Safety Comparison of Abdominoplasty and Brazilian Butt Lift

What the Literature Tells Us

Daniel A. Del Vecchio, M.D., M.B.A.; Simeon J. Wall, Jr., M.D.; Constantino G. Mendieta, M.D.; Alexander A. Aslani, M.D.; Alfredo E. Hoyos, M.D.; Patrick L. Mallucci, M.D.; Iain S. Whitaker, M.D.


Plast Reconstr Surg. 2021;148(6):1270-1277. 

In This Article

Abstract and Introduction


Background: Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures?

Methods: Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently.

Results: Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism—inherent circulatory thrombotic abnormality—BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000.

Conclusions: Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.


Abdominoplasty and Brazilian butt lift (BBL) are two popular operations in body contouring surgery. In contrast to growth-stable abdominoplasty rates in the United States and the United Kingdom, BBL demonstrates high procedural growth (Figure 1).

Figure 1.

Growth-stable abdominoplasty rates in the United States and the United Kingdom.

BBL is also in a state of technical flux. Recently, plastic surgeons in leadership positions have considered calling for a moratorium on the procedure in the United States because of perceived mortality rates.[1] In some countries, despite no official societal or governmental ban, it is "highly suggested" that the procedure not be performed until further data are available, and the operation is effectively prohibited.[2]

The central rationale for discussing a ban on the BBL stems from a survey study publication from the United States showing a mortality rate of one in 3000.[3] Additional evidence presented by proponents of a ban on BBL includes articles in the lay press depicting patients who have died from BBL surgery.

Over the past 5 to 7 years, new techniques of large-volume fat grafting have emerged. Expansion vibration lipofilling combined with safe subcutaneous buttock augmentation has been described and published in the plastic surgery literature.

The fundamental question remains: What is the real mortality rate for BBL and how does it compare to other body contouring procedures? The purpose of the present communication is to review the true mortality data from published abdominoplasty communications and to compare them to what literature and evidence is currently available regarding the mortality rate of BBL, to make a logical conclusion of the accurate risks of each procedure.