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

Synchronous pneumothorax and venous thromboembolism after body contouring surgery

INTRODUCTION

Lipoabdominoplasty is one of the most common abdominal body contouring procedures performed today; however, it carries the risk of significant complications. Pneumothorax is a rare complication of liposuction, while, venous thromboembolism has a low short-term mortality and long-term morbidity.

PRESENTATION OF CASE

A 57-year-old woman with a history of diabetes mellitus, hypertension, obesity, and severe COVID-19 three years earlier. The patient underwent 360-degree liposuction and abdominoplasty. In the immediate postoperative period, the patient developed a right pneumothorax and followed by deep vein thrombosis (DVT) and pulmonary embolism (PE), which were diagnosed and treated early. After six months of follow-up, the patient presented a complete recovery.

DISCUSSION

Pneumothorax is recognized as a rare complication of liposuction and has been limited to case reports and small case series in the medical literature with an incidence of 0.04 %. In plastic and aesthetic surgery, body contouring procedures such as lipoabdominoplasty are associated with a risk of DVT and PE of 0.2-0.6 %, and 0.3 %, respectively. In addition, we believe that performing combined aesthetic procedures may increase the risk of complications.

CONCLUSION

This is the first reported case of pneumothorax, DVT and PE after body contouring surgery. We highlight the importance of awareness of these complications and the need for a high index of suspicion for early diagnosis and treatment, which is critical for patient survival.

The effect of liposuction versus liposuction with abdominoplasty on insulin resistance in normoglycemic non-obese Mexican females: A prospective cohort study

INTRODUCTION

Several studies have evaluated the effect of liposuction or abdominoplasty on metabolic health, including insulin resistance, with mixed results. Many overweight patients, with no marked obesity, are recommended to undergo liposuction combined with abdominoplasty, but no study has evaluated the effectiveness of combining the two procedures on metabolic health.

METHODS

The present prospective cohort study compares the metabolic parameters of 2 groups of normoglycemic Hispanic women without obesity. The first group underwent liposuction only (LIPO), while the second group had combined liposuction and abdominoplasty (LIPO + ABDO).

RESULTS

A total of 31 patients were evaluated, including 13 in the LIPO group and 18 in the LIPO + ABDO group. The 2 groups had similar HOMA-IR before surgery (P > 0.72). When tested 60 days after surgery, women in the LIPO group had similar HOMA-IR compared to their preoperative levels (2.98 ± 0.4 vs 2.70 ± 0.3; P > .20). However, the LIPO+ABDO group showed significantly reduced HOMA-IR values compared to their preoperative levels (2.37 ± 0.2 vs 1.73 ± 0.1; P < .001). In this group, this decrease also positively correlated with their preoperative HOMA-IR (Spearman r = 0.72; P < .001) and, interestingly, we observed a negative correlation between the age of the subjects and the drop in HOMA-IR after surgery (Spearman r = -0.56; P < .05). No changes were observed in the other biochemical parameters that were assessed.

CONCLUSIONS

These data suggest that, when combined with abdominoplasty, liposuction does improve insulin resistance in healthy Hispanic females. More studies are warranted to address this possibility.

Decreasing Seroma Incidence Following Abdominoplasty: A Systematic Review and Meta-Analysis of High-Quality Evidence

Background

Seroma formation is the most common complication of abdominoplasties. Many preventive interventions have been proposed, but none have been recognized as a definitive solution, partly due to varying levels of evidence (LOE) in the literature.

Objectives

We aimed to analyze seroma prevention methods supported by high-level evidence.

Methods

The PubMed database was queried through August 2023. Primary articles of interest included randomized controlled trials (RCTs), prospective comparative studies, and meta-analyses of these studies. The LOE for each article was determined according to the American Society of Plastic Surgeons Rating Scale. The "seroma occurrence ratio," or ratio of seroma events in the interventional group to respective control group, was calculated to compare incidence rates between techniques.

