1051e Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures Sir: We read with great interest the article entitled “Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures” by Winocour et al.1 We would like to congratulate the authors on their work and their conclusion that provides for the first time a finding of a high level of evidence-based medicine (Level II). Based on a prospectively filled database, the authors demonstrate using a multivariate analysis that male sex (relative risk, 1.8), age 60 years or older (relative risk, 1.4), body mass index greater than or equal to 30 (relative risk, 1.3), and combined procedures (relative risk, 1.5) are independent risk factors for major postoperative complications. We would like to discuss some points related to this article based on our recent results2 and to provide insight to develop future studies. First, this study is very informative on major complications but does not analyze risk factors for minor complications, such as wound dehiscence and seroma, which are the most frequent ones. Further prospective studies including all complications are necessary to fully inform our patients before surgery and to be able to provide an unbiased message. Second, the study confirmed that male sex and preoperative body mass index impact the complication rate. Neaman et al.3 had already found a correlation between male sex and increased complications during abdominoplasties in a retrospective analysis of 1008 patients. Arthurs et al.,4 Parvizi et al.,5 and Neaman et al.3 found preoperative body mass index greater than 25 or greater than 30 as also being an independent risk factor. Nonetheless, this study led to a highly relevant finding because it identified age as a new risk factor. Because of a larger number of included patients compared with previously cited studies, it showed for the first time that advanced age is associated with an increased operative risk. This correlation was difficult to highlight in smaller samples, as old people represent a small proportion of indications of abdominoplasty. Among these risk factors, we believe that age has to be the only operative exclusion criterion, as neither male sex nor body mass index has to be considered a contraindication. Third, this study confirmed the data of our recent review comparing abdominoplasty versus abdominoplasty and breast surgery, and showing an increased complication rate when combining procedures.2 However, Winocour et al. analyzed various associated procedures with a higher level of evidence design, providing a stronger relevance to the results. In our 3. Swanson E. Limitations of the BREAST-Q as an outcomes measure for evaluation of breast augmentation patients. Plast Reconstr Surg. 2014;134:986e–988e. Reply: Face-Lift Satisfaction Using the FACE-Q Sir: Dr. Swanson’s detailed letter should be addressed in two parts. First is his criticism regarding limitations of the present study.1 We completely agree with Dr. Swanson that ideally preoperative and postoperative evaluations are performed. Our study served to demonstrate that the FACE-Q can be used in face lift patients to successfully acquire information regarding patient satisfaction and our own results. We have found these data to be extremely useful, but we recognize that an ideal study, as mentioned in our Discussion, would include preoperative sampling, a standardized postoperative interval, and larger patient samples. We hope that future studies will aim to achieve these goals. Second is his criticism of the FACE-Q, as well as the BREAST-Q. Dr. Swanson has previously expressed his views on both of these instruments2,3; his current sentiments are not new. While we may never change Dr. Swanson’s opinion, it is our belief that the BREAST-Q and FACE-Q are not only well-designed, tested, and validated outcome measures but also, most importantly, extremely useful clinically. We have experience using both, and as attested by the hundreds of studies that have used the BREAST-Q and will use the FACE-Q, there is so much valuable information to learn from our patients using these priceless tools. DOI: 10.1097/PRS.0000000000002001

Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures.

Increasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk. We performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases. The review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies. This review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

/pdf/circumferential-contouring-of-the-lower-trunk-indications-ir5ddarjfk.pdf

Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes—A Systematic Review

Lower body lift is a widespread procedure for massive weight loss patients aimed to improve the contour of the lower trunk, gluteal region and proximal lower extremity. The data about complications are confusing, and there is a lack of uniform studies for massive weight loss patients. A simple formula to carry out a reliable procedure in a short time with a low complication rate should be advocated. This retrospective study analyzed data of 323 patients undergoing lower body lift after bariatric surgery over a 10-year period. Selection criteria, careful preoperative marking, reliable intra- and postoperative care and a few surgical tips are discussed. All the complications (both major and minor) and the aesthetic satisfaction were evaluated. Risk factors assessed were patient age, tobacco consumption, current BMI, operative time and combined surgery. The overall complication rate was 42%. We recorded a lower rate of major complications and skin dehiscence; no infection and no skin necrosis were observed. The most frequent complication was seroma (35%). A complication development was straight related to age (p = 0.0177) and tobacco use (p = 0.0336). Patients’ satisfaction about overall aesthetic was high. We present our case load and describe an easy recipe to perform a safe surgery without undermining and liposuction in short operative times. The reasonable overall complication rate and the surprisingly lower rate of dehiscence and skin necrosis combined with a pleasant aesthetic result make the lower body lift an easy and safe procedure, when applied to the appropriate patient population. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience

Learning objectives After reading this article, the participant should be able to: 1. Differentiate between techniques for standard abdominoplasty and lipoabdominoplasty. 2. Assess patients for risk associated with abdominoplasty alone and combined with other procedures. 3. Implement newer modalities for abdominoplasty perioperative pain management. 4. Better understand the implications and techniques for rectus diastasis correction by rectus sheath plication. 5. Understand the evidence for eliminating the need for drains in abdominoplasty. Summary This update to past Maintenance of Certification articles offers new perspectives and builds on past knowledge regarding patient assessment, perioperative management, surgical execution, and complications of abdominoplasty.

Evidence-Based Medicine: Abdominoplasty.

Are There Factors Predictive of Postoperative Complications in Circumferential Contouring of the Lower Trunk? A Meta-Analysis.

Summary Objectives Combined aesthetic procedures are an increasing procedure and demands of the patients. The authors have assembled concrete arguments detailing the risks of combined-surgery associating abdominoplasty and mammoplasty relative to abdominoplasty alone. The purpose of this study was to compare abdominoplasty alone versus abdominoplasty combined with breast surgery in terms of short-term complications, in support of surgical choices. Research strategy Through application of the PRISMA criteria, we have realized a systematic review of the literature from 1969 to April 2015 in English and French languages by searching in MEDLINE ® , PubMed central, Embase and Cochrane Library databases. Data collection and analysis The levels of evidence for each article were evaluated. Statistical analysis of the results was carried out through association parameters including statistical tests and Odds ratios were calculated for each complication when data was available. Results We included 32 observational studies that met the inclusion criteria but only four with usable data. We highlighted a combined Odds ratio of respectively 5.35 and 14.71 for major complications in these studies for combined-surgery compared with abdominoplasty alone. Conclusions The results of this systematic review appears in favor of an increase in major complications related to abdominoplasty combined with breast surgery compared to abdominoplasty alone but the level of evidence of included studies is low or moderate. Prospective cohort comparative studies are necessary to provide strong evidence. However, we recommend to avoid this procedure in massive weight loss patients or patients with thromboembolism history.

Morbidity in combined-procedure associating abdominoplasty and breast surgery: A systematic review

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Morbidity in combined-procedure associating abdominoplasty and breast surgery: A systematic review