Recovery and risks

Day of surgery

In 80 drainless lipoabdominoplasties with a multimodal pain protocol, mean pain was 0.46 of 10 in the recovery unit and 1.23 of 10 on day 1.[1]

First week

Mean pain in the 80 patients was 1.24 of 10 at day 7, and after day 7, 95% took only anti-inflammatory drugs. ASPS says patients should be standing upright within a week or two.[1][2]

Drains

Keeping Scarpa fascia brought drain removal 3 days sooner in a randomized trial. With progressive tension sutures, the Pollocks placed no drains in 597 cases.[1][2]

Weeks 1 to 2

In 20 patients with wrist activity monitors after abdominal wall surgery, activity fell to 32.6% of the preoperative level and recovered to 64.6% by day 14.[1]

First month

In a randomized trial of 120 patients with diastasis repair, 1 month of compression held the muscle repair as well as 3 or 5 months, with earlier return to activity. Longer compression delayed the resolution of swelling.[1]

Months 6 to 12

Activity at 6 months was 16.4% above the preoperative level in the monitored patients. The scar takes several months to a year to fade.[1][2]

Major complications

In 25,478 abdominoplasties in the CosmetAssure database from 2008 to 2013, 4.0% had a major complication against 1.4% for other cosmetic operations. Rates rose from 3.1% for abdominoplasty alone to 10.4% with liposuction and another body contouring operation. A 2015 to 2022 analysis of 55,596 patients found 2.1%.[1][2]

Seroma

Seroma, a fluid collection under the flap, is the most common complication: 10.6% of 519 outpatient cases and 5% of 278 cases. In controlled studies of 664 patients, it fell from 19.5% to 7.5% with preventive measures.[1][2][3]

Blood clots (VTE)

Abdominoplasty is the cosmetic operation most often linked to blood clots: 240 of 414 clots (58%) in an outpatient database from 2001 to 2011, with age over 40 and BMI over 25 as predictors. A review found clots after 0.35% of abdominoplasties alone and 3.40% of circumferential operations.[1][2]

Bleeding and hematoma

Hematoma was the largest share of major complications in the CosmetAssure series, 31.5%. In 278 cases, hematoma followed 3%.[1][2]

Wound healing and smoking

In 132 full abdominoplasties, 47.9% of smokers and 14.8% of nonsmokers had wound healing problems. In 278 cases, skin or fat necrosis followed 2.5% and delayed healing 2%. Classic undermining cut skin blood flow below the navel to 17.2% of normal.[1][2][3]

Navel (umbilical) necrosis

Navel skin loss was reported in 9 of 71 patients (12.6%) after weight-loss surgery in one series, and led to 4 reoperations in 898 patients after weight-loss surgery in another. In 845 TULUA cases, which remove the navel and build a new one, necrosis, wound separation and infection together were 2.7%.[1][2][3]

Risk factors

Male sex (relative risk 1.8), age 55 or older (1.4), BMI 30 or more (1.3), multiple procedures (1.5) and a hospital or surgical center setting (1.6) raised major complications. Diabetes, being male and being underweight or morbidly obese raised risk in a later analysis.[1][2]

Scars and revision

In 278 cases, 12% had dog ears, 10% local fat excess and 8% unsatisfactory scars, and 24% had revision surgery. In 519 outpatient cases, 7.9% had unacceptable scarring and 6.4% a scar revision.[1][2]