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Abdominoplasty and Abdominal Contour Surgery: A National Plastic Surgery Survey
Abstract
Background: According to the American Society for Aesthetic Plastic Surgery's 2004 Cosmetic Surgery National Data Bank, during the last 7 years, the number of abdominoplasty procedures performed has increased 344 percent. A national report on abdominoplasty has not been since 1977. Grazer and Goldwyn's study reflects the preliposuction era of abdominal contouring surgery. The purpose of this study was to assess current trends in abdominal contouring techniques and associated procedures and the incidence of their complications. Methods: The study was designed as a descriptive correlation survey evaluating the frequency of various abdominal contour techniques and complications among 3300 randomly chosen members of the American Society of Plastic Surgeons. There were 497 respondents, for a response rate of 15 percent. Results: A total of 20,029 procedures were reported in the survey; 35 percent (n = 7010) were liposuction of the abdomen, 10 percent (n = 2003) were limited abdominoplasties, and 55 percent (n = 11,016) were full abdominoplasties. Survey data covered the plastic surgeon's demographics, techniques, and incidence of complications during a 12-month period. Conclusions: The authors report the largest series of local and systemic complication rates and compare them with those of previously published abdominoplasty surveys. With respect to full abdominoplasty, lower complication rates for deep vein thrombosis (0.04 percent) and pulmonary embolus (0.02 percent) were seen. No deaths were reported. There was no correlation between a surgeon's years in practice and complication rates, in concordance with the earlier study by Grazer and Goldwyn. Despite more extensive abdominal contouring techniques and the addition of liposuction to abdominal contouring, the local and systemic complication rates coincided with previous complication rates, as outlined in other studies.
... To further assess our findings, results published by van Uchelen et al, 6 Matarasso et al, 7 Pontelli et al, 8 Reinisch et al, 9 Winocour et al, 10 and Grazer and Goldwyn 11 were used to carry out additional statistical inference. The incidence rates, collected from surveys, range from 0.53% 8 to 1.16%. ...
... 6 Similarly, the sample size varies from 86 6 to 25,478 10 patients. Conversely, assuming that the average proportions are normally distributed, the corresponding 95% lower confidence bounds of these published DVT risk rates are 0.00%, 6 0.01%, 7 0.02%, 8 0.25%, 9 0.71%, 10 and 0.93%, 11 indicating that the incidence rates reported by Reinisch et al, 9 Winocour et al, 10 and Grazer and Goldwyn 11 are significantly higher than zero, whereas the joint risk rates calculated by van Uchelen et al, 6 Matarasso et al, 7 and Pontelli et al 8 are in line with our findings. The 95% lower confidence bounds of different studies are shown in Figure 2. ...
... As shown above, there is a negligible possibility that our protocol results in larger incidence rates than previously examined procedures; therefore, a 1-tailed normal test was applied to compare risk differences. After calculating the overall risk ratio and its standard error of the 2 samples, 1-tailed P values of 39.68%, 6 28.44%, 7 20.52%, 8 3.91%, 9 0.23%, 10 and 0.00% 11 were obtained. Therefore, at the 5% significance level, the hypothesis that the risk ratio of our protocol is the same as the risk rate calculated from the Reinisch et al, 9 Winocour et al, 10 and Grazer and Goldwyn 11 surveys can be rejected. ...
Background
Plastic surgery as a specialty is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT).
Objectives
To develop a prophylactic protocol to reduce the rate of DVT occurrence post-abdominoplasty.
Methods
A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7-year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours.
Results
Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Different hypotheses of DVT proportions were investigated to identify rates statistically significant with our sample, thereby providing conservative incidence rate estimates.
Conclusions
This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery. With over 116,000 procedures performed annually in the United States, abdominoplasty has become one of the most popular and sought-after surgeries in the plastic and cosmetic field 1. Despite its ever-increasing popularity and the advancement of techniques, abdominoplasty, as with any other surgery, has its complications. Such complications can include infection, seroma, haematoma, thrombosis, embolism, scarring and even death. Complications rates have been reported as high as 37%, with some studies reporting a 16% major complication rate 2. One of the most serious and troubling complications for both the surgeon and patient is deep vein thrombosis (DVT). With over 1 million patients tested, an estimated 250,000 cases of DVT are diagnosed per year in the United States alone.
... According to The Aesthetic Society, abdominoplasty is 1 of the 5 most frequently performed procedures and has a positive impact on body image and quality of life, but it is still associated with a high rate of complications. 1 The most frequent is seroma, with a reported incidence varying from 5% to 50%, but other complications can also arise, such as hematoma, infection, suture dehiscence, necrosis, and systemic complications, mainly thromboembolic accidents. [2][3][4][5][6][7][8] Abdominoplasty is associated with a greater risk of venous thromboembolism than any other aesthetic surgery procedure, the reasons for which are not fully known, 9 and adding intra-abdominal procedures has been shown to further increase the risk. 10 A meta-analysis of the 15 largest studies on full abdominoplasty complications demonstrated an average complication rate of 39% and a seroma rate of 23%. ...
... 7,24,25 The latter is still one of the most accepted and widely employed strategies, and it has been shown that its efficiency is optimized by utilizing volume-dependent rather than time-dependent criteria for drain removal. 4,7,8,[24][25][26] Furthermore, the dissection technique may also influence the complication rate. Abdominoplasty implies a large area to be dissected and coagulated even when the recent trend to limit undermining is applied. ...
... 15 In the current study, long periods with suction drains were eliminated in the diathermocoagulation group and further reduced in the subset with constant settings. This is a relevant issue as several authors present data that shows that applying strict volumetric criteria for drain removal after a classical abdominoplasty, frequently meant that patients had to use drains for more than 8 days with maximum values superior to 20 days 4,8,13,15 and in bariatric patients up to 45 days. 37 The aesthetic result may benefit from midline plication of Scarpa fascia, and abdominal wall sensation is also preserved. ...
Background
Many strategies have been developed to lower the high complications rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal.
Objectives
The present study compares two different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection.
Methods
A retrospective observational cohort study was performed in two health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty using the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1(57 patients with device settings according to surgeon’s preferences) and B2(72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, local and systemic complications.
Results
There were no statistically significant differences between the general characteristics of both groups, except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was done with a specific low voltage setting as significant differences were found. The other outcomes were identical.
Conclusions
Limiting the extension of electrodissection with the avulsion technique didn´t present any advantage. Using diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it’s aimed at minimal tissue damage, reduces patients’ time with drains.
... Breast surgeries have higher associated incidence of wound complications, including infection. 32 Postoperative infections are present in up to 35% of breast surgeries. Most literature suggests an overall incidence of less than 1% in all aesthetic surgeries combined. ...
... However, persistent, organized collections may represent hematoma development. 58 Hematoma occurrence varies depending on the procedure performed and the patient population, ranging from 3% to 15% in lipoabdominoplasty, 32,58 and 0.6% to 5.7% in breast augmentation surgery. [62][63][64][65] Risk factors for postoperative hematoma formation include anticoagulant use, older age, male gender, tobacco use, and medical comorbidities such as hypertension or malignancy. ...
... The incidence of skin necrosis varies between 3-4.4%, but less than 1% of these patients require revision. 32 In most cases, necrosis leads to healing by secondary intention, which may require months to heal depending on the affected area size. Clinical features of skin necrosis include tenderness to palpation, ecchymosis, and tissue breakdown. ...
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
... As is the case for any other surgical intervention, both abdominoplasties and lipoabdominoplasties are susceptible to complications. In 2004, Matarasso et al. [9] surveyed 497 members of the American Society of Plastic Surgeons about their preferences regarding different abdominoplasty techniques and their most frequent complications. The analysis comprised 20,029 procedures, of which 55% were traditional abdominoplasties, 35% were lipoabdominoplasties, and 10% were limited abdominoplasties, also known as mini-abdominoplasties. ...
... Infections are the second most common complication following abdominoplasty, with an estimated incidence between 1% and 3.8% [9,11], including operative site infections and infected seromas. There is often inflammation of a delimitated area that typically presents erythema, oedema, tenderness, and an elevated local temperature (Fig. 2). ...
... It resolved after 2 weeks of antibiotic treatment with ciprofloxacin. number of perforating vessels [9,11]. The rate of reoperations to achieve an acceptable aesthetic result associated with this complication is less than 1%. ...
Background:
Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them.
Methods:
A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles.
Results:
According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death.
Conclusions:
The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
... 7 Despite the good results obtained with a classic full abdominoplasty, a significant complication and secondary surgical revision rates are still reported. A meta-analysis of 15 studies about full abdominoplasty complications including seroma, 3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] demonstrated a complication rate of 39% and a seroma rate of 23%. In 2011, Najera et al 20 published a retrospective cohort study of 200 patients who underwent a full abdominoplasty. ...
... The aesthetic result was considered to be very good/good in 88% of the physician evaluation and in 91% of the patient evaluation (clinical cases: 1, Figs. 10-12; 2, Figs. [13][14][15][16]3,. No differences were found between groups concerning the aesthetic result. ...
... The relevance of this effect is high because suction drains are one of the most accepted methods of seroma prevention. 14,18,65,67 The daily drain output was evaluated on the second study, and we verified that it was quite different between the 2 study groups which concerns absolute values. 66 When Scarpa fascia was preserved, it was significantly lower from day 1 to day 10 (Fig. 8). ...
The plane of dissection used during a full abdominoplasty has been implicated on the seroma rate. Avoiding the classic plane of dissection on top of the rectus fascia and using a more superficial plane of dissection has been suggested as a strategy to improve recovery and lower the complication rate. The authors have been applying this principle in their practice for more than a decade, and they performed 2 prospective comparative studies to evaluate the clinical effects of using a more superficial plane of dissection (with Scarpa fascia preservation) during a full abdominoplasty. The technique is presented and explained along with the results of both comparative studies. The results of both studies are discussed particularly the effects on drain volume (total and daily), the duration of drain usage and the avoidance of “long drainers.” These are very relevant advantages of the technique that have not been discussed in the literature. The results and surgical strategies used by other authors which apply a more superficial plane of dissection are presented. Controversy still exits on the manipulation of the deep fat compartment by liposuction or direct fat excision. No manipulation is another option which should be considered but it has been questioned due to the risk of aesthetic compromise. A morphometric study performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty validates that option. Based on this evidence, the authors recommend that surgeons consider performing abdominoplasties using a more superficial plane of dissection in the infraumbilical area with total preservation of Scarpa fascia and the deep fat compartment. The classic plane of dissection, on top of the deep fascia, should be avoided in the lower abdomen.
... Suction drains are frequently used after an abdominoplasty, as a method to prevent seroma formation. 4,13,[15][16][17] The widest survey on abdominoplasty, by Matarasso et al, 15 reported that 98% of inquired surgeons used suction drains on their approach. In the largest clinical series published, with 1008 abdominoplasties over 11 years, all 6 surgeons involved used suction drains. ...
... Suction drains are frequently used after an abdominoplasty, as a method to prevent seroma formation. 4,13,[15][16][17] The widest survey on abdominoplasty, by Matarasso et al, 15 reported that 98% of inquired surgeons used suction drains on their approach. In the largest clinical series published, with 1008 abdominoplasties over 11 years, all 6 surgeons involved used suction drains. ...
Background:
Abdominoplasty is becoming increasingly more common, with seroma being the most frequent complication. Suction drains are used very often as a method to prevent seroma formation, and it has been suggested that techniques using Scarpa fascia preservation and closed-suction drains have lower seroma rates than other approaches. However few studies have addressed parameters that may affect drain efficiency. A prospective comparative study was conducted to determine if applying 2 or 3 closed-suction drains, after an abdominoplasty with Scarpa fascia preservation, has any effect on several outcomes.
