Menstrual Cycle Phase Does Not Affect Blood Loss in High-Energy Lipoabdominoplasty: A Prospective Controlled Study

Surgical bleeding remains a key determinant of morbidity in abdominoplasty and lipoabdominoplasty. While hormonal fluctuations during the menstrual cycle have been linked to altered hemostasis in hormonally responsive tissues such as breast and nasal mucosa, their impact on hormonally inert tissues like the abdominal wall remains unclear. This study prospectively evaluated whether menstrual phase influences perioperative bleeding in lipoabdominoplasty.

A prospective, single-center study enrolled 90 women (18-55 years) undergoing standardized lipoabdominoplasty between January 2022 and January 2025. Patients with regular ovulatory cycles were stratified into three groups: perimenstrual (days 1-7, 21-28), periovulatory (days 8-14), and luteal (days 15-20). Exclusion criteria included coagulation disorders, hormonal therapy, anemia, smoking, and major prior abdominal surgery. Intraoperative blood loss was quantified by corrected suction volumes and gravimetric analysis of sponges; postoperative drainage was measured over 48 hours. Secondary endpoints included perioperative hemoglobin drop, drain removal time, and early complications.

No significant differences were observed in intraoperative blood loss (480 ± 110 mL perimenstrual; 460 ± 105 mL periovulatory; 455 ± 115 mL luteal; p = 0.62) or postoperative drainage (p = 0.78). Hemoglobin decline, drain duration, and complication rates (seroma 6%, hematoma 4%, transfusion 1%) were comparable across groups. Correlation analysis showed that BMI and excised tissue weight, but not menstrual phase, were independent predictors of blood loss. These findings align with the hypothesis that the abdominal wall, supported by musculocutaneous perforators and stable dermal plexuses, is hormonally unresponsive and thus unaffected by cyclical endocrine changes.

No statistically significant differences in bleeding or early outcomes were detected across menstrual cycle phases in patients undergoing lipoabdominoplasty. Surgical scheduling need not be adjusted based on menstrual timing, allowing cycle-independent planning without compromising safety. Larger multicenter studies with hormone assays may further refine these observations.

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 .