Prospective clinical study of 551 cases of liposuction and abdominoplasty performed individually and in combination

Abstract

Background: Despite the popularity of these procedures, there are limited published prospective studies evaluating liposuction and abdominoplasty. Lipoabdominoplasty is a subject of recent attention. Several investigators have recommended alternative techniques that preserve the Scarpa fascia in an effort to reduce complications, particularly the risk of seromas.

Methods: Over a 5-year period, 551 consecutive patients were treated with ultrasonic liposuction alone (n = 384), liposuction/abdominoplasty (n = 150), or abdominoplasty alone (n = 17). In lipoabdominoplasties, the abdomen and flanks were first treated with liposuction. A traditional flap dissection was used for all abdominoplasties. Scalpel dissection was used rather than electrodissection. A supine "jackknife" position was used in surgery to provide maximum hip flexion, allowing a secure deep fascial repair.

Results: The complication rate after liposuction was 4.2% vs 50% for patients treated with an abdominoplasty. Approximately half of the abdominoplasty complications were minor scar deformities, including widened umbilical scars (17.3%) that were revised. The seroma rate after abdominoplasties was 5.4%; there were no seromas after liposuction alone.

Conclusions: Lipoabdominoplasty may be performed safely, so that patients may benefit from both modalities. The seroma rate is reduced by avoiding electrodissection, making Scarpa fascia preservation a moot point. A deep fascial repair keeps the abdominoplasty scar within the bikini line. Deep venous thrombosis and other complications may be minimized with precautions that do not include anticoagulation.

Fig. 1.

Illustration of liposuction treatment areas with the patient positioned on her left side. The patient starts supine and then is turned from the supine position (not shown) first onto the left side and then onto the right side to allow circumferential infusion of the anesthetic solution. The sequence is repeated for liposuction. Prone positioning is not used. In patients undergoing abdominoplasty, liposuction is performed first, followed by the abdominoplasty. (Illustration reprinted from Swanson E. Prospective clinical study reveals significant reduction in triglyceride level and white cell count after liposuction and abdominoplasty and no change in cholesterol levels. Plast Reconstr Surg. 2011;128:182e–197e.)

Video 1.

See video, Supplemental Digital Content 1, which demonstrates the superwet infusion and liposuction using side-to-side-to-supine body positioning. Prone positioning is not used, http://links.lww.com/PRSGO/A4.

Fig. 2.

Intraoperative photographs of a 40-year-old woman undergoing abdominoplasty. Liposuction of the abdomen and flanks has already been completed. A, A curved incision is made within the bikini line. B, The superior incision has been made. The resected tissue weighed 500 g. C, The medial borders of the rectus abdominis are marked. D, The superior flap is undermined only as far as necessary to allow wound closure. The diastasis has been repaired. E, Deep fascial closure has been completed, relieving skin tension. A single drain is used, exiting along the incision line. F, The umbilicus is brought out with a slight downward inclination. This patient also underwent bilateral augmentation/mastopexy and buttock fat injection.

Fig. 3.

Intraoperative photographs of a 34-year-old woman undergoing abdominoplasty. A, The operating table is flexed 80 degrees. B, A 2-0 Vicryl (Ethicon) suture is anchored to the deep fascia. C, The suture is passed through the Scarpa fascia of the abdominal flap. D, The deep fascial suture provides secure fixation and limits skin tension.

Video 2.

See video, Supplemental Digital Content 2, which demonstrates the abdominoplasty dissection and diastasis repair, http://links.lww.com/PRSGO/A5.

Video 3.

See video, Supplemental Digital Content 3, which demonstrates the jackknife positioning of the operating table, http://links.lww.com/PRSGO/A6.

Fig. 4.

This 28-year-old woman is seen before (A), 1 y (B), and 5 y (C) after an abdominoplasty and liposuction of the lower body. She also underwent augmentation/mastopexies. Photographs are matched for size and orientation. The resected tissue weighed 1000 g. The total liposuction aspirate volume was 2550 cm³. The scar shows no evidence of superior migration. There is no displacement of the mons pubis.

Fig. 5.

This 63-year-old woman is seen before (A) and 3 mo after (B) an abdominoplasty and liposuction of the lower body. Photographs are matched for size and orientation. The resected tissue weighed 2700 g. The total liposuction aspirate volume was 2950 cm³.

Fig. 6.

Example of published result of lipoabdominoplasty with limited undermining and preservation of the Scarpa fascia. The preoperative view (A) is matched for size and orientation to the postoperative view (B), allowing comparisons. The orientation of the mons pubis has been changed, which can be a benefit to such a woman with ptosis. However, the superior border of the mons pubis has been moved upward, extending the pubic hair on to the lower abdomen. The scar may be difficult to conceal in a bikini. Postoperatively, the umbilicus is positioned slightly higher, with an upward orientation. For calibration, a 34 cm width at the iliac crest level was used. (Saldanha OR, Federico R, Daher PF, et al. Lipoabdominoplasty. Plast Reconstr Surg. 2009;124:934–942.)

Video 4.

See video, Supplemental Digital Content 4, which demonstrates deep fascial anchoring, http://links.lww.com/PRSGO/A7.

Video 5.

See video, Supplemental Digital Content 5, which demonstrates wound closure, the umbilical repair, and 24-h follow-up, http://links.lww.com/PRSGO/A8.

Video 6.

See video, Liposuction, abdominoplasty, and medial thigh lifts. This video demonstrates a patient undergoing liposuction of the abdomen, flanks, and inner thighs, followed by an abdominoplasty and medial thigh lifts. It includes preoperative marking, the preparation of the patient, details of the total intravenous anesthetic and infusion solutions, body positioning including the jackknife position, and details of the wound closure including deep fascial anchoring sutures. A short segment on the medial thigh lifts is provided and the patient is also seen in follow-up 24 h after surgery. The full video is available in the “Related Videos” section of the full-text article on http://www.PRSGO.com.