Methods:
This was a single-center study conducted from September 2016 to March 2019. Patients were allocated according to choice to 1 of the 2 surgeons involved in the study, each responsible for 1 group: abdominoplasty with Scarpa fascia preservation with 2 closed-suction drains placed postoperatively (group A) or with 3 closed-suction drains (group B). A comparative analysis of selected variables was done between both groups, including time to drain removal, total and daily drain output, duration of hospital stay, emergency department visit, readmission to the hospital, secondary surgical procedure, and incidence of postoperative local and systemic complications.
Results:
A total of 73 abdominoplasties with Scarpa fascia preservation were performed in women (group A, 33 patients; group B, 40 patients). General characteristics of group A and B were similar. There were no statistically significant differences between groups in any of the determined variables, namely, main outcomes (total and daily drain output, time to drain removal) or complications (local or systemic).
Conclusions:
Our results suggest that using 3 closed-suction drains postabdominoplasty with Scarpa fascia preservation has no advantages in total and daily drain output, time to drain removal, or complications when compared with the usual 2 drains approach.
... [17][18][19] The incidence of postoperative SSI following abdominoplasty in major studies has varied between 1.1% and 15.5%. [18][19][20][21][22][23][24][25][26][27] Literature regarding complication rates in abdominoplasty started in 1977 with Grazer and Goldwyn's survey of 958 surgeons, which found an overall complication rate of 14.6%, including a wound infection rate of 7.3% and wound dehiscence rate of 5.4%. 21 More recently, in a survey-based study, Matarasso et al analyzed 11,016 full abdominoplasties from 497 respondents of members of the American Society of Plastic Surgeons (ASPS) and demonstrated an infection rate of 1.1%. ...
... 21 More recently, in a survey-based study, Matarasso et al analyzed 11,016 full abdominoplasties from 497 respondents of members of the American Society of Plastic Surgeons (ASPS) and demonstrated an infection rate of 1.1%. 24 Winocour et al investigated 25,478 abdominoplasties through the prospective CosmetAssure database and found an incidence of major SSIs of 1.1%. 26 A major SSI in the database was defined as an infection requiring an emergency room visit, readmission to the hospital, or reoperation within 30 days of surgery. ...
Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors, and varies depending on the specific operation performed. Understanding of the risk factors for the development of these infections is critical since careful patient selection and appropriate perioperative counselling will set the right expectations, and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course and avoid long-term sequelae.
... This article highlights the outcomes of this procedure: low incidence of seromas, shorter hospitalization time, given that the patients mobilize more comfortably, and safety 8,9,24,33 without the need for drains. 24,28 Lastly, patient expenses are minimal and there is a low risk of readmission after the surgery. ...
... Baroudi and Ferreira 15 Ninety-eight percentage of surgeons report using drains for prevention of seromas, with drains removed an average of 8 days later. 33 Suction drains have been used to treat and prevent development of seromas and hematomas. Seroma formation occurs during the first 2-3 weeks after surgery. ...
Background
Proactively preserving Scarpa’s fascia and thus its intrinsic lymphatic drainage and tensile strength for suture placement can eliminate the need for drains after lipoabdominoplasty and therefore reduce the rate of seroma development. In this article, we describe the effectiveness of a modified progressive traction suture (PTS) technique, which enables us to lessen the most common complications and avoid hospital readmission; these sutures take 3–5 minutes of additional surgery time.
Methods
Two hundred seventy-six patients (mean age, 38 years; range, 19–67 years), with a mean body mass index of 25 were included in this study. All patients underwent complete lipoabdominoplasty with ultrasound-assisted liposuction (VASER) throughout the abdomen and flanks. Abdominal rectus plication was performed in 100% of cases. All patients were operated on under spinal anesthesia and stayed overnight in hospital.
Results
Of the 276 patients, 1.8% developed postoperative seromas. No patients developed hematomas. New wound closure was needed in 1.4% of patients, performed within 7–10 days of surgery, scar revision in 4.7%, residual liposuction under local anesthesia in 9.7%, and liposuction under sedation in 1%; deep vein thrombosis without thromboembolic phenomenon developed in 1%, none resulting in death. In addition, the use of a PTS technique is a time-saving procedure because it takes the surgeons between 3–5 minutes of operative time, unlike that of adhesion and/or separate traction, which takes between 30 and 45 minutes.
Conclusions
The use of PTSs helped diminish complications such as seroma and hematoma and prevent additional cost involving hospital readmission and/or further surgery. Furthermore, use of these sutures required only 3–5 minutes of additional operative time.
... [2,3] The overall reported complication rate on this surgical method is about 11%, in which among them, the incidence of skin necrosis (8%) is the most common complication. [4,5] Previous studies showed Background: One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. ...
... Abdominoplasty is one of the most common surgical procedures currently performed in the area of plastic surgery. [4] Abdominoplasty is usually done with the purpose of health and beauty, but has some complications which are considerable. [14][15][16] Classic abdominoplasty is currently taking place around the world and has complications in 11% of patients [17,18] that some of these side effects are created as early symptoms, while other signs will appear in the final stages. ...
Background
One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated.
Materials and Methods
in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups.
Results
The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01).
Conclusion
The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up.
... One of the most accepted methods of seroma prevention after a full abdominoplasty is the use of suction drains [39]. This was confirmed by Matarasso's survey of 497 plastic surgeons who had performed 11,016 abdominoplasties: 98% of the surgeons used suction drains, and the average time until drain removal was 8 days [40]. Other authors also reported long periods with drains [9,41,42], and we reported 5 [18] and 6 days [19] in 2 prospective studies in nonbariatric patients. ...
... Abdominoplasty can be safely performed as an outpatient procedure in select patients [40]. This is not an option in our department, mainly due to difficulties in providing drain care for outpatients. ...
Background:
Abdominoplasty techniques using a more superficial plane of dissection with Scarpa fascia preservation have been shown to improve recovery and reduce complications in nonbariatric patients. Patients who have experienced massive weight loss frequently need body contour procedures and represent a high-risk group.
Objective:
To evaluate the effect of this technique in patients with massive weight loss after bariatric surgery.
Setting:
University hospital, Portugal.
Methods:
This was a single-center retrospective study of 51 postbariatric patients who had been undergone either a classic full abdominoplasty (group A) or a similar procedure except for the preservation of Scarpa fascia below the umbilicus (group B). General characteristics of both groups were analyzed, and recorded outcomes were total and daily volume of drain output, time until drain removal, time until hospital discharge, and local and systemic complications.
Results:
There were no statistically significant differences between groups regarding general characteristics or complications. The Scarpa fascia preservation group had a highly significant reduction of 79% on the total drain output, 7 days until drain removal, and 5 days' hospital stay. Long drainers (7 days or more with drains) were eliminated (reduction from 52% in group A to 3% in group B) and seroma had a 65% reduction.
Conclusion:
Preserving Scarpa fascia during a full abdominoplasty in postbariatric patients improves recovery by reducing total drain output and hospital stay, allowing earlier drain removal, eliminating long periods with suction drains, and reducing seroma incidence. Clear benefits for the patient were obtained.
... Many areas of the body are appropriate for contouring. The number of patients candidate to abdominoplasty procedures is increasing, because of the growing number of patients that undergoes massive weight loss by diet or after surgery (10). Abdominoplasty is a surgical technique reliable and safe. ...
... Despite the high risk of complications, we have found that patients, who have undergone extensive weight loss, accept and tolerate well the complications, against the benefits in terms of both function and esthetics. Moreover, the majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life, psychological well being, and a better social and sexual life (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Furthermore, we believe that a multidisciplinary approach to the post-bariatric patient allows maintaining long-term aesthetic and functional results obtained. ...
The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24-79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58-163 Kg); averege BMI was 31 (range 24.77-57). The average quantity of tissue removed was 1.765 Kg (range 250 g-11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the postbariatric patient allows to maintain long-term aesthetic and functional results. (www.actabiomedica.it).
... [9][10][11] Complications related to abdominoplasty have been very well described in the literature. [12][13][14][15][16][17][18][19] In general, it is a safe operation, with deep vein thrombosis (DVT) and pulmonary embolism (PE) being the only rare serious systemic complications. [19][20][21][22] The effort to decrease the postoperative morbidity led to the introduction of postoperative continuous infusion pain pumps. ...
... 30 The overall complication rates using standard abdominoplasties with drains have been described between 18% and 54%. [12][13][14][15][16][17][18][19] The most dreaded systemic complications of abdominoplasty are DVT and PE. 19,20 In 1975, Grazer and Goldwyn 19 reported a DVT incidence of 1.1% and a PE incidence of 0.8%. ...
Introduction:
Abdominoplasty is being increasingly performed as an outpatient procedure. The role of tumescent technique in decreasing postoperative pain and hospital stay has not been extensively studied.
Methods:
We reviewed 65 consecutive patients who underwent tumescent abdominoplasty over 20 months by a single surgeon. All the patients were followed up for at least 1 year. The outcomes were evaluated in terms of systemic complications such as deep vein thrombosis and pulmonary embolism and local complications such as seroma, wound infection, and skin necrosis.
Results:
Of the 65 patient records analyzed, 61 were of females and 4 of males. Average age for the patient population was 45.2 years. Mean follow-up was at least 1 year for all the patients. Ninety-five percent of patients could be discharged the same day with tumescent abdominoplasty, whereas 71% of the patients who underwent concurrent procedures with abdominoplasty were also able to go home the same day. All the patients reported excellent postoperative pain control. There was no report of deep vein thrombosis or pulmonary embolism in any of these patients. Wound complications occurred in 14 patients (21.6%), of which 12 patients had seroma (18.5%) and 2 had wound infection (3.1%). The seromas were treated with repeated aspirations or Jackson-Pratt drain placement, whereas the wound infections resolved with outpatient antibiotics.
Conclusions:
The safety and efficiency of outpatient abdominoplasty can be further facilitated by utilizing tumescence. Tumescence helps the patients be discharged sooner, usually the same day, mobilize sooner, and rely less on oral narcotics at home.
... Treatment of large areas and very long surgical times in turn may have led to fatal risk situations in some cases. [3][4][5] Furthermore, tightening of the skin has not been satisfactory in several areas. 1,[3][4][5] These drawbacks have not diminished public demand for body contouring, and there has been a considerable increase in the search for noninvasive, less risky techniques that require lower doses of anesthesia and have little or no downtime. ...
... [3][4][5] Furthermore, tightening of the skin has not been satisfactory in several areas. 1,[3][4][5] These drawbacks have not diminished public demand for body contouring, and there has been a considerable increase in the search for noninvasive, less risky techniques that require lower doses of anesthesia and have little or no downtime. Thus, ultrasound, radiofrequency, and cryolipolysis have proven effective at reducing unwanted fat deposits. ...
Demand from the general public has led to the development of laser-assisted lipolysis. We designed a working protocol to assess the clinical results of a new laser-assisted lipolysis system, SlimLipo TM . MATERIALS AND METHODS We studied 500 areas treated with laser-assisted lipolysis. Dosimetry was established and heating was assessed using thermographic photog-raphy. Pre-and postfat thickness in the treatment area was measured using ultrasonography. We assessed tightening, firmness, and regularity. Patients were questioned about tolerance, downtime, effectiveness, and fulfillment of expectations. RESULTS In most cases, the SlimLipo TM laser enabled us to achieve a 50% reduction in the thickness of the fatty tissue. A satisfactory response was obtained in all the parameters assessed, and patients were satisfied with the skin response and with the volume reduction too. Most patients considered the procedure very tolerable and were satisfied with the results, and more than 80% felt that their expectations had been met. DISCUSSION AND CONCLUSION Laser-assisted lipolysis is a technique that is still being developed. We arbitrarily set our dose considering that a 924 nm wavelength is absorbed by fat seven times more than a 1064 nm wavelength. Further studies are necessary to improve dosimetry with this device. Tightening, firmness, and regularity were satisfactory in most patients. Patients were very satisfied with regard to tolerance, pain, downtime, results, and fulfillment of expectations. In summary, we believe that this new laser is a safe and minimally invasive option for satisfactory correction of contour and volume.
