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Is There a Limit? A Risk Assessment Model of Liposuction and Lipoaspirate Volume on Complications in Abdominoplasty

Vieira, Brittany L., B.S.; Chow, Ian, M.D.; Sinno, Sammy, M.D.; Dorfman, Robert G., M.Sc.; Hanwright, Philip, M.D.; Gutowski, Karol A., M.D.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 892-901
doi: 10.1097/PRS.0000000000004212
Cosmetic: Original Articles
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Background: Combining liposuction and abdominoplasty is controversial because of concerns for increased complications and potential for vascular compromise of the abdominoplasty flap. Also, the lipoaspirate volume in abdominoplasty is regulated in some areas to as little as 500 ml when performed with abdominoplasty. This study measures abdominoplasty complication rates when performed with and without trunk liposuction, and evaluates the effect of lipoaspirate volume on complications.

Methods: Abdominoplasty and liposuction of the trunk procedures were identified in the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models determined the effect of liposuction with abdominoplasty on complications compared with abdominoplasty alone and determined the effect of liposuction volume on complications.

Results: Eleven thousand one hundred ninety-one patients were identified: 9638 (86.1 percent) having abdominoplasty with truncal liposuction and 1553 (13.9 percent) having abdominoplasty alone. Overall complication rates were 10.5 percent and 13.0 percent, respectively. Combined liposuction and abdominoplasty was independently associated with a reduced risk of both overall complications (p = 0.046) and seroma (p = 0.030). Given existing laws limiting liposuction volume to 500 or 1000 ml in combination with abdominoplasty, each of these thresholds was evaluated, with no effect on complications. Surprisingly, increasing liposuction volume was not independently associated with an increased risk of any complication.

Conclusions: When done by board-certified plastic surgeons, abdominoplasty with truncal liposuction is safe, with fewer complications than abdominoplasty alone. Regulations governing liposuction volumes in abdominoplasty are arbitrary and do not reflect valid thresholds for increased complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Chicago, Ill.; and Baltimore, Md.

From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; private practice, TLKM Plastic Surgery; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Illinois; and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.

Deidentified patient information is available to participant members of the American Society of Plastic Surgeons Tracking Operations and Outcomes for Plastic Surgeons data registry. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996.

Received for publication April 2, 2017; accepted October 2, 2017.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, March 25 through 28, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Karol A. Gutowski, M.D., Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Illinois, 2300 Chestnut Avenue, Suite 100, Glenview, IL 60026, karol@drgutowski.com

Copyright © 2017 by the American Society of Plastic Surgeons