St. Louis — Researchers looking at the safety of very large volume liposuction (VLVL) report that the frequency and severity of complications increases at an aspirate volume of 17 L and more.
"Basically when you get up in the 25-plus liter category, you are very likely to have to transfuse someone," says study author and plastic surgeon V. Leroy Young, M.D., who practices here.
According to Dr. Young, an alarming number of national deaths several years ago from liposuction resulted in surgeons forming the general consensus that patients having 5 L or more of aspirate removed should remain hospitalized overnight for observation and monitoring. But the question remained about how much liposuction was safe."We looked previously at whether the removal of large amounts of subcutaneous fat affected the insulin resistance and cardiovascular risk factors associated with obesity and showed it did not. This was an outgrowth of that study, looking at when complications might increase with these very large procedures," Dr. Young says.
VLVL patient study
The researchers arbitrarily defined VLVL as aspiration of more than 10 L in a single surgery.
They studied 45 patients at their St. Louis plastic surgery practice who the researchers identified as having VLVL since 2001. They analyzed the following: each patient's age, body mass index (BMI), surgery time, infiltration fluid in and aspirate volume out, pre- and postoperative hemoglobin and hematocrit values, need for blood transfusion, number of days hospitalized, nadir operative temperature and smoking history. They divided patients into three groups, according to aspirate volume: Group 1 10 to 14.9 L; group 2 15 to 19.9 L; and group 3 20 L and more.
VLVL study results
According to the abstract, BMI rises with group aspirate volume — group three had the highest average BMI at 43.7.
While all VLVL patients spent at least one night postoperatively in the hospital, the majority of patients in group one stayed one night versus the majority of patients staying two or three nights in group two and spending three nights (with one spending four nights) in the hospital in group three.
The difference between preoperative versus postoperative hemoglobin values did not correlate with volume aspirated, according to the study. Blood transfusions, however, were given without complication in 7 percent of group one, 27 percent of group two and 57 percent of group three.
Twenty-four percent of all the patients experienced seromas, with 22 percent in group one, 18 percent in group two and 43 percent in group three.
Serious complications, such as hematoma, were more likely to occur in groups two and three (at 45 and 43 percent respectively), versus 7 percent in group one. People with diabetes, who were more likely to be in group three than in groups one or two, experienced significantly more complications. The risk of hypothermia rose with group aspirate volume. Sixty-three percent in group one experienced hypothermia versus 100 percent in group three.
"We showed that you can do large volume liposuction — we did up to 37 L in one woman — but you have to be prepared to manage the patient for blood loss and hypothermia. You have to do everything you can to prevent hypothermia because when patients become hypothermic the complications, particularly infection, go up.
"Another important pearl is to focus on fluid management," Dr. Young says. "Overall, there are complications with large volume cases, but we found them to be manageable."
Dr. Young says his practice does a lot of large volume liposuction in patients who have had gastric bypass and gastric banding procedures. Many of these patients do not achieve ideal body-mass indexes post surgery, and they often do not lose weight uniformly, so they might need debulking in preparation for excisional procedures, such as a brachioplasty.
Dr. Young and his partners still abide by the 5 L cutoff for keeping liposuction patients overnight, but he says that with this latest knowledge, he and his colleagues are willing to do much larger volumes, assuming the patient is willing to assume the risks. CST
Disclosure: Dr. Young reports no disclosures relating to this article.