... 753 las cirugías mamarias tienen una mayor incidencia asociada de complicaciones de las heridas, incluida la infección. Las infecciones postoperatorias están presentes en hasta el 35 % de las cirugías mamarias (15). La incidencia de ISQ informada después de una abdominoplastia es variable y oscila entre el 0,2 % y el 32,6 % de los pacientes en series grandes (16) (17). ...
La infección del sitio quirúrgico (ISQ) es consecuencia de la proliferación de bacterias a través de las incisiones realizadas en un procedimiento quirúrgico. Muchos microorganismos se encuentran relacionados con la aparición de dichas infecciones, como lo son Staphylococcus aureus y especies de Streptococcus. En cuanto a la epidemiología, en los últimos años se ha encontrado una prevalencia significativa en la aparición de dichas infecciones en el área de cirugía plástica relacionado con distintos factores de riesgos y que se presentan más que todo como celulitis, hematomas, seromas, etc. Por ello, realizamos una revisión bibliográfica de artículos en inglés y español dando como resultados diferentes reportes de casos en los que se evidencia las distintas características epidemiológicas de las infecciones cutáneas en cirugías plásticas.
... The number of abdominoplasty surgeries performed has been steadily rising during the past 10 years [1]. Abdominoplasty complications include hematoma, infection, seroma, skin necrosis, hypertrophic scars, neurological symptoms, suture extrusions, umbilical anomalies, pulmonary thromboembolism/deep venous thrombosis, respiratory disorders, and death [2]. ...
Patient: Female, 45-year-old
Final Diagnosis: Improvement of scar
Symptoms: Noticeable extensive suprapubic following abdominoplasty
Medication:—
Clinical Procedure: —
Specialty: Dermatology
Objective
Rare coexistence of disease or pathology
Background
Abdominal scars can develop following abdominoplasty interventions and can cause severe functional and aesthetic disabilities. Surgery is almost no longer necessary thanks to the accessibility of more recent and sophisticated technology like lasers. Many ablative and non-ablative photothermolysis technologies and equipment have been developed, giving patients and medical professionals more alternatives but also complicating the system to be utilized and the methods to maximize the outcomes. The aim of the current study was to evaluate the volumetric action of 1540 wavelength and the efficacy and safety of the synergic sequential application of a new fractional ablative 10 600 nm CO2 and non-ablative 1540 nm lasers on abdominal postsurgical scar management.
Case Report
We treated a female patient with an abdominal suprapubic scar following abdominoplasty. The patient underwent 3 treatment sessions (with a frequency of 1 session every 50 days) with 1 pass over the entire suprapubic area using 10 600 nm CO2 fractional laser emission and 1540 fractional laser emission in simultaneous modality. A photographic evaluation was made to monitor the effect of the treatment on the aesthetic appearance of the patient’s suprapubic scar. After 6 months, the photographic assessment showed a significant improvement in scar texture and color. No patient pain or adverse effects were detected.
Conclusions
This case report describes the possibility of effectively treating abdominal suprapubic scars following abdominoplasty surgery with simultaneous and combined irradiation of 10 600 nm and 1540 nm wavelengths.
... 40 Venous Thromboembolism is the leading cause of postoperative mortality in cosmetic surgery (21%) of postoperative deaths. 41 Deep vein thrombosis and pulmonary embolism incidence in liposuction is reported at less than 1%, but there is a marked increase in deep vein thrombosis incidence when liposuction is combined with other surgeries, especially AP. 34,42,43 So, we believed that prevention strategies implemented during and after surgery are correlated positively with the few complications in our study. As complications often pose difficulty for the surgical team; applying the best standard protocol will eventually lead to better practice and subsequently, reduce the rate of complications. ...
Background: Abdominoplasty (AP) is a pervasive procedure in cosmetic clinics with spectrum cosmetic reasons used globally under the giant umbrella of enhancing the quality of life. In Saudi Arabia (KSA), AP is the most common requested body-contouring surgery. It is associated with a significant number of complications, thus, there is a need to increase the clinical knowledge of physicians about AP to increase their clinical management ability of these patients as well raise the awareness of potential patients. Aim of study: The study aims to increase the awareness about advantages and disadvantages of AP among Saudi physicians and patients going to have an AP surgery. Methodology: The study adopts a quantitative descriptive approach among public and private cosmetic clinics practicing AP surgery. An online questionnaire form was distributed to patients who had AP surgery. Results: total of 229 patients participated in this study, 172 (75.1%) males and 57 (24.9%) females. One third of participants with BMI >30. The main reasons of performing AP surgery were cosmetics (96.9%), weight loss (86.9%), sagging skin (67.2%) and stretch marks (42.8%). only 12.2% need to re-correct their primary operations and majority (89.9 %%) reported a positive response of AP satisfaction, weight loss (67.9%) and emotional and social benefits (66.4%). Conclusion: We conclude that most of the study participants were satisfied with their results. Unfortunately, there is a lack of data in Saudi Arabia, and this study somewhat fulfill the current gap about the advantages and disadvantages of AP surgery. Keywords: Cosmetic Surgery, Risks post Abdominoplasty, Advantages & Disadvantages, Obesity, KSA.
... high as 20%. 22 Most of the complications are minor and related to wound-healing issues and can be treated with conservative means, but others require revision surgery. 7 Seroma, wound infection, cutaneous necrosis, dehiscence, hematoma, and lymphorrhea are some of the direct wound complications that are hard to control and can determine a worse scar outcome. ...
Background. Scar appearance is an important outcome in abdominoplasty surgery, and its asymmetry can have a significant impact on patient and surgeon satisfaction. Here, we compared the scar symmetry reached with a ruler specially designed for the preoperative marking in abdominoplasty to the classic preoperative incision marking. Methods. In this randomized, uni-blind study, 42 patients were allocated to 2 different groups. Group 1 patients had their preoperative marking made by a group of surgeons that used the classic technique as described by Baroudi (n = 21), and Group 2 patients received their preoperative marking by another group of surgeons, using a ruler specially designed to fit the abdominal contour (n = 21). Patients were evaluated using a standard questionnaire that collected information about general patient's characteristics. On the follow-up period, we evaluated the presence of late surgical complications, need for revision surgery, patient's satisfaction concerning the postoperative scar, and 4 distances were measured in both groups to assess symmetry. Statistical analysis was made. Results. A total of 42 patients underwent abdominoplasty and were evaluated on the follow-up period (mean time: 4 months). The mean difference of corresponding measures on each side (A-B vs. A-B' and A-C vs. A-C') was higher in Group 1 comparing to Group 2. The level of correlation between corresponding measurements was higher in Group 2. Better satisfaction regarding the scar symmetry was achieved in Group 2, being this result statistically significant (P = .004). Conclusions. The use of the specialized ruler may help surgeons achieve a better scar symmetry with higher patient satisfaction.
... This was affirmed by Matarasso's overview of 497 plastic specialists who had performed 11,016 abdominoplasties: 98% of the specialists utilized attractions channels and the normal time until channel evacuation was 8 days. (35) Other creators likewise gave significant stretches of time channels (a day and a half), in two planned examinations in non-bariatric patients. Protecting Scarpa belt diminished these qualities by 3 days (38,39). ...
... The incidence of VTE in our study was very low (0.57%), similar to the rate reported by Hatef et al in 2010. 2 We decided to evaluate the risk of VTE in abdominoplasty alone and combined with liposuction because these procedures are often performed concurrently and may be associated with different risks. 30 Although abdominoplasty is also performed in combination with many other procedures, such as breast augmentation or brachioplasty, these additional procedures were too highly variable among the studies included in this review to sub-analyze. Consistent with the most recent systematic review on VTE in abdominoplasty, we did not find a difference between VTE incidence in abdominoplasty alone or in combination with liposuction, suggesting that abdominoplasty and liposuction may be combined safely. 2 Further analysis also revealed that the incidence of VTE did not decrease in patients who received chemoprophylaxis compared with those who did not. ...
Background
Many plastic surgeons avoid the administration of venous thromboembolism (VTE) chemoprophylaxis out of concern for surgical bleeding in abdominoplasty. While previous studies have attempted to address the relationship between abdominoplasty and bleeding or VTE, poor reporting techniques remain a challenge. As a result, there has been a lack of reliable data to guide clinical practice.
Objectives
To determine the prevalence of bleeding and VTE in abdominoplasty with and without chemoprophylaxis.
Methods
A systematic review was performed following PRISMA guidelines using PubMed, CINAHL and Cochrane Central. Patient demographics, comorbidities, risk category (if available), bleeding events, VTE events, and chemoprophylaxis information were recorded.
Results
Across 10 articles, 691 patients received chemoprophylaxis in the setting of abdominoplasty: 68 preoperatively, 588 postoperatively, and 35 received both. 905 patients did not receive chemoprophylaxis. 96.8% of patients were female, 73% underwent concomitant liposuction, and none were clearly risk stratified. The overall incidence of VTE and bleeding was 0.56% (9/1596) and 1.6% (25/1596), respectively. Compared to no chemoprophylaxis, chemoprophylaxis was not associated with increased incidence of bleeding [1.3% (9/671) vs. 0.91% (8/881), p=0.417], nor with decreased incidence of VTE [0.87% (6/691) vs. 0.33% (3/901), p = 0.187].
Conclusion
The prevalence of bleeding in abdominoplasty was low. Chemoprophylaxis was not associated with increased risk of bleeding or decreased risk of VTE, though the lack of risk stratification and heterogeneity of our cohort precludes firm conclusions regarding the benefits and/or risks of chemoprophylaxis. Our study underscores the importance of utilizing validated risk-stratification tools in order to guide perioperative decision making.
... As a major surgery, a number of complications can arise [2,3]. Skin necrosis, a rare complication postoperatively, results in abdominoplasty flap dehiscence which can present with decreased temperature of the area and slow capillary refill [3][4][5]. The sequelae are often due to insufficient perfusion secondary to blood flow interruption, tight garments, or pathology associated with poor wound healing like diabetes or lupus. ...
Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed.
Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.
... Furthermore, the umbilicus has often been described in the literature as an aesthetic subunit in and of itself, a central landmark that is essential to the overall aesthetics of the abdomen. The techniques provide some guidance to both aesthetic and reconstructive plastic surgeons in the pursuit of creating the perfect umbilicus following abdominoplasty and TRAM/DIEP breast reconstruction [17,18]. ...
The umbilicus is essential to the aesthetic appearance of the abdomen. However, very little has been written about the exact location of the aesthetically pleasing umbilicus as far as the Turkish population is concerned. Although a variety of reconstructive methods are available, no real standards define the location and shape of the umbilicus. This is a single cross-sectional cohort study focused on the morphometric analysis of the umbilicus in 300 adults between 18 and 65 years old. All data, including standardized measures and pictures, were determined. A total of 150 women and 150 men are incorporated into the study who referred to Kahramanmaraş Sütçü İmam University Hospital between January and July 2018. In this study, the authors observed that the umbilicus is situated around the midline plane such that the ratio of the distance between the xiphisternum and the umbilicus and the distance between the pubic symphysis and the umbilicus is 1.45. Also, the ratio of the distance between the umbilicus and anterior superior iliac spine and the between anterior superior iliac spine is approximately 0.6/1. Most umbilicus was found to be oval shape in males while round shape in females. Umbilical hood orientation was with an inferior hood in males while superior–inferior hood in females in my study at Turkish population. The present study was performed to determine the normal anatomical position of the umbilicus and umbilicus shapes in a sample of Turkish people and to obtain ideal ranges for repositioning neo-umbilicus during abdominoplasty.
... 4 The umbilicus is considered by many to be an aesthetic subunit in and of itself. 5,6 When absent, misshapen, or displaced, it can create an unnatural looking abdomen that causes undue attention to the midsection, resulting in psychological distress for the patient. 7 Position, size, shape, and depth of the umbilicus are characteristics that contribute to the overall aesthetics of the abdomen. ...
