5. Safety combination of liposuction and abdominoplasty with B&S technique
Tummy tuck, or abdominoplasty, is the fifth most frequently requested cosmetic procedure. More than 116,000 abdominoplasty surgeries were performed in the United States alone during the year 2010 ( 48 ).
The abdominoplasty with simultaneous liposuction is a procedure that has become a save and effective solution for the abdominal contouring and flaccidity. The history of abdominoplasty goes back to the late eighteen hundreds in the Johns Hopkins Hospital where it was described as a conjunct procedure for large abdominal wall hernias, and through out the twentieth century it had evolved into a procedure with acceptable aesthetic results.
Although this procedure is becoming more popular, classical abdominoplasty is related to a relatively high complication rate. General and local complications include pulmonary thrombo-embolism, seroma, hematoma and necrosis of the dermal-fat flap.
According to a national survey, postoperative mortality in a national survey was 0.2% in 1972 ( 49 ) and decreased to 0.04% by 1989 ( 50 ). The last national survey had no mortalities in over 11,000 procedures ( 51 ). Factors leading to the decrease in the incidence of wound healing problems were: undermining the flap in an inverted “V” fashion, avoiding operating on active smokers, avoiding excess tension on the flap closure, limited flap thinning and avoiding excessive flap liposuction.
Although major complications have diminished in recent decades, wound complication rates remain high—up to 30 % ( 50 , 51 , 52 , 53 , 54 ).
After the creation and publishing of the blunt-tipped liposuction by Yves-Gerard Illouz ( 56 ), the history of the abdominoplasty was changed completely and new combinations of surgeries emerged. Through out the past three decades there has been a series of publications and creations of new surgical techniques related to the association of liposuction and abdominal surgery, including proposals for reduction of abdominal flap dissection to decrease the complications statistics.
During the 1990s, the combination of liposuction and abdominoplasty gained much popularity ( 55 , 57 , 58 , 59 ). The increased use of tumescent anaesthesia in particular, enabled the procedure to be performed ambulatory—often in a physician’s office setting ( 60 , 61 , 62 , 63 , 64 ). Despite these developments, wound complications such as seromas, dehiscence and necrosis still remained high ( 58 , 59 , 60 ).
Juarez Avelar, MD, postulated that large-scale undermining of the abdominal flap involving the rupture of the lymphatic and perforator blood supply caused wound complications. To reduce these complications, he developed a new surgical technique that avoids wide undermining, which he presented at the 36th Brazilian Congress of Plastic Surgery in 1999( 65 , 66 ). Blugerman then modified this specific technique by including the use of tumescent anaesthesia ( 67 ).
This technique with the combined use of liposuction in abdominoplasty under the tumescent local anesthesia has been proved to be an effective technique to reduce complications. The tumescent infiltration used for liposuction of the abdominal wall creates an internal ex-sanguination and vasoconstriction which eliminates all stagnant blood that can be injurious for the flap, reduces in an important manner the vascular injury and the blood loss. Also the liposuction of the superior portion of the abdomen and flanks makes it possible to do a selective undermining of the flap thus preserving the vascularity and sensitivity of the flap. Adding to this, liposuction of the flap and contiguous areas greatly improve the cosmetic outcome.
Nowadays we have combined the use of laserlipolisys and radiofrequency assisted liposuction ( 60 ) with the abdominoplasty in patients with different indications, such as vascular fragility or cutaneous flaccidity correspondingly, bringing better results with lower risks.
The purpose of this article is to demonstrate the safety and effectiveness of this relatively new abdominoplasty technique.