Purpose: Abdominal plastic surgery procedures are commonly requested by patients undergoing intra-abdominal surgery. Although motivated by the desire to avoid a second anesthetic and minimize recovery time and cost, patient wishes must be balanced against a potential increased risk of complications. This retrospective case series examines two surgeon's six year experience with 114 patients undergoing 1) abdominal plastic surgery procedures performed in conjunction with either gynecologic or general surgery operations 2) abdominoplasty in conjunction with other cosmetic plastic surgery procedures and 3) patients undergoing abdominoplasty alone. This retrospective series was designed to assess our complication rates in procedures combining abdominal plastic surgery and intra-abdominal surgery as well as how these complication rates compared to standard plastic surgery procedures.

Materials and Methods: All 114 plastic surgery procedures were performed by the two senior authors between February 2001 and February 2007. Group 1 consisted of patients undergoing abdominoplasty in conjunction with either gynecologic or general surgery procedures, Group 2 consisted of patients undergoing abdominoplasty in conjunction with other cosmetic plastic surgery procedures, and Group 3 consisted of patients undergoing abdominoplasty alone. The groups were assessed for complication rates (both the presence of complication as well as subdivided into major and minor) as well as variables thought to be associated with increased complication rates such as BMI, tobacco use, and ASA status.

Results: Group 1 consisted of 49 patients (43 female, 6 male, mean age 46 ± 9 years, BMI 31 ± 8, ASA 1.8 ± .6 Group 2 consisted of 21 patients (19 female, 2 male, mean. age 43 ± 11 years, BMI 27 ± 5, ASA 1.4 ± .6), and Group 3 consisted of 44 patients (44 female, 0 males, mean age 44 ± 11years, BMI 28 ± 7, ASA 1.5 ± .7). 73 procedures were performed on an inpatient basis (46 from Group 1, 9 from Group 2, and 14 from Group 3), and 41 procedures were performed on an outpatient basis (3 from Group 1, 12 from Group 2, and 30 from Group 3). A total of 20 complications (2 major, 18 minor) were identified. 15 complications (all minor) occurred in the first group, 3 complications (2 major, 1 minor) occurred in the second group, and 2 complications (both minor) occurred in the third group. Major complications included a secondary surgical procedure for revision liposuction and fat grafting in one patient, and a revision liposuction secondary to mechanical failure of the liposuction machine in the second patient. There was a statistically significant increase in the overall complication rate of patients in group 1 as compared to groups 2 and 3 (p=.004), as well as a statistically significant increased risk of complications in patients with a BMI > 30 (p=.011) regardless of group. In addition, males had a statistically significant higher incidence of complications (p<.001). ASA status and tobacco use were not associated with an increased risk of complications.

Conclusion: Although the results of this study suggest that combining abdominoplasty with general or gynecological surgery increases the overall complication rate, the complications were self-limited and treated with either minor office procedures under local anesthesia or local wound care. In addition, this study supports a higher complication rate in obese patients. With appropriate patient selection and pre-operative counseling, combined abdominal plastic surgery and intra-abdominal operations may be performed safely.
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