients who had abdominoplasty alone (Table 1).
It was concluded that the addition of Monsplasty to a standard abdominoplasty significantly increased the patient's satisfaction in their sexual lives, as well as, increasing their partner's attraction to them.
Fulltext
Introduction
Body image is an important factor which aids in building healthy self-esteem and confidence [1]. It is important that a person is comfortable with their appearance in order to have a satisfactory sexual life. The mons pubis is triangular area of feminine fatty tissues located at the level of pubic symphysis and is considered one of the important aesthetic features of the feminine physique. [2]. Laxity and ptosis of the mons pubis is a troubling finding in many females who are obese or have lost a significant amount of weight [3]. The Ptosis of the mons pubis can be considered an important factor of dissatisfaction in a sexual relationship; [4]. Some patients who suffer from ptosis in the pubic region may feel embarrassed and, in some cases, the deformity is so apparent that it cannot even be hidden by clothing.
Ptosis of the mons pubis can easily be corrected during an abdominoplasty procedure [5].
Aside from having a poor cosmetic appearance, pubic functionality can also be compromised, with difficulty in maintaining hygiene and altered sexual functions. Neglecting to treat the mons area during abdominal contouring may leave the patient with residual contour irregularities, ultimately affecting the aesthetic or functional result. We investigated whether there were significant improvements in patient satisfaction, functional outcomes, and aesthetic results in women who underwent abdominal
contouring surgery with monsplasty.

Methods

Mons ptosis is defined as:

An increase in length of the mons pubis greater than 2 cm when gently stretched compared to its relaxed state length. This distance is measured from the commissure to the infraabdominal crease [6], (Figure 1).
We did a prospective study of 80 patients over a period of 32 months. The study group consisted of patients who were admitted to our plastic surgery unit for abdominoplasty between the 1st of March 2015 and the 31st of December 2017. Patients were required to have a stable weight for more than 6 months, and normal laboratory test results, including complete blood count, electrolytes, and coagulation studies.
All patients included in the study had mild to severe laxity of the mons pubis. All female patients with BMI of 27.5 to 35 were included in the study. It was found that most patients with BMI less than 27.5 had a natural appearing, smooth, mons pubis and therefore were excluded from the study.
All patients included in the study were in the age group of 30-50 years and had active sexual life with a BMI of 27.5 to 35 and mons ptosis of greater than 2 cms.
Patients with diabetes or a history of chronic smoking were excluded, due to, possible neuropathy and the increased risk of necrosis of the flaps respectively. Monsplasty was offered to all 80 participants.
Demographic information such as age, parity, weight loss sexual relationship and hormonal status were obtained from the patients.
Patients giving consent for surgery after consultation, were separated into two groups to undergo abdominal contouring procedures with monsplasty or without monsplasty..
Out of 80 patients, 46 accepted to undergo Monsplasty and were categorized as group 1. The other 34 patients preferred abdominoplasty alone and were categorized as group 2. The patients refusing to undergo monsplasty were scared to add another procedure and not able take the decision Patients in both the groups completed a preoperative and follow-up questionnaire six months after surgery. The questions on the survey assessed patients' preoperative and postoperative satisfaction with the aesthetic appearance of their mons region.
At the 6-month post-operative follow up, a questionnaire about sexual satisfaction postoperatively was filled out by the patients in both groups (Figure 2)

Procedure

Standard Abdominoplasty was performed for all patients followed by Monsplasty in the group 1 alone. For the Monsplasty; an inferior abdominal wall marking of 5 to 7 cm above the commissure was done. The pubis was then raised 2-3 cm above its original position, and fixed to the aponeurosis of the rectus abdominis muscles. The thickness of mons pubis fat was then measured. If it was found to be more than 2.5 cm, de-bulking was one from the lower portion to achieve a subcutaneous thickness of 2.5 cm. Deep sutures were taken in the tissue of the pubis, and it was fixed to the abdominal fascia in order to sustain a smooth, natural looking mons pubis. The aim was to elevate the pubis, correct the shape, and to resect the excess adipocutaneous tissues.
This was achieved in all 46 patients. Meticulous hemostasis was done to ensure the results were not compromised by a hematoma or bleeding. All other significant complication, which might have compromised the final result, were also avoided. The patients from group 1 and 2 followed up in an outpatient setting at 1 week, 3 weeks, 3 months, and 6 months after discharge (Figure3).

