What do you get when you add liposuction to tummy tuck? A better result with fewer complications. That’s according to the recent article “Prospective Clinical Study of 551 Cases of Liposuction and Abdominoplasty Performed Individually and in Combination” published this month in Plastic and Reconstructive Surgery-Global Open.
Despite the fact that liposuction and tummy tuck are often performed at the same time, few clinical studies have examined how safe and effective this combined procedure is. This is the second published study by author Eric Swanson, MD, a plastic surgeon based in Leawood, Kan., that systematically examines this hot topic. In his previous paper, Dr. Swanson concluded that patients who underwent liposuction alone or in combination with tummy tuck were satisfied with results and experienced a boost in self-esteem. In this more recent paper, he shows that not only do patients achieve excellent cosmetic results with the combined procedure, but specific approaches and techniques reduce complications and risk.
In this paper, Dr. Swanson examined 5 years of data collected from 551 patients who had a tummy tuck (17), ultrasonic liposuction (384), or tummy tuck plus liposuction (150). He compared the tummy tuck and liposuction groups with the combined lipoabdominoplasty group to determine how safety and effectiveness stacked up. Patients who received the combined treatment first had liposuction of the tummy and love handles followed by abdominoplasty. All abdominoplasties were performed using a scalpel for traditional flap dissection vs electrodissection. The reason, writes Dr. Swanson, it that “Electrodissection has long been recommended to reduce blood loss (before infusion of the abdomen with epinephrine solution was commonly performed) and is used by most plastic surgeons for flap dissection. However, cutting electrocautery produces an internal burn injury, with the usual pathophysiology of such an injury consisting of increased capillary permeability leading to fluid accumulation. Electrodissection causes more tissue destruction and seroma formation than scalpel dissection.”
Indeed, the biggest concern with the combined treatment is the development of seromas, which are collections of fluid under the skin.
According to Dr. Swanson, the low 5.4% seroma rate in his abdominoplasty and lipoabdominoplasty patients is a result of applying ultrasound in shorter bursts, using the scalpel instead of electrodissection, and by using epinephrine to reduce blood loss and eliminate the need for cautery.
“Some investigators report an increased risk of seromas in patients treated with simultaneous liposuction,” he writes. “Limiting epigastric ultrasound (<1 min) and liposuction times (<2 min) minimizes risk.”
No liposuction-alone patients experienced seromas.
Despite the positive findings, Dr. Swanson admits that there are some limitations to his study. He points out that his conclusions are based on lipoabdominoplasty using total IV anesthetic and infusion solutions, a superwet technique, the jackknife position and the wound closure techniques he describes in the paper.
To see this procedure performed, video is available in the “Related Videos” section of the full-text article on http://www.PRSGO.com.
Plastic and Reconstructive Surgery-Global Open is the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).
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