Objective: An aesthetically pleasing umbilicus is a vital component of patient satisfaction following an abdominoplasty. An umbilicus that is moderate to small is desired to achieve the best aesthetic result, but a small umbilicus has potential for stenosis. This article presents a method for umbilical stenting that creates a modest umbilicus, while preventing stenosis. Methods: All patients underwent abdominoplasty with an umbilical reconstruction using an inverted U-flap method between 2015 and 2017. An earplug was placed into the umbilicus at 2 weeks postoperatively for a total of 4 to 6 week. Patients were evaluated subjectively on the aesthetic outcome. Results: Twenty-one female patients were evaluated 6 weeks postsurgery. In all cases, both the patient and the surgeon were 100% satisfied with the final size. Umbilical size ranged from 1.8 to 2.2 cm. Conclusions: Use of an earplug for umbilical stenting is a simple and reproducible method to create an aesthetically pleasing umbilicus and avoid stenosis.
... The common complications previously associated with liposuction, including bleeding, wound infection, and seroma/hematoma formation, became less common. 2,3 Mark Gilliland first described abdominal etching by liposuction along the linea semilunaris, linea alba, and transverse inscriptions of the rectus abdominis muscle while preserving the fat over the central muscle body of the individual rectus abdominis muscles, bordered by the muscular inscriptions, to accentuate the appearance of this musculature. [4][5][6] This high-definition liposculpture technique involves differential liposuction to create desirable details of the abdominal musculature of the abdomen, truck, and pelvis. ...
Background:
The ideal body is characterized by a muscular physique and defined anterior abdominal wall. Despite diet and exercise, many are unable to achieve this desired result. Liposuction with abdominal etching is used to achieve high-definition abdominal aesthetics. The etching technique is performed with liposuction in a superficial plane, to create indentures consistent with "six-pack abs," or definition of vertical abdominal lines.
Methods:
The authors' abdominal etching preoperative markings, surgical technique, and postoperative care are discussed. The surgeons' experience with abdominal etching in 50 consecutive patients is reviewed, including rate of complications and patient satisfaction.
Results:
The average patient age was 36.4 years. We had an almost equal number of men (n = 26) and women (n = 24), with an average body mass index of 26.7 kg/m. The average blood loss was 275 ml, the average tumescence was 6 liters, and the average lipoaspirate was 5 liters. There were no major complications such as fat embolus, deep venous thrombosis, or intraabdominal injury. The most common minor postoperative complications were contour irregularities (12 percent), seromas (10 percent), and hyperpigmentation (2 percent). The majority of patients were satisfied (98 percent). The average length of postoperative follow-up was 27 months.
Conclusions:
Abdominal etching is a safe and effective method of creating a defined anterior abdominal wall for patients who desire the muscular definition of vertical abdominal lines. Almost all of our patients reviewed were satisfied with this procedure, maintained long-term results, and had an acceptable rate of complications.
Clinical question/level of evidence:
Therapeutic, IV.
... According to the ranking, the most common procedure was abdominoplasty [2]. In expert hands, the complication rate is less than 1% [3]. Since the number of non-certified plastic surgeons has increased, the complication rate has also increased considerably. ...
... 44 The most common complication after liposuction is contour irregularities, with an incidence of up to 20%. [131][132][133] Measures to prevent this include liposuction in deeper planes, equalization after aspiration (SAFE liposuction), and use of smaller cannulas. If appreciated intraoperatively, autologous fat transfer or contouring of adjacent concavities can be used to help improve deformities. ...
Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications, will be reviewed along with measures to optimize patient safety and outcomes.
... While the use of drains has traditionally been associated with prevention of seroma, the need for drains may decrease if traditional dissection is limited 9 . Ninety-eight percent of surgeons performing full abdominoplasty report using drains for prevention of developing seroma, with the drains removed an average of 8 days later 16 .In study conducted by Fang, Lin, & Mustoe, 2010 ,one group of patients had standard dissection at the level of the abdominal wall muscular fascia and another group had a more superficial plane of dissection, at or just below Scarpa's fascia. The standard dissection group developed seven seromas and had drain removal at Day 8 as compared with the modified dissection group with 2 seromas and drain removal at Days 4 and 5. ...
Background: According to the American Society for Aesthetic Plastic Surgery's 2008 Cosmetic Surgery National Data Bank, the number of abdominoplasty procedures performed has increased approximately333% since 1997 and represent the fifth most frequently performed procedure in 2009 1,2. Abdominoplasy is one of the most common practiced procedures in Egypt. Large dead spaces is predisposing factor for seroma collection, subsequent infection and wound dehiscence, also wound edges tension is serious predisposing factor for local edges complication. So technique for minimization of dead spaces through certain point's plication of superficial facial system to abdominal wall musculatures plus closure of tension free edges will be beneficial in minimizing the complication and secondary aesthetic countering of the abdomen. Objective: Use quilting sutures in minimized fashion and certainly defined anatomical points plus tension free wound edges and explain the outcomes. Methods: Twenty two female patient aged from 32 to 49 years old, who was submitted to abdominoplasty with Certain points placation of superficial facial system to abdominal wall musculatures using quilting sutures (abdominopexy) plus closure of tension free wound edges innovated technique. Patient evaluation as regard post operative seroma and local wound complication. Results: Patients submitted for this technique got benefit of minimized dead space and so no post operative hematoma or seroma with early removal of drains and excellent tension free edges wound Healing. Conclusion: Certain anatomical points plication of superficial facial system to abdominal wall musculatures plus closure of tension free edges will be beneficial in minimizing the complication specially seroma and secondary aesthetic countering of the abdomen
... Approximately one -third of bariatric surgery patients require a body contouring procedure after massive weight loss [6] . Abdominoplasty is a common aesthetic procedure for correcting abdominal apron and has a wide appeal [7] . Many obese patients also have ventral hernia or divarication recti. ...
Background: Obesity is a major health problem and bariatric surgery has been shown to be the most effective approach in the management of obesity. Abdominoplasty is a common aesthetic procedure for divarication recti with abdominal apron and it has a wide appeal. The aim of this study is to determine the usefulness of laparoscopic sleeve gastrectomy with concomitant abdominoplasty.
Subjects/methods: This is a retrospective study over a 7 - year period from 2009 to 2015, conducted on 82 patients who underwent sleeve gastrectomy and simultaneous abdominoplasty at Sunrise Group of Hospitals, Kochi and Dubai. A classical Pfannenstiel incision was made and the skin flap raised, laparoscopic sleeve gastrectomy carried out with the usual port placement directly on the sheath. Ventral hernia (if present) repaired, neoumbilicus created, redundant skin and fat excised and the flap sutured in layers over suction drains. Patients were followed up indefinitely.
Results: Eighty two patients underwent combined laparoscopic bariatric surgery and abdominoplasty. Of these, 68 (82.93%) had ventral hernia repair carried out and 14 (17.07%) underwent abdominoplasty alone. The median length of stay was 4 days. 6 patients developed postoperative seroma, and 1 patient had surgical site cellulitis; whereas 3 patients developed surgical site infection. To date, one patient required a revision abdominoplasty.
Conclusion: Considering the advantages, comparable hospital stay and the low rate of complications, it would be safe to conclude that LSG with concomitant abdominoplasty is a beneficial procedure in patients of obesity and abdominal apron.
Background: Obesity is a major health problem and bariatric surgery has been shown to be the most effective approach in the management of obesity. Abdominoplasty is a common aesthetic procedure for divarication recti with abdominal apron and it has a wide appeal. The aim of this study is to determine the usefulness of laparoscopic sleeve gastrectomy with concomitant abdominoplasty.
Subjects/methods: This is a retrospective study over a 7 - year period from 2009 to 2015, conducted on 82 patients who underwent sleeve gastrectomy and simultaneous abdominoplasty at Sunrise Group of Hospitals, Kochi and Dubai. A classical Pfannenstiel incision was made and the skin flap raised, laparoscopic sleeve gastrectomy carried out with the usual port placement directly on the sheath. Ventral hernia (if present) repaired, neoumbilicus created, redundant skin and fat excised and the flap sutured in layers over suction drains. Patients were followed up indefinitely.
Results: Eighty two patients underwent combined laparoscopic bariatric surgery and abdominoplasty. Of these, 68 (82.93%) had ventral hernia repair carried out and 14 (17.07%) underwent abdominoplasty alone. The median length of stay was 4 days. 6 patients developed postoperative seroma, and 1 patient had surgical site cellulitis; whereas 3 patients developed surgical site infection. To date, one patient required a revision abdominoplasty.
Conclusion: Considering the advantages, comparable hospital stay and the low rate of complications, it would be safe to conclude that LSG with concomitant abdominoplasty is a beneficial procedure in patients of obesity and abdominal apron.
... Obese patients are at a higher risk of hematoma/seroma formation, skin necrosis, infection, and delayed wound healing. 24,28,29 According to Nemerofsky and Aly, the threshold BMI to perform circular body contouring is 35 and 32 kg/m 2 , respectively. 12,24 One specific complication, venous thromboembolism, is also significantly increased if the BMI exceeds 30 kg/m 2 (Table 4). ...
Introduction:
Most post-bariatric patients seek body contouring procedures to correct skin excess after massive weight loss. Among these procedures, some surgeons are still wary of circular abdominoplasty, mainly because it is considered a major intervention associated with a high complication rate. The aim of this study was to assess the complication rate of circular abdominoplasty performed on patients presenting with massive weight loss, with a particular emphasis on patient selection and surgical technique.
Methods:
Fifty-six consecutive patients who underwent circular abdominoplasty following massive weight loss between January 2001 and March 2015 were included in the study. The indications for the procedure were abdominal skin excess extending to the flanks and the posterior region of the lower trunk. Data were collected retrospectively through medical charts and photographs.
Results:
Forty-nine patients were female. The mean age was 39.8 years, with a mean preoperative body mass index of 25.7 kg/m(2). The mean time between bariatric surgery and circular abdominoplasty was 3.3 years. The overall complication rate was 23.2%, mostly minor, with only one (1.7%) early surgical revision under local anesthesia for delayed wound healing. Blood transfusion was required for 8.9% of patients.
Conclusion:
Patient selection (e.g., body mass index < 30 kg/m(2)), precise preoperative planning and markings, and simple and careful surgical technique with minimal liposuction and undermining are crucial. Ensuring these key factors renders circular abdominoplasty a reliable and safe procedure, with low complication rates.
... In the literature, reported seroma rates have been reported as highly variable, and range anywhere between 2% and 10%. [12][13][14][15][16][17] Seromas may be linked to several factors in abdominoplasty. 5,18,19 It may manifest from disruption of the lymphatics in the lower abdomen as others have shown the limiting dissection to a superficial plane may reduce the rates of seroma. ...
Background:
Abdominoplasty is a common aesthetic procedure in the United States. Pollock and Pollock described their progressive tension technique in 2000 and published a series of 597 patients in 2012 of their experience. The reported seroma rate in the literature ranges from 2% to 26% with drains and 0.1% to 4% with progressive tension sutures (PTS) without drains.
Objectives:
Given these data, we decided to use PTS and forego drains in abdominoplasty. Here we present our experience with the transition.
Methods:
This is a retrospective chart review of 451 abdominoplasties performed at our outpatient surgery center over a 7-year period (2009-2015). We gathered data on patient demographics, concomitant liposuction, and complications and length of follow up.
Results:
Five main differences were examined in PTS vs traditional abdominoplasty using drains groups. These included rate of seroma, wound complication, scar revision, hematoma, and follow up. We found a decreased rate of seroma in the PTS group, 2% vs 9%. Wound complications were similar. Scar revision was slightly higher in the PTS group at 17% vs 10% in traditional abdominoplasty, this association had a P value of .048. The rates of hematoma were similar (0% vs 1%). The mean follow up was 6 months in PTS and 9 months in traditional abdominoplasty. Addition of liposuction did not increase the rate of seroma.