Results

Twenty articles and 9 categories of techniques were analyzed. Study designs included 10 RCTs, 2 prospective cohort studies, 7 prospective comparative studies, and 1 retrospective randomized study. The use of progressive-tension and quilting sutures had the most data supporting a statistically significant reduction in seroma (occurrence ratio 0.306, P < .001). Tissue adhesives and preservation of Scarpa's fascia were also well reinforced (0.375, P < .01 and 0.229, P < .011, respectively), while increasing the number of drains was not (P = .7576). Meta-analysis demonstrated that compared with 2 drains alone, alternative techniques were more effective at reducing seroma occurrence (pooled risk ratio 0.33, 95% CI, 0.11-0.99).

Conclusions

This review highlights multiple seroma prevention techniques for abdominoplasty investigated in recent high-quality literature. We suggest future randomized comparative studies of the various seroma prevention methods to fully ascertain their efficacy following abdominoplasty.

Level of Evidence 1

Expanding Usage of Superior Pedicled Techniques with Reducing Resistance in the Pedicle by Lipoaspiration

BACKGROUND

Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area.

METHODS

The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale.

RESULTS

One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity.

CONCLUSION

Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lipoabdominoplasty: Comparing UAL Versus UAL/PAL Techniques on Complication Profile and Patient Safety

PURPOSE

This study intends to assess the complications and outcomes related to the use of UAL (LIPO SAVER, LHbiomed Co, Gangnam-gu, Korea) versus a combination of UAL and PAL (Microaire, Charlottesville, VA, USA) within the abdominoplasty procedure.

MATERIAL AND METHOD

A retrospective study used patient data and chart reviews in a single surgeon's private cosmetic practice. The study involved patients who underwent the lipoabdominoplasty technique with UAL and a combination of UAL and PAL (UAL/PAL) over 4 years from October 2017 through December 2022. A total of 280 patients (272 female, eight male) who underwent standard (n:258) or fleur-de-lis abdominoplasty (n:22) due to skin excess, musculofascial laxity, and lipodystrophy were included in the study. Patients with illnesses affecting microcirculation, such as diabetes mellitus type I and II, cardiopulmonary diseases, oral contraceptive usage, hereditary bleeding and thrombotic disorders, and those who had undergone revision abdominoplasties were excluded.

RESULTS

BMI above 30 kg/m2 was associated with an increased risk of both minor and major complications in the UAL abdominoplasty group (P = 0.005 and 0.001, respectively). On the other hand, BMI over 30 kg/m2 was associated with an increased risk of major complications in the UAL/PAL abdominoplasty group (P = 0.011). BMI over 30 kg/m2 was associated with an overall increased rate of minor and major complications in both the UAL and UAL/PAL groups (P = 0.001 and 0.001, respectively). There was no statistical difference between the UAL and UAL/PAL groups regarding complications, but a slight increase in the overall complication rate was observed in the UAL group (P = 0.061). Additionally, the study unveiled that there was no correlation found between age, gender, duration of surgery, lipoaspirate volumes and combined surgeries with an increased risk of complications between groups.

CONCLUSION

BMI over 30 kg/m2 has been shown to have an adverse effect on the profile of complications in both groups, resulting in an increased risk, especially for major and minor complications such as seroma in the UAL group.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database

BACKGROUND

Combining multiple surgical procedures into a single operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood.

OBJECTIVES

This study compared 30-day complication rates associated with combined plastic surgery procedures with the rates for index procedures.

METHODS

This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016 to 2020 to identify the 3 most frequent combinations of augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty.

RESULTS

The 30-day overall complication rate was 5.0% (1400 of 26,771 patients), with a higher complication rate for combined procedures compared with index (7.6% vs 4.2%, adjusted odd ratio [aOR], 1.91 [95% CI, 1.61-2.27], P < .001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared with index. Complication rates for reduction mammaplasty combinations compared with index were not statistically different after controlling for demographics (aOR, 1.02 [95% CI, 0.61-1.64], P = .93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR, 4.84 [95% CI, 3.31-7.21), P < .001) and augmentation mammaplasty (aOR, 1.60 [95% CI 1.13-2.22], P = .007) compared with index.

CONCLUSIONS

Combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared with index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision-making when recommending these combinations to patients.

LEVEL OF EVIDENCE: 4

[Increased risk of bleeding during abdominal dermolipectomies in men: Myth or reality?]

