Reducing Seromas: Lipoabdominoplasty with Lower Body Lift in the Massive Weight Loss Patient
Kristen M. Rezak, MD1, Loren J. Borud, MD2.
1Cleveland Clinic Florida, Weston, FL, USA, 2Kellogg School of Management, Northwestern University, Chicago, IL, USA.
Purpose: To evaluate the safety and efficacy of the Saldanha lipoabdominoplasty technique when combined with lower body lift in the massive weight loss (MWL) patient.
Methods and Materials: This study is a retrospective analysis of 40 consecutive MWL patients who underwent lower body lift (LBL) over a one year period, with a minimum follow-up of 6 months. Group A consisted of 20 consecutive MWL patients who underwent LBL using the standard abdominoplasty technique of an inverted V-shaped, direct undermining of the abdominoplasty flap. Group B consisted of 20 consecutive LBL patients using the Saldanha lipoabdominoplasty method with a discontinuous, no-direct undermining technique. In all cases, a total of four closed suction drains were placed: two in the lateral trochanter and buttock regions; and two in the lower abdominal area. Patients were examined weekly in the early postoperative period until all drains were removed.
Postoperative records were carefully examined with respect to seroma, time-to-removal of drains, and drain output volumes. Aesthetic outcome was evaluated using the preoperative and six-month postoperative photographs, which were analyzed by a group of five blinded reviewers.
Summary of Results: The ability to mobilize tissue as high as the costal margins with the lipoabdominoplasty method is shown in Figure 1. The arrows depict the movement of the tissues at the costal margin level before and after discontinuous undermining using the Saldanha lipoabdominoplasty technique. Aesthetic analysis by blinded reviewers revealed that there was no significant difference in cosmetic outcome between the two groups. Figure 2 shows a 37 year old patient with a maximum BMI of 57.6, who stabilized at her new BMI of 30.2 following laparoscopic Roux-en-Y gastric bypass. Her lower body lift was performed using the lipoabdominoplasty method described above. The patient photographs show views before (upper panels) and after (lower panels) surgery.
Drainage outputs and incidence of seroma formation were markedly reduced in the lipoabdominoplasty group. The average time to removal of all drains was 25 days in the standard group and 15 days in the lipoabdominoplasty group (p=0.017, Student's T-test). The need for sclerosant use for persistent high drain outputs was 40% in Group A compared to 0% in Group B (p=0.033, Fisher's exact test). In the standard group, there was a 20% incidence of seroma formation following drain removal; and a 10% incidence of need for reoperation for seroma, compared with 0% and 0% in the lipoabdominoplasty group, although these trends were not statistically significant.
Conclusion: When incorporated into the lower body lift, the Saldanha lipoabdominoplasty technique can be safely used in massive weight loss patients with aesthetic results equivalent to standard techniques. In addition, the lipoabdominoplasty method is associated with a significant decrease in drain usage and number of postoperative visits.