Conclusions:
PTS without drains significantly decreased the seroma rate in our practice. Our experience adds to the mounting evidence that surgeons should consider using the PTS technique and abandon the use of drains in abdominoplasty. A well powered, multicenter, randomized controlled study is needed in order to definitively lay this question to rest.
Level of evidence:
4 Therapeutic.
... 4 Recent studies show lower rates, with 0.04% for DVT and 0.02% for PE. 5 During this procedure, the degree of plicature of the rectus abdominis inevitably generates an increase of intra-abdominal pressure (IAP). ...
Background:
Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation.
Objectives:
To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty.
Methods:
A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature.
Results:
The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant.
Conclusions:
Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes.
Level of evidence:
3 Therapeutic.
... Después de la introducción de la lipoaspiración, la lipectomía abdominal adquirió una nueva dimensión, al combinar ambos procedimientos conforme a las diferencias anatómicas y los problemas funcionales asociados 10 . En el año 2006, una encuesta a 497 cirujanos reveló que solamente el 56% de los encuestados realizaba algún tipo de Liposucción asociada a una abdominoplastia 11 . Para mejorar el contorno corporal se ofrecía a los pacientes intervenidos con una abdominoplastia la lipoaspiración, en dos tiempos diferidos en al menos seis meses 12 . ...
Con el advenimiento de la lipoaspiración en 1980, existió un gran progreso del abordaje de la pared abdominal, evolucionando a nuevos conceptos de remodelación del contorno corporal, como la lipoabominoplastia descrita por Saldanha en el año 2001. El objetivo del estudio es comparar los resultados de la abdominoplastia clásica con Lipoaspiración de contorno contra la lipoabdominoplastia. Analizando morbilidad postoperatoria y grado de satisfacción. Se estudiaron prospectivamente todos los pacientes intervenidos en la ciudad de Valdivia, excluyendo a los pacientes con IMC mayor de 35, hernias abdominales asociadas, cicatrices quirúrgicas extensas de la pared abdominal. Se designaron aleatoriamente mediante método de distribución de probabilidad uniforme. El paciente ni el encuestador supieron la técnica empleada. Los análisis estadísticos fueron realizados mediante estadística descriptiva y chi cuadrado. Hubo 30 pacientes por grupo. Ambos grupos fueron comparables según las variables demográficas. Hubo complicaciones en el 16,7% de las intervenciones. Siendo más frecuentes los seromas en el grupo de la abdominoplastia. El grado de satisfacción fue elevado en ambos grupos, sin embargo, los "retoques" solicitados por los pacientes fue mayor en el grupo de la abdominoplastia clásica. Nuestros resultados son comparables con otras series, creemos que el mayor porcentaje de seromas fue dado por el mayor tallaje del colgajo dermo graso. Sin duda que las técnicas de remodelación de la pared abdominal se deben analizar en forma particular, teniendo en consideración los distintos parámetros anatómicos de cada paciente.
... The use of suction drains is still the most accepted method of seroma prevention [ 25 , 72 ]. This was fully confi rmed in Matarasso's [ 22 ] survey of 497 plastic surgeons who had performed 11,016 full abdominoplasties: 98 % of the surgeons used suction drains after a full abdominoplasty. ...
A technique of dual-plane abdominoplasty is presented. It can be applied to every type of abdominoplasty, and it uses a more superficial plane of dissection (on top of Scarpa fascia) in the infraumbilical area and the classical plane (on top of the deep fascia) in the supraumbilical area. The authors have been applying this technique in their practice for more than a decade and conducted two prospective comparative studies on the subject: a level 2 study involving 208 patients and a level 1 randomized controlled trial with 160 patients. The beneficial effect of using a more superficial plane of dissection on the seroma rate has been fully confirmed along with other very relevant advantages: lower drain volume, earlier drain removal, prevention of long drainers, shorter hospital stay, and lower hematoma and infection rates. The aesthetical result obtained with this technique was very good, considering both physician and patient evaluations.
... Hester et al 6 presented 2.5% seroma rates using electrodissection, and the same low rate is accomplished by many other surgeons. [5][6][7][8] This alone should run counter to Swanson's postulation that the dissection with a cold blade leads to less seroma. ...
First, I would like to express my great admiration to Dr Swanson1 for providing a valuable example for the exercise of the scientific method. It is inevitable that his observations, accumulated from extensive experience, have generated a hypothesis to be tested and verified.
The hypothesis that seroma is caused by thermal injury is by no means a new concept, and has been advocated by some authors in the past. There may have been some merit to the hypothesis in the times where electrosurgery was rudimentary and old diatherms were true candles flaming the surrounding tissue. The power efficiency rating (PER) is a measure of the ability of an electrosurgical generator to accurately deliver the selected power into a wide range …
... Abdominoplasti cerrahisi sonrası; seroma, hematom ve dermal-yağ flep nekrozu oluşumu gibi lokal komplikasyonlar daha sık izlenirken derin ven trombozu ve pulmoner emboli gibi sistemik komplikasyonlar nadir olarak görülür [2,3]. Bunlar arasında en sık görülen komplikasyon, batın ön duvarında dermal-yağ flep derininde eksudatif karakterde sıvı koleksiyonu ile karakterize seromadır [4,5]. ...
... In the past, authors recommended against concomitant abdominal liposuction with abdominoplasty. [1][2][3][4][5] There has slowly become a partial acceptance of liposuction with abdominoplasty; however, in the majority of cases, this involves altering the abdominoplasty technique in one way or another. This has led to the evolution of a different operation entirely, sometimes called lipoabdominoplasty. ...
There continues to be controversy about performing abdominoplasty concurrently with abdominal liposuction. The concern is that liposuction on the already vascularly compromised abdominal flap will lead to increased complications and flap necrosis. The central abdomen is supplied by the epigastric system. If perforator vessels from this system are spared, the blood supply to the abdomen can be spared and liposuction should be able to be safely performed on the elevated abdominal flap. The purpose of this study was to evaluate the safety of abdominoplasty with concurrent abdominal liposuction when a perforator vessel is spared.
A standard abdominoplasty was performed, sparing one or two perforator vessels from the deep superior epigastric artery system. A retrospective chart review of 300 consecutive patients who underwent abdominoplasty surgery combined with concurrent abdominal liposuction was performed. Complications, total volume of abdominal liposuction, and results were reviewed.
The overall complication rate was 17.3 percent (52 patients). Sixteen percent (48 patients) suffered minor complications and 1.3 percent (four patients) suffered major complications.
Abdominoplasty can be combined safely with concurrent abdominal liposuction when a perforator vessel is spared. The combination of concurrent liposuction with abdominoplasty showed no increase in complication rates when a perforator vessel was spared. The perforator vessels are located consistently in a 2-cm radius located 4 cm from the midline and 6 cm from the subcostal margin. The potential advantages of abdominoplasty with concurrent liposuction include a better postoperative cosmetic result.
Therapeutic, IV.
Abdominoplasty is particularly common in people who have undergone pregnancy as well as in people having massive weight loss so much so that it is now among the 5 most commonly performed cosmetic procedures in the United States [1]. Abdominoplasty is undertaken to improve body contours and it has progressed from being purely skin removal to now being a combination of lipocontouring followed by skin removal and breast surgery the best aesthetic result [2]. Abdominoplasty is an increasing popular procedure that has expanded by 79% over the past 13 years. The selection of the abdominoplasty technique depends on the presence, location, and extent of skin excess (whether upper or lower abdomen or both). If there is skin excess only in the lower abdomen then use of short scar procedures is recommended [3].
Background:
A growing body of literature aims to describe abdominal aesthetic goals in order to tailor surgical and non-surgical treatment options to meet patient goals. We aimed to integrate lay-person perceptions into the design of a novel professional aesthetic scale for the abdomen.
Methods:
An iterative process of expert consensus was used to choose 5 domains -1) abdominal muscle lines, 2) abdominal shape, 3) scar, 4) skin, and 5) umbilicus. A survey was developed to measure global and domain-specific aesthetic preferences on 5 abdomens. This was distributed through Amazon Mechanical Turk to 340 respondents. Principal component analysis was used to integrate survey data into weights for each of the scale's sub-questions. Attending plastic surgeons then rated abdomens using the final scale, and reliability and validity were calculated.
Results:
The final scale included eleven sub-questions - hourglass shape, bulges, hernia, infraumbilical skin, supraumbilical skin, umbilicus shape, umbilicus medialization position, umbilicus height position, semilunar lines, central midline depression, scar - within the 5 domains. Central midline depression held the highest weight (16.1%) when correlated to global aesthetic rating, followed by semilunar lines (15.8%) and infraumbilical skin (11.8%). The final scale demonstrated strong validity (Pearson r=0.99) and was rated as easy to use by 7 attending plastic surgeons.
Conclusion:
The final scale is the first published professional aesthetic scale for the abdomen that aims to integrate lay-person opinion. In addition, this analysis and survey data provide insights into the importance of eleven components in overall aesthetic appeal of the abdomen.
Background:
Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures?
Methods:
Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently.
Results:
Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000.
Conclusions:
Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.
Background
The demand for abdominoplasty procedures has increased in surgical centres as a result of patient preference and economic concerns. The International Society of Aesthetic Plastic Surgery (ISAPS) published the Facility Accreditation Guideline on 22 October 2018. It is a list of recommendations that aim to reduce the incidence of complications and increase safety standards.Objectives
The objective of this work was to detect the effects of the ISAPS guidelines on the morbidity associated with abdominoplasty procedures in day care surgical centres.Methods
The authors performed a retrospective study. Data regarding complications of abdominoplasty were collected from medical records of the last 350 cases of abdominoplasty performed in December 2018. The complications and their incidences were compared with similar previously published data of abdominoplasty operations performed by other authors and in surgical centres before initiation of the ISAPS Facility Accreditation Guideline.ResultsIn all cases, we achieved a significant reduction in skin and adipose tissue with improvement in body shape. The incidence of major and minor post-operative complications was lower than that reported in other literature.Conclusions
This report shows that abdominoplasty is a safe procedure with low complication rates, which are even lower when the ISAPS Facility Accreditation Guideline is followed together with national, regional, state and other legal requirements.
Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
L'obésité est en constante augmentation en France et dans le monde. La chirurgie bariatrique, visant à faire perdre du poids aux patients en obésité morbide, a de ce fait connu un essor sans précédent ces dix dernières années. Ainsi, le chirurgien plasticien doit de plus en plus faire face à une demande de chirurgie morphologique afin de corriger les séquelles d'amaigrissement, avec en première ligne l'abdominoplastie. L'objet de ce travail est de préciser les différences entre les patients post-bariatriques et les autres ainsi que leurs influences sur la survenue de complications après abdominoplastie. Matériel et méthodes. - Il s'agit d'une étude rétrospective concernant les patients opérés d'une abdominoplastie au CHU de Rouen entre janvier 2000 et décembre 2010. Résultats. - 238 dossiers ont été revus comportant 114 patients post-bariatriques et 124 patients témoins. Plusieurs différences ont été mises en valeur entre les groupes comme l'IMC maximum, III" au moment de la chirurgie, les taux de facteurs de risques cardiovasculaires ainsi qu'une durée opératoire plus longue dans le groupe post bariatrique. Le taux de complications chez ces patients était sensiblement plus important (55.3% contre 26.6%) avec essentiellement une majoration des problèmes de cicatrisation. Des facteurs de risques de complications ont été retrouvés comme un poids maximal important, l'obésité au moment de la chirurgie, l'allongement de la durée opératoire et l'utilisation des lames de Delbet. Discussion et conclusion. - De plus en plus fréquente, il apparait que la décision d'abdominoplastie chez les patients post bariatriques nécessite une prise en charge spécifique du fait de particularités inhérentes à cette population.
Background: Abdominoplasty is a surgical procedure with the aim of creation of an abdomen with normal naval and abdominal wall appearance with least scar. This procedure is accompanied with various complications. Current study aimed to assess the effects of abdominal plication following abdominoplasty on respiratory tract pressure.
