Aesthetic Surgery of the Thoracoabdominal Area Combining Abdominoplasty and Circumferential Lipoplasty: 7 Years?? Experience

Lipoabdominoplasty: What We Have Implemented and What We Have Modified over 26 Years

Lipoabdominoplasty is one of the most commonly performed procedures in body-contouring surgery. We present a retrospective study of our 26 years of experience to improve the results and assure the greatest possible safety in lipoabdominoplasty. We include all of our female patients who underwent lipoabdominoplasty performed from July 1996 to June 2022, dividing the patients into two groups: group I underwent circumferential liposuction avoiding abdominal flap liposuction for the first 7 years, and group II underwent circumferential liposuction including abdominal flap liposuction for the subsequent 19 years, pointing out the differences in the processes, results, and complications of both groups. Over a period of 26 years, 973 female patients underwent lipoabdominoplasty: 310 in group I and 663 in group II. Ages were very similar; however, weight, BMI, amount of liposuction material, and weight of the abdominal flap removed were higher in group I. Twenty percent of patients in group I were obese compared to 7% in group II. The average amount of liposuction in group I was 4990 mL compared to 3373 mL in group II and 1120 g of abdominal flap in group I versus 676 g in group II. Minor and major complications were 11.6% and 1.2% in group I versus 9.2% and 0.6% in group II, respectively. In our more than 26 years of performing lipoabdominoplasty, we have maintained most of our initial procedures. These processes have allowed us to perform surgery safely and effectively with a low morbidity rate.

The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis

BACKGROUND

Combining abdominoplasty with liposuction is a common practice for optimal patient aesthetic outcomes. In the past, several practitioners have argued against liposuction due to the potential for vascular insufficiency, especially with central liposuction. Despite these concerns for flap damage with resultant necrosis, the incidence of this complication has not been comprehensively investigated.

OBJECTIVES

The authors therefore examined the incidence of necrotic complications, including skin and fat necrosis as well as partial/total flap loss, in patients who underwent abdominoplasty alone (AA) or abdominoplasty with partial or circumferential liposuction (APCL).

METHODS

Literature searches were performed in PubMed/Medline and Embase with no query limits. For the systematic review, data from the studies were extracted into a form including primary author, publication year, study design, number of AA and APCL patients, abdominal zone(s) treated with liposuction, average lipoaspirate volume, follow-up time, necrotic complications, and revision procedures. A meta-analysis was separately performed for 13 studies that included patients who underwent both AA and APCL.

RESULTS

The overall rate of necrotic complications was lower in the APCL group (0.39%) compared with the AA group (1.01%). The incidence of necrotic complications was low for all patients, with a pooled partial flap loss rate of 0.24% and a pooled skin necrosis rate of 0.23%. The forest plots revealed that patients who underwent APCL do not face a higher risk of skin necrosis or revision compared with those who underwent AA.

CONCLUSIONS

Performing APCL is a safe combined procedural approach and can confer added benefits of improved patient satisfaction and aesthetic outcomes.

LEVEL OF EVIDENCE: 4

Liposuction infiltration: The Quito formula - a new approach based on an old concept

INTRODUCTION

Liposuction is a highly sought after surgical procedure. Despite its popularity, not all of the factors associated with its execution are well understood. No well-established guidelines exist for plastic surgeons regarding the subcutaneous infiltration of fluid and, thus, the procedure is often performed subjectively.

OBJECTIVE

To establish the usefulness of the Quito formula (infiltrate volume = weight [kg] × percentage of body surface to be liposuctioned × 2.4 [mL]) for calculating the volume of fluid to be infiltrated subcutaneously during small-volume liposuction performed under epidural anesthesia.

METHODS

A prospective study was conducted on a group of 50 patients who were candidates for liposuction on multiple body parts between November 2004 and February 2010.

RESULTS

The maximum volume of infiltrate was 5000 mL and the maximum volume of aspirate was 4500 mL, with a 30% total aspirated area. No patient required blood transfusion, and there were no major complications. However, one patient presented with a small local infection, another with a sacral seroma and two patients had postdural puncture headaches. No patient showed clinical signs consistent with overhydration, dehydration, pulmonary embolism, fat embolism or lidocaine intoxication.

CONCLUSIONS

When performing small-volume liposuction, subcutaneous infiltration using the Quito formula to calculate the volume of infiltrate proved to be useful, safe and objective.

SAFE circumferential liposuction with abdominoplasty

The SAFELipo technique allows for safe, consistent liposuction that does not damage flap blood supply and is easily taught to, and reproducible by, other surgeons. The fat separation used in the SAFELipo technique is performed without suction, which prevents suction avulsion injury to blood vessels by the cannula. Blood vessels then remain intact while free, separated fat is aspirated with small diameter cannulas.

A study of perfusion of the distal free-TRAM flap using laser Doppler flowmetry

The aim of this study was to characterise microcirculatory changes in the distal part of a flap and to evaluate whether measurement of the microcirculation may predict flap complications (FC). In this prospective study, 30 patients undergoing a delayed breast reconstruction were included. Perioperative data were recorded and with the laser Doppler flowmetry (LDF; Perimed) blood flow was recorded in the central part (zone I) and the distal part (zone IV) of the flap. A lower blood flow was observed in zone IV of patients with flap complications compared to patients without flap complications (P=0.013). In addition, LDF demonstrated different flow trends in zone I compared to zone IV indicating a delayed opening of the choke vessels connecting the angiosomes in the distal part of the flap. The LDF has proven to be a useful investigative tool to monitor microcirculatory changes. In future studies it will be used to evaluate interventions aimed at decreasing distal ischaemia and reducing flap complications.