Purpose:  Liposuction at the time of abdominoplasty is frequently performed for a wide variety of indications. While serving as a useful adjunct, considerable debate exists with respect to its effectiveness and possible contribution to post-operative complications.   Additionally, many abdominoplasties are performed with the use of tumescence alone, a practice with potentially unrealized benefits. The purpose of this abstract is to review a consecutive series of patients undergoing a cosmetic abdominoplasty, investigating the effect of synchronous liposuction and abdominoplasty, as well as the use of tumescence alone with abdominoplasty.

Methods:  A retrospective review was conducted of 1008 consecutive patients who underwent abdominoplasty over an eleven-year time period at a six-surgeon plastic surgery practice.  Data was collected detailing patient demographics, intraoperative interventions, and post-operative course. Patients were divided based on the performance of liposuction, anatomical area of liposuction (flanks or abdominal flap), and use of tumescence. Post-operative complications were divided into major or minor complications.

Results:  Of the 1008 patients, 555 underwent liposuction of the flanks while 469 underwent liposuction of the abdominal wall at the time of abdominoplasty. Liposuction of the flanks or abdominal flap (zone II) lead to an increase risk of total complications, minor complications, seroma formation and revisions (Table 1). Major complications were not affected. Three hundred forty-nine patients received tumescent without concurrent liposuction. Tumescent use  was associated with a significant decrease in hematoma, fat necrosis and minor complications (Table 2).

Conclusion:  Tumescence of the abdominal flaps serves a protective mechanism in reducing complications, namely hematoma and fat necrosis. The exact mechanism for this risk reduction remains unknown. However, because of the significant risk reduction we recommend tumescent without liposuction as an adjunct to abdominoplasty.  Liposuction places the patient at an increased risk for post-operative complications, and while minor, inevitably lead to higher revision rates with decreased patient satisfaction. Seroma rates are markedly increased as a result of disrupted lymphatic pathways in the abdominal flap.  Furthermore, flank liposuction may also lead to an increase in dead space and extensive disruption of laterally based lymphatic channels not typically associated with an abdominoplasty alone.  Surgeons should be aware of the potential complications of performing liposuction at the time of abdominoplasty and seek measures for complication reduction and improved patient selection.

Table 1. Outcomes of Concomitant Abdominal or Flank Liposuction

	Liposuction Abdomen	No Liposuction Abdomen	Liposuction Flanks	No Liposuction Flanks
Total Complications	40.1% (p=<0.001)	26.2%	30.4% (p=<0.001)	25.4%
Major Complications	26.8% (p=0.021)	18.2%	20.9% (p=0.013)	14.8%
Minor Complications	39.9% (p=<0.001)	25.0%	37.5% (p=<0.001)	25.2%
Revision Rate	42.6% (p=0.006)	30.2%	41.6% (p=<0.001)	29.1%
Infection	4.9% (p=0.185)	3.1%	1.3% (p=0.231)	2.4%
Hematoma	3.1% (p=0.551)	2.3%	4.0% (p=0.743)	3.5%
Seroma	19.0% (p=0.004)	12.2%	18.4% (p=0.004)	11.7%
Fat Necrosis	3.5% (p=0.103)	1.7%	3.2% (p=0.104)	1.5%

Table 2. Tumescent without Liposuction and Abdominoplasty Outcomes

	Tumescent	No Tumescent
Total Complications	28.7%	34.8%	p=0.048
Major Complications	15.2%	19.8%	p=0.086
Minor Complications	26.9%	34.7%	p=0.013
Hematoma	0.9%	3.5%	p=0.011
Seroma	12.3%	17.0%	p=0.54
Infection	1.3%	2.4%	p=0.999
Fat Necrosis	0.9%	3.3%	p=0.018