Abdominoplasty in the Obese Patient: Risk Versus Reward

Joseph Batac, M.D.; Malack Hamade, B.S.; Hassan Hamade, B.S.; Laurence Glickman, M.D., M.Sc.


Plast Reconstr Surg. 2019;143(4):721e-726e. 

In This Article

Abstract and Introduction


Background: The incidence of obesity is on the rise worldwide. Many surgeons elect not to perform abdominoplasty on patients with a high body mass index, fearing an increased risk of perioperative complications. In this study, the authors compare the outcomes of obese and nonobese patients who underwent abdominoplasty.

Methods: A retrospective chart analysis was performed on all patients who underwent abdominoplasty by a single surgeon from 2009 to 2016. Complication rates were compared in obese and nonobese patients. Patients were excluded if they did not undergo a full abdominoplasty, underwent a combined surgical procedure, or underwent liposuction in an area outside of the abdomen or flanks at the time of the abdominoplasty.

Results: A total of 83 patients were included: 62 nonobese and 21 obese patients. The obese group had a higher average body mass index (34. 9 kg/m2 versus 25.1 kg/m2; p < 0.001). Follow-up time was similar (310 days versus 265 days; p = 0.468). No significant differences were seen with regard to perioperative seroma formation (14.2 percent versus 22.5 percent; p = 0.419)), wound dehiscence (9.5 percent versus 11.29 percent; p= 0.822), hematoma formation (4.7 percent versus 1.6 percent; p = 0.438), or surgical-site infection (9.5 percent versus 8.0 percent; p = 0.835). No instances of venous thromboembolism were observed.

Conclusions: Abdominoplasty, with or without concurrent liposuction, in obese patients, is a safe and effective procedure with similar perioperative complication rates as the nonobese patient population. No significant differences were observed in perioperative complications.

Clinical Question/Level of Evidence: Risk, II.


Abdominoplasty is one of the top six cosmetic procedures performed in the United States.[1,2] Although abdominoplasty is widely performed, it carries the highest risk of complications among all cosmetic procedures.[3] Many surgeons choose to not perform abdominoplasty on patients who are obese, fearing that patients with a high body mass index are at increased risk for perioperative complications such as wound dehiscence, surgical-site infection, deep vein thrombosis or pulmonary embolism, and seroma.[3]

Although the impact of a high body mass index as an independent factor on abdominoplasty complications is unknown, comorbid conditions commonly associated with obesity, such as diabetes, hypercholesterolemia, hypertension, and ischemic heart disease, have been shown to increase complication rates.[4] Complications seen in these patients include bleeding, skin or fat necrosis, wound dehiscence, surgical-site infection, hematoma, pulmonary embolism, and seroma.[3,5] Seroma formation is the most common of these complications; however, the reported incidence rates range broadly from 5 to 38 percent.[4,6] Clinicians are divided as to whether performing abdominoplasty with liposuction increases the risk of seroma formation.[7] The senior author (J.B.) of this study previously reported seroma incidence rates of 31.2 and 16 percent in patients with and without liposuction, respectively.[8] In this study, we examined the influence of obesity on perioperative abdominoplasty complication rates.