Medial Thighplasty in the Massive Weight Loss Population: Risk Factors and Complications in 106 Patients

Introduction: Despite the increasing popularity of the medial thighplasty for management of inner thigh skin redundancy in the massive weight loss population, there is little objective data regarding this procedure¹. We sought to describe thighplasty outcomes and safety at our institution.

Methods: A retrospective review was performed on data collected from a registry at the University of Pittsburgh over a 9-year period. Complications assessed included seroma, wound dehiscence, infection, hematoma, lymphedema, and VTE. Use of liposuction, co-morbidities and re-operation were also assessed.

Results: Fifty-two subjects (41 females and 11 males) underwent thighplasty with a mean age of 42.8±10.6 years, a mean maxBMI of 53.9±14.7kg/m², a mean currentBMI of 29.8kg/m²±5.5kg/m² and a mean deltaBMI of 24.3±10.8kg/m². Twenty-seven (52%) underwent full-length vertical thighplasty, nineteen (36%) underwent short scar incision thighplasty, and two (4%) underwent horizontal incision only. 37 (71%) had at least one complication. The wound dehiscence rate was 62%, the seroma rate was 23%, the infection rate was 15%, and the prolonged edema rate was 10%, with some patients developing more than one complication. Three subjects developed lymphedema requiring specialized care. Two patients required re-operation: one for a seroma and one for a sinus tract. One patient developed a DVT. There were no statistically significant correlations with co-morbidities (gender, BMI indices, smoking history, steroid use, diabetes, anemia, hypothyroidism, operative time, thighplasty type, and total number of concomitant procedures) and complications (p>0.05); however hypertension was suggestive of a relationship with prolonged edema (22% vs. 2.9%, p=0.05) and seroma formation (39% vs.15%, p=0.06). 35 (67%) underwent liposuction of the thigh at the time of their thighplasty with an average total aspirate of 1613 ± 1811cc. There was no significant difference in complication rates between patients who had undergone excisional thighplasty alone and those who had concomitant liposuction of the thigh (77% percent versus 59% percent, p> 0.05). 6 subjects (12%) underwent revision to optimize aesthetic results.

Conclusion: Thighplasty is a challenging procedure with a high rate of complications; most are minor and can be managed conservatively without operative intervention. Liposuction of the thigh may be safely performed around the area of planned excision, but larger studies are still warranted.