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Retrospective Analysis of Predictive Factors for Complications in Abdominoplasty in Massive Weight Loss Patients

  • Original Article
  • Body Contouring
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Abstract

Introduction

Ex-obese patients present with redundancy of abdominal skin and soft tissue due to massive weight loss (MWL). The plastic surgeon can restore the body shape through body contouring procedures. Hence the need to adequately direct patients to body contouring by identifying suitable candidates exists. Our work aims to retrospectively analyze the abdominoplasty complications in our case series to identify associated risk factors and evaluate the effect of combined procedures on abdominoplasty outcomes.

Materials and Methods

We retrospectively investigated predictive factors of abdominoplasty procedure complications on 213 MWL patients who received abdominoplasty with and without rectus sheath plication, abdominal liposuction, and other body contouring procedures. We identified risk and protective factors with univariate and multivariate regression analysis. Furthermore, we assessed the impact of additional procedures on the complication rates.

Results

The overall complication rate was 49.8% (26.8% minor complications; 23% major complications). The delayed wound healing rate was 27.7%, and the revision surgery rate was 25.8% (14.7% early revision; 14.2% late revision). These results were compared with literature reports. Several negative predictors emerged as non-modifiable (advanced age, diabetes mellitus, surgical mode of weight loss) or modifiable (preoperative obesity and body mass index (BMI); active smoking; preoperative anemia; use of fibrin glue or quilting sutures). Performing rectus sheath plication improved most of the outcomes. Liposuction of hypochondriac regions and flanks led to increased safety and reduced the risk of surgical dehiscence and delayed wound healing, in contrast to epimesogastric liposuction. The other combined body contouring procedures did not worsen the outcomes, except for poor scarring.

Conclusion

Our findings encourage us to continue associating rectus sheath plication, liposuction, and other body contouring surgeries with abdominoplasty. We emphasize the importance of proper patient selection, particularly with regard to anemia, before body contouring surgery in the interests of offering safe surgery and satisfactory results. Further studies are needed to investigate how the optimal BMI cut-off and abstinence from smoking (in terms of time) before surgery reduce postoperative complications.

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 https://www.springer.com/journal/00266.

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Funding

The authors received no funding or financial support for the research of this article.

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Authors and Affiliations

  1. Plastic and Reconstructive Surgery Unit, Treviso General Hospital, Treviso, Italy

    Paolo Marchica

  2. Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Via Nicolò Giustiniani, 2, 35128, Padua, PD, Italy

    Alfio Luca Costa, Tito Brambullo, Giuseppe Masciopinto, Caterina Gardener, Martina Grigatti, Franco Bassetto & Vincenzo Vindigni

  3. Department of Psychiatry, Department of Neuroscience, Padua University Hospital, Via Nicolò Giustiniani, 2, 35128, Padua, Italy

    Massimo Marini

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  1. Paolo Marchica
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Marchica, P., Costa, A.L., Brambullo, T. et al. Retrospective Analysis of Predictive Factors for Complications in Abdominoplasty in Massive Weight Loss Patients. Aesth Plast Surg 47, 1447–1458 (2023). https://doi.org/10.1007/s00266-022-03235-5

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