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Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures

Winocour, Julian M.D.; Gupta, Varun M.D.; Ramirez, J. Roberto M.D.; Shack, R. Bruce M.D.; Grotting, James C. M.D.; Higdon, K. Kye M.D.

Plastic and Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 597e–606e
doi: 10.1097/PRS.0000000000001700
Cosmetic: Original Articles
Press Release

Background: Among aesthetic surgery procedures, abdominoplasty is associated with a higher complication rate, but previous studies are limited by small sample sizes or single-institution experience.

Methods: A cohort of patients who underwent abdominoplasty between 2008 and 2013 was identified from the CosmetAssure database. Major complications were recorded. Univariate and multivariate analysis was performed evaluating risk factors, including age, smoking, body mass index, sex, diabetes, type of surgical facility, and combined procedures.

Results: The authors identified 25,478 abdominoplasties from 183,914 procedures in the database. Of these, 8,975 patients had abdominoplasty alone and 16,503 underwent additional procedures. The number of complications recorded was 1,012 (4.0 percent overall rate versus 1.4 percent in other aesthetic surgery procedures). Of these, 31.5 percent were hematomas, 27.2 percent were infections and 20.2 percent were suspected or confirmed venous thromboembolism. On multivariate analysis, significant risk factors (p < 0.05) included male sex (relative risk, 1.8), age 55 years or older (1.4), body mass index greater than or equal to 30 (1.3), multiple procedures (1.5), and procedure performance in a hospital or surgical center versus office-based surgical suite (1.6). Combined procedures increased the risk of complication (abdominoplasty alone, 3.1 percent; with liposuction, 3.8 percent; breast procedure, 4.3 percent; liposuction and breast procedure, 4.6 percent; body-contouring procedure, 6.8 percent; liposuction and body-contouring procedure, 10.4 percent).

Conclusions: Abdominoplasty is associated with a higher complication rate compared with other aesthetic procedures. Combined procedures can significantly increase complication rates and should be considered carefully in higher risk patients.


Nashville, Tenn.; and Birmingham, Ala.

From the Department of Plastic Surgery, Vanderbilt University; and the Department of Plastic Surgery, University of Alabama.

Received for publication January 16, 2015; accepted April 24, 2015.

Presented at Plastic Surgery The Meeting 2014: American Society of Plastic Surgeons Annual Meeting, in Chicago, Illinois, October 10 through 14, 2014.

Disclosure: Dr. Grotting is a founder and shareholder of CosmetAssure. He is an author for Quality Medical Publishing and Elsevier. He is a shareholder of Keller Medical and Ideal Implant. None of the other authors have a financial interest in any of the products or devices mentioned in this article. No funding was required for this project.

Julian Winocour, M.D., Department of Plastic Surgery, D-4207 Medical Center North, Nashville, Tenn. 37232-2345,

©2015American Society of Plastic Surgeons