INTRODUCTION

Abdominoplasty is the most frequently performed procedure for the treatment of weight loss sequelaes. It carries risks of complications, especially in patients with multiple metabolic comorbidities. It is commonly accepted that the male population develops more postoperative complications, particularly haemorrhage, but there are very few studies showing this excessive morbidity. The aim of this study was to determine the increased risk of bleeding after anterior and circular abdominoplasty in men by comparing two series of 105 male and female patients.

MATERIALS AND METHODS

This is a retrospective, single-center study including 105 male subjects undergoing simple or circular abdominoplasty between 2013 and 2022. The control group was composed of 105 women screened on the same terms. The data collection focused on different pre-, intra-, and postoperative variables, with the occurrence of a hematoma or the need for a transfusion during follow-up as the primary outcome. The analysis was performed according to a univariate and multivariate models.

RESULTS

The rate of hematoma or transfusion, seroma, infection, amount of blood loss, and length of hospital stay were significantly greater in the male group. Multivariate analysis confirmed the independence of gender on the risk of developing a hematoma or requiring a transfusion.

CONCLUSION

This study shows the excess morbidity in men, particularly haemorrhage, after abdominoplasty. This underlines the importance of a rigorous haemostasis and follow-up in this at risk population.

The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis.

METHODS

In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I² index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2).

RESULTS

In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05).

CONCLUSIONS

This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Leveraging the Tracking Operations and Outcomes for Plastic Surgeons Database for Plastic Surgery Research: A "How-To" Guide

SUMMARY

The Plastic Surgeries Registry Network supported by the American Society of Plastic Surgeons (ASPS) and the Plastic Surgery Foundation offers a variety of options for procedural data and outcomes assessment and research. The Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database is a registry created for and used by active members of ASPS to monitor all types of procedural outcomes. It functions as a way for individual or group practices to follow surgical outcomes and constitutes a huge research registry available to ASPS members to access for registry-based projects. The TOPS registry was launched in 2002 and has undergone several iterations and improvements over the years and now includes more than 1 million procedure records. Although ASPS member surgeons have proven valuable assets in contributing their data to the TOPS registry, fewer have leveraged the database for registry-based research. This article overviews the authors' experience using the TOPS registry for a database research project to demonstrate the process, usefulness, and accessibility of TOPS data for ASPS member surgeons to conduct registry-based research. This article pairs with the report of the authors' TOPS registry investigation related to 30-day adverse events associated with incision location for augmentation mammaplasty.

Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database

BACKGROUND

Enhanced understanding of early postoperative adverse events will improve patient counseling and preoperative risk modification to decrease complications in implant-based breast augmentation. This study seeks to evaluate the early major adverse events following cosmetic breast augmentation.

METHODS

A retrospective cohort analysis of the Tracking Outcomes and Operations for Plastic Surgeons database was performed to identify any women undergoing augmentation mammaplasty with an implant between 2008 and 2016.

RESULTS

A total of 84,296 patients were studied. Major adverse events were identified in 0.37 percent. Seroma requiring drainage was observed in 0.08 percent, hematoma requiring drainage was observed in 0.15 percent, deep wound disruption was observed in 0.09 percent, and implant loss was observed in 0.11 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2 (relative risk, 2.05; p < 0.001), tobacco use (relative risk, 2.25; p < 0.001), and diabetes mellitus (relative risk, 1.8; p < 0.05). Use of a periareolar incision significantly increased the risk of developing an early postoperative complication (relative risk, 1.77; p < 0.001).

CONCLUSIONS

The findings of this study indicate an early major adverse event rate following cosmetic breast augmentation with implants of 0.37 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2, tobacco use, and diabetes mellitus. In addition, when controlling for other factors, periareolar incision significantly increased the risk for major adverse events, when compared to an inframammary incision.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction

BACKGROUND

The aesthetic and functional outcomes of the donor site following abdominal-based free flap breast reconstruction have been suboptimal. The objective of this study is to evaluate a modified liposuction-assisted abdominoplasty technique combined with rectus plication (LPARSP) adopted from cosmetic abdominoplasty practice.