Methods: This was a census clinical-trial study conducted on 100 patients who had undergone abdominoplasty in Isfahan City, Iran, during 2016-17. Respiratory functions including pulse rate, respirator rare, peak inspiratory pressure, and peak expiratory pressure were assessed in patients prior to and immediately after abdominoplasty. Data were analyzed with using SPSS software. P-value of less than 0.05 was considered significant.
Findings: 100 patients including 92 women (92%) and 8 men (8%) with mean age of 37.77 ± 7.89 years were participated in this study. Mean arterial blood pressure, mean tracheal pressure, systolic blood pressure, diastolic blood pressure, mean blood pressure, and respiratory rate of patients were significantly different prior to and after the surgery (P < 0.05); but pulse rate was not statistically different prior to and after the surgery (P > 0.05). The least tracheal pressure (17 mmH2O) and the most satisfaction (5 out of 5) was achieved with upper abdomen plication of 15 centimeters and lower abdomen plication of 14 centimeters.
Conclusion: Tracheal pressure and respiratory rate can be used for assessment of respiratory function immediately after abdominoplasty. Results of the current study showed that the size of plication had significant effect on tracheal pressure, respiratory rate, and patients' satisfaction after abdominoplasty.
Abdominoplasty is a radical surgery that results with dramatic changes. When combined with liposuction, fat injections, and/or breast surgery, the whole torso is totally reshaped, either in single or multiple sessions. However, it is a more risky surgery with higher morbidity and mortality rates than other cosmetic procedures. Overall major complication rates after abdominoplasty is 4 %, compared with 1.4 % after other surgical cosmetic procedures [1]. Detailed preoperative evaluation, appropriate patient selection, and correct surgical planning are critical to reduce complications, improve results, and increase patient satisfaction. General health issues are important for the patient selection. A careful evaluation of the abdominal tissues, i.e., the skin, fat, and abdominal wall, is necessary for a proper technique selection and surgical strategy.
At the end of the twentieth century, Avelar (Rev Bras Cir 6:3–20, 1999) presented new surgical concepts for abdominoplasty which are highlights of the remarkable Kelly’s (John Hopkins Med J (10):197, 1899) publication that described the basic fundaments on “resection of the abdominal panniculus.” Great improvement of the traditional abdominoplasty technique was introduced by Callia (Contribution to the study of surgical correction of the pendulum and distended abdomen: original technique (PhD Thesis). Sao Paulo, Faculty of Medicine, University of São Paulo, 1965) through wide undermining of the abdominal flap. Later, Illouz (Rev Chir Esthet Franc. 6(9):ap 1980, 1980) with his wonderful liposuction technique made an important contribution to the aesthetic treatment of body contour and also of the abdominal wall. Nevertheless, abdominoplasty has undergone a deep change with the advent of combination of traditional abdominoplasty with liposuction with limited panniculus undermining proposed by Avelar (Rev Bras Cir 6:3–20, 1999). Following Avelar’s concepts, Leão (Abdominoplastia: a new abordagem. Anais the XXXVII Brazilian Congress of Plastic Surgery. Porto Alegre-RS. November 12–15, 2000) performed reinforcement of the aponeurosis above the umbilicus, and Erfon (Abdominoplasty by vascular closed system associated with liposuction. Presented at the XVI North-Northeast Surgery Day. Plástica Costa do Sauipe, Bahia. 13 1 15 September) presented plication of the abdominal aponeurotic wall below the umbilicus.
As bariatric surgery becomes ever more popular, so does body-contouring surgery to eliminate excess skin after radical weight loss. To date, the literature has described a number of risk factors affecting the postoperative outcome. Our study aimed to define those factors more closely, focusing on abdominoplasty ("tummy tuck") patients who suffered intra- and postoperative complications.
The study collective included 205 patients over 5 years (2001-2006) who underwent dermolipectomy at our department. The mean follow-up was 5.94 years. Every abdominoplasty was performed under general anesthesia with intraoperative one-dose antibiotic. The analysis included a complete review of all medical records. Statistical analysis was performed with the R-2.5.0 Software for Windows.
The overall rate for major complications that required operative revision and/or antibiotics was 10.2 %, including 2.9 % cases of infections. Forty-one percent had minor complications, such as seromas, hematomas, wound healing problems, and wound dehiscences. The logistic regression models demonstrated that smoking combined with the age, a BMI higher than 30 kg/m(2), and the amount of removed tissue (measured in g) lead to significantly more wound healing problems in nearly all age groups. The probability of infections correlated with later drain removal.
Regardless of the amount of tissue removed, no main risk factor for complications could be identified. A complication-free course and good outcome can be best achieved with careful patient selection and preoperative planning.
ABSTRACT
The subcutaneous tissue has deserved a growing interest due to the generalization of bariatric surgery and the popularity of body contour surgery. It has been the object of few scientific studies and some doubts still persist about its structure. Previous studies described a trilaminar structure (superficial and deep fat compartments separated by Scarpa fascia) in the lower abdominal wall. Contradictory perspectives do exist regarding the relative compartment dominance and changes with increasing adiposity. The presence, extension and structure of Scarpa fascia are other issues surrounded by considerable controversy since its original description in the XIX century by Antonio Scarpa. A clearer understanding of these issues will have a positive impact in body contour surgery.
The surgical procedures for body contour of the abdominal region, usually known as abdominoplasty, are among the most frequently performed for either aesthetic or reconstructive purposes. Since the classical descriptions of the abdominoplasty technique published in the 60s, there has been a continuous effort to develop modifications with the aim of improving results and lower complications. Nevertheless, abdominoplasty continues to be a surgical technique that implies a considerable risk of complications along with a high secondary surgical revision rate. Scarpa fascia is usually ignored in the classical descriptions of the abdominoplasty surgical technique but it has been suggested that it may have an important role in this type of surgery, namely reducing the most frequent complication: seroma. There are no objective data that validate this statement, more specifically prospective clinical studies.
Chapter I is a general introduction to this work. The concepts and current knowledge on abdominoplasty are presented as well as on the anatomy of the subcutaneous tissue of the abdominal wall and on the level of dissection used during an abdominoplasty. The aim of this bibliographic revision is to contextualize the scope of this work and understand its purpose. The objectives, general and specific, are defined.
In Chapter II, a clinical prospective comparative study with 208 patients to investigate the effects of preserving Scarpa fascia during a full abdominoplasty in the immediate postoperative period is presented. The outcomes were: time to suction drain removal, total volume of drain output, length of hospital stay.
In Chapter III, the effects of preserving Scarpa fascia during a full abdominoplasty on results and complications, in the immediate and late postoperative periods, were studied by means of a clinical prospective randomized study (Randomized Controlled Trial) with 160 patients. The study was designed according to the guidelines from the Consolidated Standards of Reporting Trials Group (CONSORT). The outcomes of this study were: time to drain removal, daily and total volume of drain output, length of hospital stay, systemic complications ( need for blood transfusion, pulmonary fat embolus syndrome, thromboembolic complications, death), local complications (seroma, hematoma/bleeding, wound infection, healing problems/wound dehiscence without necrosis, skin necrosis ), emergency department visit, second admission to the hospital, secondary surgical revision and aesthetic result (evaluated separately by the patient and also by the care provider).
In Chapter IV an anatomic study is presented that was performed with the surgical specimens from 41 patients submitted to a classical abdominoplasty with umbilical transposition. Two different approaches were used: gross morphometric and histologic analysis of fresh surgical specimens. For that, the thickness of the two adipose layers was assessed in predetermined location points followed by microscopic evaluation of the surgical specimens to verify the presence and structure of Scarpa fascia and to study the organization of the adipose tissue.
In Chapter V two additional publications on the subject of this thesis are presented. One is an abstract of an oral communication presented in the Annual Meeting of the American Society of Plastic Surgery (Plastic Surgery 2011 held in Denver, United States of America) and the other is a letter to the editor. The former briefly presents the results of the prospective study detailed in Chapter II. The latter presents a discussion on the experimental design of the study from Chapter III as well as a state of the art summary of dual plane abdominoplasties.
In Chapter VI a brief synopsis of the key findings of the anatomic and clinical trials is presented along with a comparison with other published studies. A discussion is presented about the mechanisms and possible explanations of the results, limitations of the studies, clinical and research implications of the results as well as their external validity and applicability. Finally, the main conclusions of this thesis are presented.
Abdominal contour deformities after massive weight loss are highly variable, ranging from a mild upper protuberance to multiple rolls. Correction of these deformities is challenging and may require advanced surgical techniques. Evaluating the incidence of patients presenting with various abdominal deformities and the factors influencing these deformities could aid patients undergoing weight loss.
All massive weight loss patients presenting for abdominal contouring from 2002 to 2012 were reviewed, and abdomens were graded using a modified Pittsburgh Rating Scale. Data collected for each patient included body mass indices, history of bariatric surgery, and type of abdominal contouring surgery.
One thousand six patients were evaluated, with a mean age of 44.2 ± 10.5 years. The mean maximum body mass index was 51.7 ± 9.6 kg/m, mean current body mass index was 30.0 ± 6.4 kg/m, and mean change in body mass index was 21.7 ± 7.0 kg/m. Sixty-four percent had a high-grade deformity. Patients with a larger change in body mass index had higher deformity grades (p < 0.001). Patients with higher deformity grades were more likely to undergo a fleur-de-lis abdominoplasty (p < 0.001).
Most patients presenting for body contouring after massive weight loss have high-grade abdominal deformities with multiple rolls. Change in body mass index is positively correlated with deformity grade and more aggressive contouring procedures. Patients interested in massive weight loss should be counseled that, depending on desire for eventual outcomes, more complex procedures may be required to correct the resultant abdominal deformity.
Therapeutic, IV.
Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to abdominal wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the "U-M dermolipectomy," "V umbilicoplasty," the rectus abdominis "myofascial release," and suctionassisted lipectomy. The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas. Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable easier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the abdominal wall musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex abdominal wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results. (Plast. Reconstr. Surg. 105: 425, 2000.) (C)2000American Society of Plastic Surgeons
Like other surgical patients, those undergoing elective aesthetic surgery are at risk for deep vein thrombosis. The author discusses ways to reduce this risk, such as limiting the number of procedures performed in the same operative session, using mechanical devices and pharmacologic agents, and doing careful postoperative assessment.
Background: Previously published articles presenting rates for lipoplasty morbidity and mortality have reported on procedures performed before mid 1998.
Objective: The present survey reports on morbidity and mortality for lipoplasty procedures performed by members of the American Society for Aesthetic Plastic Surgery (ASAPS) from September 1, 1998, through August 31, 2000. It assesses whether ASAPS-member surgeons have modified their lipoplasty practices in accordance with the 1998 recommendations of the Lipoplasty Task Force.
Methods: In September 2000, ASAPS sent out a 4-page questionnaire to 1432 Active Members, all of whom were board-certified plastic surgeons. The survey included questions about complications and fatal outcomes associated with lipoplasty procedures, performance of combination procedures, patient selection, changes in lipoplasty and anesthesia techniques, and surgical facility accreditation. Completed surveys were anonymous and were mailed by respondents directly to an independent research firm for collation. Further data analysis was conducted by an independent statistician.
Results: A total of 754 questionnaires were returned, for a response rate of 53%. ASAPS members reported on 94,159 lipoplasty procedures. In all, 66% of the procedures were lipoplasty only, 20% were lipoplasty without abdominoplasty but with one or more additional procedures, and 14% were lipoplasty with abdominoplasty, with or without any other procedures. The most frequently reported postoperative event was nausea/vomiting (1.02%, or 1 per 98 procedures). The most frequently reported major complication was skin slough (0.0903%, or 1 per 1107 procedures). In all, there were 245 major complications, for a rate of 0.2602%. Death associated with lipoplasty performed as an isolated procedure was rare; the mortality rate was 0.0021%, or 1 per 47,415 procedures. Stated positively, the estimated non-mortality probability is 99.98%. When lipoplasty was performed with other procedures, excluding abdominoplasty, the rate was 0.0137%, or 1 per 7314 procedures. When lipoplasty was combined with abdominoplasty, with or without other procedures, the rate was 0.0305%, or 1 per 3281 procedures—a rate 14 times greater than that for lipoplasty only. Nearly 33% of respondents said that they had modified their approach to lipoplasty and/or their approach to patient selection within the last 24 months in accordance with published recommendations of the Lipoplasty Task Force.
