Trends in abdominoplasty: More outpatient surgery and concomitant liposuction

Abdominoplasty continues to be a safe and effective procedure, with more cases performed on an outpatient basis and increased use of concomitant liposuction, according to a new 16-year analysis in Plastic and Reconstructive Surgery.

"Taking advantage of quality-improvement data submitted by US Board-certified plastic surgeons, our study provides new insight on the evolution of the abdominoplasty technique," says lead author Michael J. Stein, MD, MAS, FRCSC, FACS of Lenox Hill Hospital, New York, N.Y.

Shifts in 'tummy tuck' techniques and outcomes from 2005 to 2021

Abdominoplasty—sometimes called "tummy tuck"—is a cosmetic surgical procedure to improve the appearance of the abdomen. In 2022, ASPS Member Surgeons performed nearly 162,000 abdominoplasty procedures, according to ASPS statistics.

To assess the evolution of practice patterns and surgical techniques, Dr. Stein and colleagues analyzed data from the Continuous Certification process of the American Board of Plastic Surgery (ABPS). In that process, plastic surgeons submit information on specific "tracer procedures" as evidence of ongoing improvement in clinical practice.

The researchers analyzed data on 8,990 abdominoplasty cases submitted by 390 ABPS-certified plastic surgeons between 2005 and 2021. To assess trends over time, cases were divided into early (2005-14) and recent (2015-21) cohorts.

The study period saw an increased rate of outpatient abdominoplasty, without an overnight hospital stay, from 77% to 81%, and increased use of heparin to prevent blood clot-related complications. Patients treated more recently were more likely to undergo multiple surgical procedures, particularly liposuction, to reduce fat in the abdominal tissue flap.

'Abdominoplasty remains a safe and reliable procedure'

Other technical changes included decreased use of wide tissue undermining, vertical plication of the abdomen, and postoperative surgical drains—although all these techniques continued to be used in most abdominoplasty cases. The researchers note that while the observed changes are statistically significant, they are "best appreciated as positive or negative practice trends between cohorts, rather than clinically significant changes in practice."

"Abdominoplasty remains a safe and reliable procedure over the study period, with a slight but statistically significant decrease in adverse events in the recent cohort," Dr. Stein and co-authors conclude. "Careful pre-operative evaluation of patients should identify risk factors that increase the risk of complications."

Senior author and past ASPS President Dr. Alan Matarasso of Manhattan Eye, Ear and Throat Hospital has contributed to similar reviews using ABPS Continuous Certification data for other "tracer" procedures—most recently including a report on trends in cosmetic breast augmentation. Fellow authors include Drs. Arun Gosain and Peter Rubin.

Dr. Matarasso says, "While not without potential sources of bias, the use of ABPS Continuous Certification data—with mandatory reporting of large numbers of common procedures by Board-certified plastic surgeons—provides unique insights into trends in surgical practice and benchmarks to inform further safety and quality improvement efforts."