Commentary on: The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis Free

Correcting anatomic changes in abdominal contour—skin flaccidity, accumulation of local fat, and diastasis of the rectus abdominis muscles—remain among the most frequently performed plastic surgery procedures.^1,2 The wide undermining required in traditional abdominoplasty has been replaced by the selective and conservative undermining of lipoabdominoplasty (LAP), which maintains the abdominal perforating vessels that emerge from the lower and upper epigastric arteries.³ This conservative approach has demonstrated the safety of multipedicled flaps, decreased morbidity, excellent results, and low complication rates, especially flap necrosis. Many studies, including this article, have investigated the issue of vessel maintenance and consequent reduction in flap necrosis.^4-10

Following its technical evolution, LAP has in the last 4 years incorporated the concept of anatomic lipodefinition, promoting a better and more natural appearance of the abdomen.^11-13 Regardless of the technology used, modern understanding and identification of each patient’s anatomy during preoperative marking is essential. Some areas are subjected to deep liposuction, others to a combination of superficial plus deep liopsuction of varying degrees of intensity, depending on the proximity of the perforators and the intention to define the musculature of the abdominal wall, promoting “negative” and “positive” areas, which express the natural curves of the abdomen.¹⁴

The technical and technological evolution of both liposuction and abdominoplasty has promoted better aesthetic results. Nevertheless safety aspects must be considered to make these important advances possible. Through a systematic review and meta-analysis, the authors of this article confirmed a lower rate of skin necrosis in LAP compared with isolated abdominoplasty. Based on a database of PubMed/Medline citations (in English and Spanish), they assessed the safety of LAP in relation to the incidence of skin and flap necrotic complications in a diverse population of patients and for various abdominal areas treated with liposuction. From 318 articles identified, 12 were selected that met the inclusion criteria of the meta-analysis, involving 12,388 patients; 8 of these studies were retrospective and 4 prospective. The authors compared the necrosis rates between abdominoplasty and LAP, finding rates of 1.01% and 0.37%, respectively. In the same sequence, the study showed surgical revision rates of 1.33% and 0.40%.

This article demonstrates interesting findings. First, LAP represented the significant majority of studies included in the paper, indicating that the combination of liposuction and abdominoplasty appears safer, with an overall necrotic complication rate of 0.37%. The complication rate of 1.01% with abdominoplasty alone represents a considerable decrease compared with the rates of 4% to 6% reported in the literature.^15,16 This result may suggest a change to a more conservative approach to flap undermining, even when traditional abdominoplasty is performed. There is a need to conduct new studies addressing this issue.

The association of liposuction with abdominoplasty is still a topic that generates much discussion.^17,18 Controversies are beneficial and represent a reality in plastic surgery. Despite this, there is a consensus that LAP has established a safety standard in the practice of these two established techniques—liposuction and abdominoplasty.^19-23

Based on the results of this review, abdominoplasty with concomitant liposuction has a lower overall rate of necrotic complications than abdominoplasty alone, highlighting the favorable surgical developments that have improved the safety profile of this combined procedure. In particular, the combination of liposuction with abdominoplasty has the potential to improve patient satisfaction, self-esteem, and quality of life. This meta-analysis may serve to produce new studies, researching necrotic complications and other postoperative complications in the future.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

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