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No increased risk in combo tx, study shows


Dr. Stevens
New Orleans — Adding lipoplasty to abdominoplasty does not increase patient morbidity compared to abdominoplasty alone, according to a retrospective study of more than 400 cases.

The study was developed in response to a temporary moratorium the Florida Medical Board placed on simultaneous abdominoplasty and liposuction when multiple deaths were reported following the combination procedure.

"The medical community tends to be cautious, and justifiably so, being as patient safety must be the number one concern of any surgeon," says the study's lead investigator, W. Grant Stevens, M.D., medical director of Marina Plastic Surgery Associates, Marina Del Rey, Calif., and a Cosmetic Surgery Times editorial adviser. "However, in the case of the Florida moratorium, the banning of liposuction combined with abdominoplasty represented a somewhat reflexive reaction to very unfortunate surgical deaths. The moratorium was difficult to back up from a scientific basis and was later appropriately removed," he says. "Many properly trained, board certified plastic surgeons perform abdominoplasty and liposuction in the same setting, and having performed hundreds of these combined cases, I decided to compile my experience to determine whether this is a reasonable and safe practice."

The series A total of 406 consecutive combination abdominoplasty/liposuction cases, all performed by Dr. Stevens at the Marina Outpatient Surgery Center, were reviewed. Cases were sorted into two groups: patients who had abdominoplasty only, and those who had abdominoplasty combined with simultaneous liposuction. The liposuction group was further subdivided into four groups based on the volumes of aspirate. Group A had <1,000 cc, group B had 1,000 to 3,000 cc, group C had >3,000 cc and group D had unquantified amounts of aspirate.

More than 95 percent of the patients were female, and the average patient age was 45 (ranging from 19 to 75). Minor complications assessed included seromas, hematomas, infections and small wound breakdowns. Major complications evaluated included large (>5 cm) flap necrosis, need for blood transfusion, deep vein thrombosis, pulmonary embolus, myocardial infarction and death. None of these major complications were seen in any of the 406 cases. Additionally, the amount and location of liposuction, age, body mass index (BMI) and surgery time of each patient were evaluated as a contributing factor to morbidity. Operating room time averaged 2.2 hours, and no case lasted more than six hours. Those cases lasting longer than three hours generally included abdominal, breast and facial surgery in one setting, according to Dr. Stevens.

"Essentially, what we found was that no statistically significant associations in complication rates were seen when liposuction (up to 5,000 cc aspirate) was added to abdominoplasty," he says. "Minor complication rates were consistent with those seen in the literature for abdominoplasty alone and were consistent across all the liposuction volume subgroups within our study."

The study was presented here at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS). Following the presentation, an informal poll showed that approximately 90 percent of the audience — most of whom were board certified plastic surgeons — use combined abdominoplasty and liposuction in their practices.

"This shows that our study was not looking at techniques 'on the fringe,' but was rather backing up the usual practices of a significant number of board-certified plastic surgeons," Dr. Stevens says.

Additional support An earlier retrospective study of morbidity in patients undergoing combined procedures (Aesthetic Surg J. 2004;24:4,314-317), led by Dr. Stevens, also showed that combined procedures are safe when performed with appropriate precautions by an experienced, board-certified plastic surgeon.

Dr. Stevens says that public pressure for combined procedures has been increasing due to the advantages of a single anesthesia and recovery period, as well as reduced surgical costs and more dramatic results.


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