Conclusions: The ASAPS survey documents the current safety of lipoplasty when it is performed as an isolated procedure by properly trained surgical specialists adhering to recommended standards of clinical practice. Further studies are needed to examine the factors that increase the risk in combined procedures as well as the effectiveness of prophylactic measures in avoiding complications.
Abdominoplasty is a major surgical procedure associated with a variety of complications. Some studies1–3 indicate that the risk of severe complications, including mortality, ranges from 1 in 617 to 1 in 2320. This article focuses on avoiding and treating some of the more common problems typically encountered in abdominoplasty.
One “complication” that is not reported routinely occurs when an operation is successful but the patient is disappointed with the results. Invariably this situation is the result of a lack of communication or a misunderstanding. Initially patients should be educated about the objectives of the operation, and these objectives should be reconciled with their goals and concerns. In addition, patients should have a thorough understanding of the basic technique of the surgery, the use of anesthesia, and the recovery process, which will limit any surprises that may be upsetting to the uninformed. Furthermore, the surgeon should attempt to understand the patient's motivations and goals to avoid any conflicts. Although some patients may be anatomically suitable for a procedure, not everyone is a candidate for elective surgery.
Alan Matarasso, MD, New York, NY , is a board-certified plastic surgeon and an ASAPS member.
The combination of liposuction and abdominoplasty has improved our ability to contour the abdomen. However, potential wound healing problems (Table 1), particularly in the abdominoplasty triangle (from umbilicus to pubis), should be considered6 (Figure 1). Undermining the flap in an inverted “V” fashion (thereby preserving the Huger Zone III intercostal blood supply), avoiding excess tension on the flap closure, limiting flap thinning, and limiting excessive liposuction are measures that aid in preserving flap integrity (Figure 2). If an abdominal flap appears to be compromised, the umbilicus can be externalized after surgery, thereby preserving some additional midline crossover blood …
The technique advocated by the author is widely indicated for the reduction and correction of abdominal deformities, giving very favorable aesthetic and physiologic results. The lateral projection of the incision permits an adequate distribution of the flaps, compensating for the difference in the amplitude of the two cutaneous borders, besides giving a satisfactory body contour.
We present a new method for doing an abdominal lipectomy, one which eliminates many of the technical problems in doing this operation.
Some 958 surgeons replied to a survey designed to determine the complications of abdominoplasties. The results appear in this paper. We believe that the patient contemplating an abdominoplasty and the surgeon planning it should be aware of the unpleasant reality of these complications, which range from the annoying to the lethal. It is of some solace, however, that despite the inevitability of readily visible scars, nearly all of these patients are quite satisfied with their results.
Suction abdominoplasties are associated with a number of surgical complications, mainly in obese people and diabetic patients. The aesthetic result is often spoiled by poor balance caused by improper distance between the "guide points" of an harmonious abdomen (e.g., minimum of 10 cm between the pubic scar and the umbilicus). Almost all surgical complications are caused by extensive undermining and can be avoided by an en bloc resection without any undermining (the suction lipectomy of the upper flat creates a "mesh undermining" which is almost as efficient). A new neo-umbilicoplasty, described here, can be situated in the "right position" with good aesthetic results.
A 6-year retrospective series of 133 abdominoplasties was studied and type and incidence of complications are presented. From this series a group of 34 patients was re-examined between 4 and 10 1/2 years postoperatively and conclusions were made from this long-term follow-up. A high incidence of injury to the lateral cutaneous nerve of the thigh was recorded. A blood transfusion was required in 19% of the cases, the average hospitalisation was 12.4 days and the complication rate ranged between 24% in those who did not attend review and 65% in those who were re-examined. Objectively judged, 55% of the patients had excellent or good results, but subjective patient satisfaction was nearly 90%.
The records of 487 patients undergoing abdominoplasty combined with closed liposuction of flap and flanks were reviewed regarding complications, revisions, and certain risk factors related to flap necrosis. Six patients developed general nonfatal complications including 1 deep phlebitis and 1 pulmonary embolism. Thirty-nine local complications occurred including 24 cases of flap necrosis, 4 hematomas, 2 dehiscences, 1 abdominal perforation, 1 infection, and 5 cases of seroma. Wide undermining and the "opposite T" incision emerged as significant risk factors related to flap necrosis. Neither the suction procedure nor obesity nor age had significant influence on the slough incidence. Although the present study does not include controls, liposuction does not appear to represent any significant additional risk when performed in connection with abdominoplasty.
There have been three previous case reports of fat embolism syndrome (FES) after lipectomy. We present a case of FES diagnosed by pulmonary angiography. It seems likely that there is an incidence of subclinical fat embolization after liposuction, but conservative patient selection and aggressive postoperative management can lessen the morbidity and mortality of FES.
Although combined suction-assisted lipectomy (SAL) and surgical abdominoplasties have been described, the surgical excisions have in general been small and limited to the lower portion of the lower abdomen (i.e., just above the pubis). For the obese patient this is an insufficient lipectomy. SAL alone is unsatisfactory because the marked skin excess will not shrink sufficiently to allow a desired final result. Surgical abdominoplasty alone is also insufficient in the obese patient because the thickness of the abdominal panniculus is not reduced and, additionally, secondary to tissue tension with wound closure, some necrosis of skin above the pubis is not unusual. In this article results are described from a small consecutive series of obese patients treated with a combined extensive SAL, surgical lipectomy, and surgical abdominoplasty. The sequence of fat removal is different than that which has been previously described. In all of the patients the results were pleasing, and there were only two relatively minor complications.
The clinical records of 563 patients undergoing either abdominoplasty alone or in combination with other major surgical procedures were reviewed in order to determine the relative safety of combined procedures. One-hundred-seventeen patients had abdominoplasty alone; 230 had abdominoplasty with either an intraabdominal or major pelvic procedure with or without an additional major aesthetic procedure; 216 had abdominoplasty with one or more major aesthetic procedures (without intraabdominal or pelvic procedures). The rates of occurrence of major complications, including death, pulmonary embolus, and infection, among the three groups were examined. Also examined were morbidity factors such as length of hospital stay and the need for blood transfusion. In this study, the only risk factor identified in predicting major morbidity, specifically the occurrence of pulmonary embolus, was obesity, not the complexity of the surgical procedure.
In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.
Lipoplasty enhances the plastic surgeon's ability to treat milder forms of abdominal deformities. Proper patient selection and maintenance of flap blood supply are explained.
Stretching of the abdominal wall and skin following pregnancy or excessive weight gain may be limited to the infraumbilical area. In these patients, abdominal repair may be accomplished with a shorter incision and without the necessity for relocating the umbilicus with its attendant visible scar. Forty patients are presented in whom excellent aesthetic repairs were effected through short curvilinear, low abdominal incisions with removal of a modest amount of excess skin. Fascial plication from pubis to umbilicus or above is facilitated by buried figure-of-eight sutures. Suction-assisted lipectomy may be employed as an adjunct. Recovery is facilitated by the reduced incision line length, reduced undermined area, and absence of tension in the midline skin incision, such as may occur in a standard abdominoplasty in which large amounts of panniculus and skin are removed with a complete repair of the abdominal wall. The limited abdominoplasty may be safely performed with ketamine-diazepam anesthesia in an office surgical center. Major complications are few and generally reflect the unpredictable nature of the elasticity of the abdominal skin.
Some patients requesting abdominal contour surgery may have all their deformity below the semicircular line. Five patients in a series of 14 treated with mini-abdominoplasty are described to define the indications, technique, course, and complications.A miniplasty corrects the limited deformity of lower abdominal musculofascial relaxation and regional fat deposition. It corrects the defect when suction alone is insufficient and a full abdominoplasty is too much. (C)1987American Society of Plastic Surgeons
Presented here is our experience with a new approach to abdominoplasty using a limited incision with liposuction. The indications and advantages of the proposed technique are discussed. The procedure was performed in 20 consecutive cases. The benefits of the procedure are the resultant natural contour of the abdominal wall and umbilicus, the maintenance of the mons pubis at its original site, and, most importantly, a limited scar.
Cosmetic surgery of the abdomen is requested frequently by patients and is being performed increasingly at the time of elective gynecologic surgery. However, little information is available regarding the safety of combining these procedures. In this study intraoperative and postoperative morbidity was compared in the following groups of patients: 1) abdominoplasty plus one of five common gynecologic procedures (N = 76); 2) one of the five gynecologic procedures alone, matched for age, weight, and time of operation (N = 76); and 3) abdominoplasty alone (N = 70). Patients in group 1 experienced significantly longer operative time, longer hospital stays, and greater blood loss, which required more transfusions than group 2 or 3. These problems were accentuated in patients who weighed more than 70 kg or were older than age 35. In addition, five patients (6.6%) in group 1 had a documented pulmonary embolus within 18 days of surgery, whereas no pulmonary emboli occurred in group 2 or 3. Because of the increased morbidity, careful patient selection is necessary when abdominoplasty and gynecologic procedures are performed at the same time.
Previous reports underestimate the morbidity of a lipectomy, having focused on mortality statistics. Alterations of respiratory kinetics leading to complications do not always correlate with the usual signs and symptoms of respiratory failure. Patients at increased risk, namely, those with obesity, a smoking history, or lung disease, deserve special attention, including appropriate pulmonary function studies in the preoperative and postoperative phase. The following studies are indicated in the preoperative assessment of the high-risk patient: (1) vital capacity, (2) arterial blood gases, and (3) chest radiograph.
The authors register a revision of the literature regarding the types of low transversal pubic incisions used in abdominoplasty. Since 1987, the traditional open W-type incision changed to a new type called the bicycle handlebar. In this procedure, the pubic segment remains in a lower line at the level of the pubic hair, while the lateral limbs are in a high position. The anterior superior iliac spine is used as reference. Different types of procedures where the umbilical skin hole reaches the pubic incision are described and illustrated. This procedure is also used in secondary abdominoplasty. In all cases, the incision's new position should remain hidden under a bathing suit.
The use of liposuction began a trend toward less invasive abdominal contour surgery and resulted in a variety of techniques based on individual anatomy. An analysis of 170 patients was undertaken to determine which patients benefited from even less invasive techniques that evolved from these concepts. The selection criteria used were based on the physical examination of the skin, fat and muscle layers, and patients' goals, willingness to accept incisions, and tolerance for the recovery period. The options used for this new category of treatment were subtypes of the abdominolipoplasty system (type 1, suction-assisted lipectomy; type 2, miniabdominoplasty; type 3, modified abdominoplasty; type 4, full abdominoplasty) and included extended liposuction (type 1a); "open" miniabdominoplasty (type 2a); and endoscopically assisted or muscle access abdominoplasty (type 3a). Also included in this series were patients whose procedures were downstaged to a less extensive alternative and cases during which the abdominoplasty incision was used for access for another operation. All procedures resulted in smaller or fewer incisions. Results suggested that the current period (1991-present) is marked by less invasive treatment options, characterized by a preponderance of "closed" techniques (60% vs. 40%: 1986-1991). With the availability of technology to treat muscle and adipose tissue through inconspicuous incisions, judgment regarding the capability of the skin to recontour becomes the overriding physical factor in the decision-making process. The outcomes support the conclusion that minimal-access variations in abdominoplasty are appropriate alternatives, reflecting a philosophical alteration in the approach to patients.
