Reducing Seroma in Outpatient Abdominoplasty: Analysis of 516 Consecutive Cases

Background: Over the past 30 years, the preferred techniques and settings for abdominoplasty have evolved considerably, but controversy remains regarding the surgical and postoperative approaches that best limit serious complications such as seroma. Objective: The authors evaluate their 28-year experience with abdominoplasty and suggest a technique (progressive tension sutures without placement of drains) for reducing the overall complication rate, most significantly with regard to seroma. Methods: A retrospective review was conducted of 517 consecutive abdominoplasty cases in the senior author's clinic. The cases were divided into five groups based on operative setting, postoperative care, and surgical technique. Concurrent procedures and complications were also reviewed. Results: The authors found that the last group of patients, in whom abdominoplasty with progressive tension sutures (but without drains) was performed as an outpatient procedure, had the lowest incidence of seroma. Specifically, the incidence of clinically significant seroma formation requiring aspiration was 9.6% in early groups, when abdominoplasty was performed as an inpatient procedure; the rate was 24% when it was performed as an outpatient procedure without the placement of progressive tension sutures, but was then reduced to 1.7% with the placement of progressive tension sutures and no drains. Conclusions: Abdominoplasty can be safely performed with other concomitant procedures (such as liposuction) in a strictly outpatient setting when surgical time is limited. Despite controversy in the previous literature, the authors' data support the conclusion that the placement of progressive tension sutures without drains dramatically decreases overall complication and seroma rate during abdominoplasty.