Managing Complications in Abdominoplasty: A Literature Review

Abstract

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.

Keywords: Abdominoplasty; Complications; Cosmetic techniques; Lipectomy; Reconstructive surgical procedure; Surgery, plastic.

Fig. 1.. Drainage of a postoperative seroma

Twenty millilitres of serohaematic fluid was aspirated 3 weeks after a lipoabdominoplasty.

Fig. 2.. Infected seroma in a 2-week-old lipoabdominoplasty patient

(A-C) Cellulitis caused by an infected seroma 2 weeks postoperatively. Eighty millilitres of purulent fluid was obtained.

Fig. 3.. Erythematous desquamating plaque around the umbilicus

Although allergic contact dermatitis was suspected, cultures proved an infection by Enterococcus faecalis. It resolved after 2 weeks of antibiotic treatment with ciprofloxacin.

Fig. 4.. Surgical debridement of an infected seroma

(A, B) Preoperative and intraoperative photographs of a 51-year-old female patient who, 1 week after undergoing an abdominoplasty, presented with fever and systemic compromise, erythema in the lower abdomen, and suppuration through the umbilicus incision. She was admitted for antibiotic treatment and surgical debridement. (A) Preoperative photograph; erythema and epidermolysis are noted. (B, C) Intraoperative photographs before (B) and after (C) debridement below the abdominal flap

Fig. 5.. Epidermolysis 10 days after a mini-abdominoplasty

Fig. 6.. Abdominal flap necrosis

(A, B) Preoperative photographs of a 64-year-old patient before undergoing an abdominoplasty. (C) Necrotic plaque in the lower end of the abdominal flap 2 weeks after abdominoplasty. (D) Abdominal wound after debridement, 3 weeks after the operation and before starting negative pressure wound therapy (NPWT). (E) The same wound after 2 weeks of NPWT; abundant granulation tissue can be appreciated. (F, G, and H) Postoperative photographs, 3 months after the initial abdominoplasty and 1 month after primary closure of the abdominal wound.

Fig. 7.. Puncture attempt of a late-onset haematoma

Fig. 8.. Hypertrophic scarring 2 months postoperative

Fig. 9.. Secondary abdominoplasty

(A, B) Preoperative photographs of a 61-year-old female patient with a previous history of diabetes and tobacco consumption who had undergone an abdominoplasty eight years before. (C, D) Postoperative photographs 3 months after a secondary abdominoplasty. The patient chose a scar in a cephalic position rather than a vertical scar caused by repositioning the umbilicus.

Fig. 10.. Non-complicated abdominoplasty case

(A–F) Preoperative and 3-month postoperative photographs of a 41-year-old post-bariatric female patient who underwent a lipoabdominoplasty with a simultaneous augmentation mastopexy with silicone implants.