Modern abdominoplasty techniques were developed in the 1960s. The advent of liposuction has reduced the need for classic abdominoplasty and allowed more aesthetic sculpting of the entire trunk. However, the combination of significant truncal liposuction and classic abdominoplasty is not recommended due to the increased risk of complications. Although the surgical principles of classic abdominoplasty certainly have stood the test of time, they are based on two theoretical assumptions that may be proved to be inaccurate. The first assumption is that wide direct undermining to costal margins is essential for abdominal flap advancement. In fact, discontinuous undermining allows effective loosening of the abdominal flap while preserving vascular perforators. The second inaccurate assumption is that with aging and weight fluctuations (including pregnancy), abdominal skin relaxation occurs primarily in the vertical direction from the xiphoid to the pubis. This is true in the lower abdomen, but in most patients a strong superficial fascial system adherence to the linea alba in the epigastrium limits vertical descent. Epigastric laxity frequently results from a progressive horizontal loosening due to relaxation of the tissue along the lateral trunk. Experience with the lower-body lift procedure has shown that significant lateral truncal skin resection results in epigastric tightening. In these patients, the ideal abdominoplasty pattern would resect as much or more laterally than centrally, leading to more natural abdominal contours. Fifty patients who underwent high-lateral-tension abdominoplasty with and without significant truncal liposuction and other aesthetic procedures were followed for 4 to 16 months. The primary indication for surgery was moderate to severe laxity of abdominal skin and muscle with or without truncal fat deposits. Complication rates were equal to or less than those of historical controls and did not increase with significant adjunctive liposuction. The key technical elements of this procedure include direct undermining limited to the paramedian area, discontinuous undermining to costal margins and flanks as needed, skin resection pattern with significant lateral resection and highest-tension wound closure placed laterally, superficial fascial system repair with permanent sutures along the entire incision, and liberal use of adjunctive liposuction in the upper abdomen and the lateral and posterior trunk.
The safety and locations for liposuction over the aesthetic unit of the abdomen in situations where a full (type IV) abdominoplasty was combined with liposuction were studied. The locations were determined based on the axial- and random-pattern blood supplies of the anterior abdominal wall. By using these areas and technical guidelines to enhance success, the combined procedures were undertaken in a consecutive series of patients. The efficacy of the procedures was assessed by patient acceptance and by the difference in the incidence of complications from an abdominoplasty alone group. The complication rates of the two groups were found to be similar, although it was ascertained that medically higher-risk situations, smoke exposure, and disregard for interacting vascular territories were detrimental to combined surgery. In addition, four suction areas (SA 1-4) were delineated, and the results suggested that certain areas are more reliable than others, that each suction area interacts with and affects neighboring areas, and that these are germane in preoperative planning. A risk-profile classification was established, and this proved beneficial for initial patient screening.
The techniques of umbilical stalk separation, closure of the umbilical site in the midline, and short upturned incision lines define the operation described as limited abdominoplasty. The operation has evolved over the past 17 years into a procedure which is applicable in the majority of patients who have suffered distortion of the entire abdominal wall, with panniculus formation and fatty deposition. The use of liposuction is an essential part of "limited" abdominoplasty and of "complete" abdominoplasty. To protect the flap, techniques once applied only in the lesser procedures are now used for patients requiring a repair of the abdominal wall from the xiphoid to the pubis. These techniques also include advancement of the incision line to the "French line" position for aesthetic reasons. A description of the technical maneuvers required as well as the objectives for correction of the deformity in patients of all abdominoplasty types is presented. Patient selection is no longer an absolute criterion for the type of abdominoplasty repair that is selected.
Abdominoplasty is a common procedure in plastic surgery. Reviewing 150 patients who underwent abdominoplasty, it has been observed that 72% of the patients already had an abdominal scar. How to deal with abdominoplasty in an abdomen with a previous scar is discussed in this article.
In tumescent liposuction, large volumes of dilute lidocaine and epinephrine are infused subcutaneously to prepare fat for extraction. Reported cardiopulmonary complications of tumescent liposuction have been few, and the anesthetic and hemodynamic advantages are several. We report an instance of pulmonary edema in a healthy 55-year-old male body-builder who received 7900 cc subcutaneous and 2200 cc intravenous fluid. With normal cardiopulmonary and renal function, the patient responded promptly to intravenous diuretics without sequelae. Out of over 900 patients who have had tumescent liposuction with up to 15 liters infused parenterally, this is the first case of pulmonary edema.
Forty-two female patients underwent liposuction of large volumes and extensive abdominoplasty during an 18-month period, with an average follow-up period of 9 months. Fifty-two percent of the patients underwent a third surgical procedure, which was basically aesthetic. The average age was 40 years; weight varied between 51 kg and 113 kg, with only 11 percent of the patients at their ideal weight. The tumescent technique was used for performing liposuction, which was done on the loins, trochanters, lumbar, upper scapular, and upper lateral abdominal regions, avoiding liposuction of the abdominal flap in all cases except for one. The abdominoplasty was extensive with detachment to the xiphoid process without detaching liposuctioned areas. Volumes of 1600 ml to 11,200 ml were obtained through liposuction, with an average of 4230 cc, and minimal blood loss. Fatty dermal tissue was removed through abdominoplasty and it varied between 400 g and 5000 g with an average of 1300 g. Only the two heaviest patients required an autologous blood unit, because they underwent breast reduction at the same time. All the other patients were managed exclusively with intravenous crystalloids solutions. No major complications arose, and only five patients had minor complications. Based on these results, we consider it to be feasible to combine the liposuctioning of large volumes with abdominoplasty to improve body shape, even with the addition of a third surgical procedure. Nevertheless, it is essential to use the tumescent technique for liposuction to reduce bleeding to a minimum and to allow us to perform other procedures.
During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.
Troubling reports of adverse outcomes after liposuction prompted a census survey of aesthetic plastic surgeons. All 1200 actively practicing North American board-certified ASAPS members were polled by facsimile, then mail, regarding deaths after liposuction. Patient initials together with case summaries precluded data replication yet assured patient anonymity and preserved surgeon privacy. Incomplete returns or ambiguous findings were authenticated, where feasible, by direct follow-up. Total number of lipoplasties performed by plastic surgeons was interpolated from the ASPRS procedure database for the survey time frame of 1994 to mid-1998. Lacking reliable annual case volume estimates, deaths from lipoplasties performed by non-ABPS surgeons were excluded from the actual mortality rate computation but were included in cause-of-death ranking statistics. Responding aesthetic plastic surgeons (917 of 1200) reported 95 uniquely authenticated fatalities in 496,245 lipoplasties. In this census survey, the mortality rate computed to 1 in 5224, or 19.1 per 100,000. A virtually identical 20.3 per 100,000 mortality rate was obtained in a 1997 random survey commissioned by the parent society. Pulmonary thromboembolism remains as the major killer (23.4+/-2.6 percent); lacking consistent medical examiners' toxicology data, the putative role of high-dose lidocaine cardiotoxicity could not be ascertained. Where so stated, many deaths occurred during the first night after discharge home; prudence suggests vigilant observation for residual "hangover" from sedative/anesthetic drugs after lengthy procedures. Taken together, these two independent surveys peg the late 1990s mortality rate from liposuction at about 20 per 100,000, or 1 in every 5000 procedures. Set beside the 16.4 per 100,000 fatality rates of U.S. motor vehicle accidents, liposuction is not an altogether benign procedure. We do not have comparable mortality data for lipoplasties performed by non-ABPS-certified physicians.
A total of 101 consecutive abdominoplasty patients were reviewed retrospectively. Of these, 14 male (mean age at time of operation, 34.3 years; range, 23 to 53 years) and 72 female (mean age at time of operation, 38.9 years; range, 19 to 64 years) patients had adequate documentation for inclusion in this study. Complications were recorded as either wound complications (wound infection, partial wound dehiscence, seroma, hematoma, and skin edge necrosis) or complications after surgery (deep vein thrombosis, pulmonary emboli, ileus, sensibility disorder of the skin of the thighs, and death). The complications were subsequently correlated for sex, race, the patient's age at surgery, body mass index before surgery, and the seniority of the surgeon. Nine male patients (64.3 percent) and 11 female patients (15.3 percent) had wound complications. Almost 10 percent of our patients sustained an injury to the lateral cutaneous nerve of the thigh. Male patients should be informed about their possible higher risk of complications, and special attention must be given by the surgeon to the prevention of such complications.Moreover, specific attention must be given to the preservation of the lateral cutaneous nerves of the thigh in both male and female patients undergoing abdominoplasties.
Assessing the quality of care delivered in office-based outpatient surgery centers is difficult because formerly there was no central data collection system. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), in its ongoing effort to assess and improve patient care, has developed an Internet-based quality improvement and peer review program to analyze outcomes for surgery centers it accredits. Reporting is mandatory for all surgeons operating in AAAASF-accredited facilities. Each surgeon must report all unanticipated sequelae and at least six random cases reviewed by an accepted peer review group biannually. A total of 411,670 procedures were analyzed during a 2-year period (from 2001 to 2002). There were 2597 sequelae reported during this period. The most common sequela was hematoma formation following breast augmentation. Infection occurred in 388 cases. Deep vein thrombosis, pulmonary embolism, and intraoperative cardiac arrhythmias were found to occur in a frequency consistent with previous reports. Significant complications (hematoma, hypertensive episode, wound infection, sepsis, and hypotension) were infrequent. A total of 1378 significant sequelae were reported for 411,670 procedures. This calculates to one unanticipated sequela in 299 procedures (an incidence of 0.33 percent). Seven deaths were reported. A death occurred in one in 58,810 procedures (0.0017 percent). The overall risk of death was comparable whether the procedure was performed in an AAAASF-accredited office surgery facility or a hospital surgery facility. This study documents an excellent safety record for surgical procedures performed in accredited office surgery facilities by board-certified surgeons.
Anecdotally, plastic surgeons have complained of working harder for the same or less income in recent years. They also complain of falling fees for reconstructive surgery and increasing competition for cosmetic surgery. This study examined these notions using the best available data. To gain a better understanding of the current plastic surgery market, plastic surgeon incomes, fees, volume, and relative mix of cosmetic and reconstructive surgery were analyzed between the years 1992 and 2002. To gain a broader perspective, plastic surgeon income trends were then compared with those of other medical specialties and of nonmedical professions. The data show that in real dollars, plastic surgeon incomes have remained essentially steady in recent years, despite plastic surgeons increasing their surgery load by an average of 41 percent over the past 10 years. The overall income trend is similar to that of members of other medical specialties and other nonmedical professionals. The average practice percentage of cosmetic surgery was calculated and found to have increased from 27 percent in 1992 to 58 percent in 2002. This most likely can be explained by the findings that real dollar fees collected for cosmetic surgery have decreased very slightly, whereas those for reconstructive procedures have experienced sharp declines. This study demonstrates that plastic surgeons have adjusted their practice profiles in recent years. They have increased their case loads and shifted their practices toward cosmetic surgery, most likely with the goal of maintaining their incomes. The strategy appears to have been successful in the short term. However, with increasing competition and falling prices for cosmetic surgery, it may represent a temporary bulwark for plastic surgeon incomes unless other steps are taken.
Florida board proposes strict regulations on in-office surgical procedures
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Saul A. Florida board proposes strict regulations on in-office surgical procedures. Plast. Surg. News Feb. 1, 1999.
Howtodealwithabdominoplasty in an abdomen with a scar
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CardosodeCastro,C.,etal.Howtodealwithabdominoplasty in an abdomen with a scar. Aesthetic Plast. Surg. 17: 67, 1993
Abdominoplasty combined with gynecologic surgical procedures Fatal outcomes from liposuction: Census survey of cosmetic surgeons
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Voss, S. C., Sharp, H. C., and Scott, J. R. Abdominoplasty
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ASPRS Task Force report calls for scrutiny of lipoplasty training, large volume removals (society issues new briefing paper, news release)
American Society of Plastic and Reconstructive Surgeons.
ASPRS Task Force report calls for scrutiny of lipoplasty training, large volume removals (society issues new briefing paper, news release). Plast. Surg. News March 5, 1998.
Plastic and Reconstructive Surgery • May 2006