Intramuscular Pressure Dynamics During Rectus Abdominis Fat Grafting and Plication

Rectus abdominis fat transfer (RAFT) has gained increasing popularity for abdominal contouring; however, the effects of fat grafting and abdominal plication on intramuscular pressure remain poorly understood. This study aims to characterize intramuscular pressure changes during RAFT using standardized fat grafting volumes.

A retrospective cohort study was conducted, including 86 patients undergoing RAFT. Intramuscular pressure was measured intraoperatively using a compartment pressure monitoring system at 3 time points: before fat grafting, after fat grafting, and after abdominal plication. Measurements were obtained in predefined zones of the rectus abdominis and external oblique muscles using standardized grafting volumes.

Fat grafting alone resulted in minimal and nonsignificant changes in intramuscular pressure across all anatomical regions. In contrast, abdominal plication was associated with consistent increases in pressure, reaching statistical significance in multiple zones, including the infraumbilical and inferior regions, as well as the external obliques. Despite these increases, no cases of fat necrosis, ischemia, or major complications were observed. The overall complication rate was 3.48%, limited to surgical site infections. Patient satisfaction improved substantially following the procedure.

Abdominal plication seems to be the primary contributor to intramuscular pressure elevation during RAFT, whereas fat grafting alone has a limited impact. Although increased pressures were not associated with immediate adverse outcomes, clinically relevant thresholds remain undefined. These findings provide insight into abdominal wall pressure dynamics; however, further prospective studies are required to determine their clinical significance and implications for surgical practice.