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Abdominoplasty in patients with obesity

No increase in complications with abdominoplasty in patients with obesity

The findings help to alleviate concerns that patients with obesity are at higher risk of complications after abdominoplasty

Abdominoplasty can be safely performed in obese patients, with no increase in complications compared to non-obese patients, according to researchers from Long Island Plastic Surgical Group, Garden City, NY, USA. In this study, the authors compare the outcomes of obese and nonobese patients who underwent abdominoplasty. The findings help to alleviate concerns that patients with obesity are at higher risk of complications after abdominoplasty.

The paper, ‘Abdominoplasty in the Obese Patient: Risk versus Reward’, published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), included 82 patients who underwent abdominoplasty over a seven-year period. Twenty-one patients were classified as having obesity, based on an average BMI35. The remaining 62 patients were classified as non-obese (average BMI25).

"Abdominoplasty, with or without concurrent liposuction, in obese patients is a safe and effective procedure with similar perioperative complication rates as the non-obese patient population," writes ASPS Member Surgeon, Dr Laurence Glickman, and colleagues of Long Island Plastic Surgical Group, Garden City, NY.

The researchers performed a retrospective chart analysis on all patients who underwent abdominoplasty by a single surgeon from 2009 to 2016. Complication rates were compared in obese and nonobese patients. Patients were excluded if they did not undergo a full abdominoplasty, underwent a combined surgical procedure, or underwent liposuction in an area outside of the abdomen or flanks at the time of the abdominoplasty. Obese patients were more likely to have high blood pressure; otherwise, risk factors were similar between groups.

Complication rates were compared between groups, with an average follow-up time of close to one year. They reported that patients with obesity had a higher average BMI (34. 9 versus 25.1 p<0.001). Follow-up time was similar (310 days versus 265 days; p=0.468). There were no significant differences with regard to perioperative seroma formation (14.2 percent versus 22.5 percent; p=0.419)), wound dehiscence (9.5 percent versus 11.29 percent; p=0.822), haematoma formation (4.7 percent versus 1.6 percent; p=0.438) or surgical-site infection (9.5 percent versus 8.0 percent; p=0.835). There were no instances of venous thromboembolism observed.

Abdominoplasty is the fifth most common cosmetic procedures in the US, with nearly 130,000 procedures performed in 2017, according to ASPS statistics. Although widely performed, abdominoplasty carries the highest complication rate of all cosmetic procedures.

"Many surgeons elect not to perform abdominoplasty on patients with a high BMI, fearing an increased risk of perioperative complications," the authors wrote.

Most previous studies of abdominoplasty in high-BMI patients have focused on those who have undergone bariatric surgery (such as gastric bypass), who are at increased risk of complications.

The findings help to clarify the ‘risks and rewards’ of abdominoplasty in non-bariatric surgery patients with a BMI in the obese range.

"Our study results suggest that patients with a BMI greater than 30 in and of itself should not be viewed as a strict contraindication to abdominoplasty," they concluded. "Plastic surgeons should evaluate patients on a case-by-case basis and patients should be counselled as to the potential perioperative risks of this procedure."

They also emphasise the importance of discussing realistic postoperative goals with patients considering abdominoplasty.

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