Seroma after Lipoabdominoplasty: Fat Thickness of the Abdominal Wall Is Probably a Contributory Factor

Sir: It was with great interest that I read the article “Seroma in Lipoabdominoplasty and Abdominoplasty: A Comparative Study Using Ultrasound” (Plast Reconstr Surg. 2010;126;1742–1751). The article proves the fact that the cautious tread of liposuction has become a confident step of lipoabdominoplasty. The authors' statement that “the presence of fluid collections is not a complication but a natural process that occurs after abdominoplasty” is a very valid supportive reassurance for all abdominoplasty surgeons. It becomes a complication only when the volume exceeds the ability of the local tissues to absorb this normal fluid ooze. The probable reasons are more exudation and less resorption. More exudation occurs in more extensive traumatic dissection, diabetes, and a larger traumatized surface area as in conventional abdominoplasty. Less absorption may take place when the lymphatics are less either because of trauma, previous surgery, or a smaller area with functional lymphatics. The many advantageous results of lipoabdominoplasty (e.g., harmonious abdomen, less seroma, less pain, less wound complications, and better preservation of sensation) all prove the superiority of lipoabdominoplasty. This study has proved that methods of obliterating the potential space and shearing forces by quilting sutures and limited dissection in lipoabdominoplasty might be the likely factors for the lower incidence of seroma. The study has included only individuals with normal body mass indexes, which is not the case in many other countries where a body mass index above 30 is a regular feature. The basal metabolic index and incidence of seroma have been quoted differently.1,2 I have been performing lipoabdominoplasty for the past 7 years, mainly on patients with high body mass indexes, and seroma was common, but the incidence was less than in conventional abdominoplasty. I started to observe whenever I performed aggressive liposuction of the abdomen that the incidence of seroma was less than when I was performing the procedure less aggressively. To achieve an objective result, I set 2.5 cm as an arbitrary fat thickness to achieve at the end of liposuction. After resection of the dermal fat, if I find the fat thickness was more (Fig. 1), I perform an open liposuction (Fig. 2) to achieve a fat thickness of 2 to 3 cm (Fig. 3). This 2.5 cm is an arbitrary fat thickness that I follow.Fig. 1.: Fat thickness after abdominal liposuction and dermolipectomy is more than 3 cm thick.Fig. 2.: Open liposuction.Fig. 3.: After open liposuction, the fat thickness is 2 to 3 cm.I attempted this method rigorously in 19 patients, and I found that only four patients had minimal seroma in the first 14 days that needed only one or two aspirations, and there was no seroma by the third postoperative week. In all of these patients, there was no problem in wound healing, there was no delay, and there was no necrosis. I conceptualize these positive findings as follows: Seroma is caused by local factors playing the main role after surgery; it is not a systemic manifestation caused by a high body mass index. By aggressive liposuction, the fat load is less; thus, the fluid discharge is less. By sucking the fat, more lymphatic channels are bared open, which absorbs the exudates. The limited dissection prevents any vascular compromise. This interesting observation—fat thickness may be a contributory factor in seroma—needs further controlled study with a greater number of high–body mass index patients. From this article, it is well documented that the lipoabdominoplasty and quilting sutures definitely reduce the seroma—a fact to be considered to practice both methods simultaneously in the same patient. When such a procedure is attempted, my proposition of aggressive liposuction will help to take this dermal fat to rectus quilting suture easily because of less abdominal wall fat. James R. Kanjoor, F.R.C.S. Canadian Medical Center Near Amiri Hospital Sharq, Block 3, Building 20, 12th Floor Kuwait [email protected]

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