Results

At the 6 months follow up, a final questionnaire targeting the patient's postoperative sexual satisfaction was filled out by the patients in both groups. The results for the 2 groups, patients who had undergone Monsplasty with abdominoplasty (group1), and patients who opted for standard abdominoplasty without Monsplasty (group 2), were as follows:
All patients in group 1 were extremely satisfied with the results of their surgery. There was no residual or recurrent deformity at the 6 months follow up, and the results of the surgery seemed to be long-lasting (Table 1).

Conclusion

It can be inferred from the results of the study that there is a significant benefit to adding Monsplasty to the standard abdominoplasty procedure, if indicated by ptosis of the mons pubis. Improving the appearance of the mons pubis plays a role in raising the self-confidence of patients, which in turn, significantly improves their sexual life and performance [3-5].
Our study is limited by the subjective nature of the responses from our surveyed patients. However, the opinions expressed by our patients in this study consistently displayed improvements in both aesthetic and functional properties after monsplasty.
Another limitation is that we were unable to identify which factors influenced satisfaction scores. The analysis assessing the influence of body mass indices, pannus resection weight, and change in BMI, on satisfaction scores were not considered. Perhaps by increasing our patient population and other influenciong factors we could have achieved a more robust statistical analysis, which might have helped us to determine the factors influencing satisfaction or dissatisfaction. Future long-term follow-up is warranted to examine the durability of the monsplasty technique.
We have developed simple modifications during the surgical planning of abdominoplasty, which may help achieve better patient satisfaction in regards to their appearance. The main changes to the procedure include: anchoring of the abdominal flap, fixation of the pubis at a higher position in the rectus abdominis sheath, and de-bulking of the mons pubis flap.
With proper incisional design, monsplasty can be performed safely during abdominal contouring with a high rate of patient satisfaction to improve both form and function of the pubic region. With regards to pubic deformity after massive weight loss, the results obtained in this study are proof that the adaptations to the well-known procedure are safe, easily reproducible, offer a high level of cosmetic and functional outcome, and have long lasting results (Table 2).

References
1. Pujols Y, Seal BN, Meston CM. The association between sexual satisfaction and body image in women. J Sex Med. 2010;7(2 Pt 2):905-916.
2. Patoue A, De Runz A, Carloni R, Aillet S, Watier E, Bertheuil N. Safe monsplasty technique. J Plast Surg Hand Surg. 2018;52(2):74-79.
3. Bloom JM, Van Kouwenberg E, Davenport M, Koltz PF, Shaw RB Jr, Gusenoff JA. Aesthetic and functional satisfaction after monsplasty in the massive weight loss population. Aesthet Surg J. 2012;32(7):877-885.
4. de Brito MJ, Nahas FX, Bussolaro RA, Shinmyo LM, Barbosa MV, Ferreira LM. Effects of abdominoplasty on female sexuality: a pilot study. J Sex Med. 2012;9(3):918-926.
5. Pechevy L, Gourari A, Carloni R, Sauvaget F, Bertheuil N, Goga D. Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact. Ann Chir Plast Esthet. 2016;61(1):e21-35.
6. Michaels J 5th, Friedman T, Coon D, Rubin JP. Mons rejuvenation in the massive weight loss patient using superficial fascial system suspension. Plast Reconstr Surg. 2010;126(1):45e-46e.
Tables & Figures
Figure 1: Preop marking showing:
1 stands for commissure, 2 stands for infra-abdominal crease , 3 the black dotted line stands for distance from commissure to infra-abdominal crease at relaxed state , the red dotted line stands for distance from commissure to infra-abdominal crease at relaxed state after gentle strectching to redrape the area to its optimal appearance


Figure 2: Preop picture showing 8.5 cm distance at relaxed state compared to 12.5 cm distance after stretching



Figure 3: The excess fat was debulked to get 2.5 cm only thickness.


Table 1. Illustrates the questionnaire that was filled out by the participants in the study, as well as the results for both groups. Group 1 comprised of patients who underwent abdominoplasty combined with Monsplasty; whereas, group 2 patients underwent standard abdominoplasty alone.



Table 2



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