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

Background: Combined liposuction and abdominoplasty is a common procedure but is controversial due to concerns for increased complications, and potential for disruption of the vasculature of the abdominoplasty flap (1). Because of these concerns, the lipoaspirate volume in abdominoplasty has been a topic of regulatory concern with laws restricting liposuction volume to as little as 500 mL when done with an abdominoplasty. Objectives: This study aims to evaluate complication rates in abdominoplasty performed with and without abdominal liposuction, as well as evaluate the effect of lipoaspirate volumes on complications in abdominoplasty. Methods: Abdominoplasties and suction-assisted lipectomies of the trunk were identified in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. Multivariate regression models were used to determine the effect of liposuction in combination with abdominoplasty on complications compared to abdominoplasty alone, as well as to determine the effect of liposuction volume on complications. Results: 11,191 patients met inclusion criteria with 9,638 (86.1%) patients undergoing abdominoplasty with truncal liposuction and 1,553 (13.9%) patients undergoing abdominoplasty alone. Corresponding overall complication rates were 10.5% and 13.0%. Combined liposuction and abdominoplasty was independently associated with a reduced risk of both overall complications (p=0.046) and seroma (p=0.030) (Table 1). Of 1,611 patients with a recorded lipoaspirate volume, 140 (8.7%) patients experienced at least one post-operative complication. Given existing laws limiting liposuction volume to 500 or 1,000 mL in combination with abdominoplasty (2, 3), each of these thresholds were evaluated with no effect on complications. Surprisingly, increasing liposuction volume was not independently associated with an increased risk of any complication. Conclusions: Abdominoplasty in combination with truncal liposuction is a safe procedure with a lower rate of complications than abdominoplasty alone. Current regulations governing liposuction volumes in abdominoplasty are arbitrary and do not reflect valid thresholds for increased complications. In the hands of board certified plastic surgeons, trunk liposuction and abdominoplasty is safe, with no significant risk of increased morbidity from increasing liposuction volumes. Conflicts of Interest: None Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Ethical Approval: De-identified patient information is available to participant members of the American Society of Plastic Surgeon's (ASPS) Tracking Operations and Outcomes for Plastic Surgeons (TOPS) data registry. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996. Disclaimer: The ASPS and the surgeons participating in TOPS are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors of this study. Prior Presentations: American Association of Plastic Surgeons (AAPS) 96th Annual Meeting, Austin, Texas, March 2017. *Corresponding Author: Karol A. Gutowski, MD., Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Illinois, Chicago, IL, Email: Karol@DrGutowski.com, Telephone: (773)870-0732, Fax: (847)780-1188 ©2017American Society of Plastic Surgeons