Ambulatory abdominoplasty tailored to patients with an appropriate body mass index

The office-based surgery setting potentially offers advantages to both the patient and the plastic surgeon, but some patients may not be considered good candidates for abdominoplasty or combined abdominoplasty/lipoplasty performed in the ambulatory setting.

We conducted a retrospective case review of 22 patients who underwent ambulatory abdominoplasty to correct diastasis recti during a 1-year period to evaluate the utility of body mass index (BMI) in patient selection for office-based abdominoplasty procedures using a tumescent technique.

Patients selected for ambulatory abdominoplasty in an office-based setting had BMIs ranging from 22 to 34, with an average BMI of 27, and were American Society of Anesthesiologists (ASA) class I or II. Patients with a BMI that placed them in a "morbidly obese" category (BMI of 35 or above) received general anesthesia with an overnight hospital stay. In borderline cases involving obese patients, a qualified anesthesia provider was consulted to determine whether ambulatory surgery was appropriate, based on the patient's airway and an overall evaluation of the patient's history and physical examination. Patients who underwent ambulatory abdominoplasty received a tumescent anesthetic solution of 50 mL 1% lidocaine with 1 mg epinephrine per liter of normal saline, up to 35 mg/kg body weight. Lipoplasty of the lateral and epigastric regions was routinely performed at the end of all abdominoplasties. The length of surgery was 3 hours to 5.5 hours, depending on the number of regions undergoing lipoplasty.

There were no reportable surgical or anesthetic complications in any of our patients. Patients reported a high level of satisfaction with the results.

BMI evaluation, and in some cases additional risk assessment by a qualified anesthesia provider, can be helpful in determining proper candidates for ambulatory abdominoplasty and combined abdominoplasty/lipoplasty procedures.