PATIENTS AND METHODS

All abdominal-based free flap breast reconstructions from 01/2017 to 03/2019 were reviewed. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and body mass index with patients who underwent conventional abdominoplasty (CA group). Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed.

RESULTS

A total of 28 patients were included. Groups were similar in demographics. The mean amount of lipoaspirate in the LPARSP group was 1054±613.5 ml. The postoperative course was similar in both groups. The LPARSP technique resulted in a lower positioned horizontal scar (p = 0.03). The aesthetic outcome was superior in the LPARSP group (p < 0.0001). Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). In addition, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups.

CONCLUSIONS

Lipoabdominoplasty with rectus plication represents a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Superior functional and aesthetic results paired with improved abdominal wall sensation are achieved compared to CA.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

A New Surgical Approach to Body Contouring

BACKGROUND

The success of body contouring surgery will largely depend on the correct choice and performance of the technique, and utilization of the necessary scientific measures. Thus, this study sought to highlight the combination and evolution of the abdominoplasty-assisted liposuction technique, while individualizing each case for the patient's benefit.

METHOD

We present a series of 188 cases from the past 3 years (2017-2019), using our modification to the surgical technique: performing 360-degree liposuction first, and then abdominoplasty in the same surgical time. We show our aesthetic results, surgical time, and complications, so as to compare them with the literature.

RESULTS

Of the 188 cases, 184 were women (97.9%) and 4 were men (2.1%). In 11 cases (5.8%), we recorded 4 hours as a minimum surgical time and 8 hours in 16 cases (8.5%) as a maximum time. Regarding complications, hematomas were recorded in 1 case (0.5%) as the least frequent complication and seromas in 18 cases (9.6%) as the most frequent complication. The aesthetic results, although not objectively measurable, are flattering for both the patient and the surgeon, as shown by documented evidence (photographs) before and after surgery.

CONCLUSIONS

Our study supports favorable results. Modification of this technique has resulted in outstanding body contouring surgery. We hope this procedure can be reproduced because of its few complications and the pleasant results it yields.

A Comparison of Common Plastic Surgery Operations Using the NSQIP and TOPS Databases

Both the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and the American Society of Plastic Surgeons Tracking Operations and Outcomes for Plastic Surgeons (TOPS) databases track 30-day outcomes.

Methods

Using the 2008-2016 TOPS and NSQIP databases, we compared patient characteristics and postoperative outcomes for 5 common plastic surgery procedures. A weighted TOPS population was used to mirror the NSQIP population in clinical and demographic characteristics to compare postoperative outcomes.

Results

We identified 154,181 cases. Compared with NSQIP patients, TOPS patients were more likely to be younger (47.9 versus 50.0 years), have American Society of Anesthesiologists class I-II (92.1% versus 74.6%), be outpatient (66.0% versus 49.3%), and be smokers (18.7% versus 11.7%). TOPS had extensive missing data: body mass index (40.6%), American Society of Anesthesiologists class (34.9%), diabetes (39.3%), and smoking status (37.2%). NSQIP was missing <1% of all shared categories except race (15.6%). The entire TOPS cohort versus only TOPS patients without missing data had higher rates of dehiscence (5.1% versus 3.5%) and infection (2.1% versus 1.7%). TOPS versus NSQIP patients had higher dehiscence rates (5.1% versus 1.0%) but lower rates of return to the operating room (3.1% versus 6.6%), infection (2.1% versus 3.0%), and medical complications (0.3% versus 2.2%). Nonweighted and weighted TOPS cohorts had similar 30-day outcomes.

Conclusions

NSQIP and TOPS populations are different in characteristics and outcomes, likely due to differences in collection methodology and the types physicians using the databases. The strengths of each dataset can be used together for research and quality improvement.

Standards and Trends in Lipoabdominoplasty

BACKGROUND

Lipoabdominoplasty has evolved over the last 6 decades through contributions from numerous luminaries in plastic and reconstructive surgery.

METHODS

The authors review historical perspective and provide a contemporary examination of trends in lipoabdominoplasty.

RESULTS

In 1967, Pitanguy popularized abdominoplasty (without liposuction) as a technique for augmenting ventral hernias repairs and subsequently for aesthetic improvement of the abdomen. After the introduction of suction assisted lipectomy by Illouz in 1983, abdominoplasty became a central tool in a diverse armamentarium of anterior and lateral abdominal wall contouring procedures. Liposuction was initially utilized with mini-abdominoplasty in order to improve contour. Subsequently, Matarasso advanced the safe combination of liposuction with full abdominoplasty. Additionally, he systematized the variety of cutaneous undermining, excision, and liposuction procedures utilized in abdominal contouring as indicated by the degree of skin laxity and musculofascial diastasis. Lockwood advocated high lateral tension closure of the superficial fascial system of the abdomen to improve the contour of the hips and flanks. Saldanha advanced selective undermining and anterior abdominal wall perforator preservation to minimize wound healing and seroma complications associated with lipoabdominoplasty procedures.

CONCLUSION

In abdominal contour surgery, surgeons can rely on classic techniques and algorithms that have withstood the test of time while modifying their approaches with advances backed by compelling and rigorously obtained evidence.

Abdominoplasty with Combined Surgery

Abdominoplasty is the fifth most common cosmetic plastic surgery procedure performed in the United States and combining it with other procedures has become more the norm than the outlier. Liposuction is the most common adjunctive procedure, followed by breast surgery, lower back lift, and thigh lift, in addition to hernia repair and gynecologic procedures. The goal of these combination procedures includes creating more global aesthetic improvement while protecting patients from complications, based on consideration of confounding medical variables and increased risks presented by surgery of prolonged duration and exposure.

Nanofibrillar cellulose wound dressing supports the growth and characteristics of human mesenchymal stem/stromal cells without cell adhesion coatings

BACKGROUND

In the field of regenerative medicine, delivery of human adipose-derived mesenchymal stem/stromal cells (hASCs) has shown great promise to promote wound healing. However, a hostile environment of the injured tissue has shown considerably to limit the survival rate of the transplanted cells, and thus, to improve the cell survival and retention towards successful cell transplantation, an optimal cell scaffold is required. The objective of this study was to evaluate the potential use of wood-derived nanofibrillar cellulose (NFC) wound dressing as a cell scaffold material for hASCs in order to develop a cell transplantation method free from animal-derived components for wound treatment.

METHODS

Patient-derived hASCs were cultured on NFC wound dressing without cell adhesion coatings. Cell characteristics, including cell viability, morphology, cytoskeletal structure, proliferation potency, and mesenchymal cell and differentiation marker expression, were analyzed using cell viability assays, electron microscopy, immunocytochemistry, and quantitative or reverse transcriptase PCR. Student's t test and one-way ANOVA followed by a Tukey honestly significant difference post hoc test were used to determine statistical significance.

RESULTS

hASCs were able to adhere to NFC dressing and maintained high cell survival without cell adhesion coatings with a cell density-dependent manner for the studied period of 2 weeks. In addition, NFC dressing did not induce any remarkable cytotoxicity towards hASCs or alter the morphology, proliferation potency, filamentous actin structure, the expression of mesenchymal vimentin and extracellular matrix (ECM) proteins collagen I and fibronectin, or the undifferentiated state of hASCs.

CONCLUSIONS

As a result, NFC wound dressing offers a functional cell culture platform for hASCs to be used further for in vivo wound healing studies in the future.

Reshaping the Oversized Waist through Oblique Flankplasty with Lipoabdominoplasty

BACKGROUND

Designed in response to the failure of circumferential lower body lifts to deepen waists, oblique flankplasty with lipoabdominoplasty aesthetically reshapes not only the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity.

METHODS

The oblique flankplasty with lipoabdominoplasty technique was standardized, with 5 of 56 cases presented. Operative records on the lower torso from March of 2000 to January of 2018 yielded 30 initial oblique flankplasty with lipoabdominoplasty cases and hundreds of lower body lifts. A subset of randomly selected lower body lift and flank liposuction operations yielded 91 cases. Through SurveyMonkey, the authors and 16 unbiased observers graded flank and global deformity using the Pittsburgh Rating and novel posterior trunk aesthetics scales.

RESULTS

The oblique flankplasty with lipoabdominoplasty deepened and smoothly transitioned waists. Medial rotation of the lateral buttocks over the posterior iliac spine retained lateral fullness and established hip prominence. Central buttock laxity was corrected without intergluteal cleft lengthening. The immediate result persisted, satisfying high patient expectations. There were three minor complications and three nonexcisional revisions, with no unscheduled hospital admissions. The mean flank deformity for all cases was 1.93 was by chi-square analysis, which was significantly more than 0.88 for postoperative deformity (p < 0.001). Subgroup analysis of each procedure group showed a significant reduction in deformity. Comparing flankplasty with lower body lift, oblique flankplasty with lipoabdominoplasty had slightly greater flank deformity and far greater reduction in deformity and overall aesthetic improvement.

CONCLUSIONS

For grade 2 and 3 flank deformities, oblique flankplasty with lipoabdominoplasty provides a tighter skinned lower torso with gender-appropriate curvatures, including a deeper and more smoothly transitioned waist than lower body lift, leading to uniform patient satisfaction. There was minimal secondary deformity or complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Safety of Lipoabdominoplasty Versus Abdominoplasty: A Systematic Review and Meta-analysis

BACKGROUND

Lipoabdominoplasty is a powerful operation to maintain a youthful physique for aging people, improve body contouring, and remove excess skin caused by massive weight loss. Nonetheless, it is controversial to combine abdominoplasty and liposuction because of the potential for vascular damage of the abdominal flap and increased complications. The purpose of this article was to determine the complication rates of lipoabdominoplasty compared with traditional abdominoplasty.

METHODS

PubMed, EMBASE, and Cochrane databases were searched through July of 2018. Study results were analyzed utilizing a fixed random effects model. The outcomes were expressed as relative risk (RR) and 95% confidence interval. Subgroup analyses were conducted based on complications.

RESULTS

Overall, 17 trials enrolling 14,061 adult patients were searched. Of these patients, 577 (4.1%) developed seroma; 113 (0.8%) experienced hematoma; 783 (5.6%) experienced wound infection, dehiscence, or fat necrosis; 35 (0.2%) developed deep venous thrombosis; and 110 (0.7%) experienced scar deformity. A forest plot revealed fewer complications in the lipoabdominoplasty group than in the traditional abdominoplasty group (RR = 0.85; 95% CI 0.74-0.97; p = 0.017). Subgroup analysis showed that the lipoabdominoplasty group had a lower incidence of hematoma (RR = 0.56; 95% CI 0.36-0.86; p = 0.009) and seroma (RR = 0.69; 95% CI 0.57-0.85; p = 0.000).

CONCLUSIONS

Lipoabdominoplasty is a valuable tool to perfect body shape. This meta-analysis showed no evidence that it was associated with higher rates of complications.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improving Abdominal Plastic Scars with a Dietary Supplement-A Comparative Study

Introduction:

Massive weight loss following bariatric surgery has a major functional and aesthetic impact on patients. Many patients are nonetheless reluctant to undergo plastic surgery in connection with their former obesity because they fear potentially large scars, even though such scars are not visible (ie, they are covered by undergarments).

Purpose:

The aim of this study was to evaluate the quality of wound healing in patients receiving Celergen supplementation following abdominoplasty, compared with a control group. The hypothesis was that supplementation would speed up wound healing and improve scar quality.

Materials and Methods:

We conducted a prospective, monocentric, controlled study of patients undergoing abdominoplasty. A group of patients received Celergen, a food supplement, for 3 months and were monitored for 1 year after their surgery.

Results:

Of 33 patients who underwent abdominoplasty, 25 received Celergen supplements. There was no significant difference between the 2 groups. The mean time to wound healing was significantly better in the group receiving supplementation compared with the control group [respectively, 24.6 ± 9.31 days and 34 ± 13.48 days (P = 0.03)]. The Patient and Observer Scar Assessment Scale (POSAS) observer score was significantly better at 1 year in the group receiving supplementation compared with the control group [12.68 ± 6.6 and 17.38 ± 5.24 (P = 0.01), respectively]. There was no significant difference in the total POSAS score at 1 year (P = 0.166).

Conclusion:

Celergen supplementation significantly improved the time to healing and the POSAS observer score at 1 year for patients undergoing abdominoplasty.