A Comparative Outcome Review of Abdominoplasty Following Massive Weight Loss

Abdominoplasty after massive weight loss has higher complication rates than for other reasons. It is unclear if outcomes vary by method of weight loss, especially with increasing use of glucagon-like peptide-1 receptor agonists.

One hundred seventy-six patients had abdominoplasty after massive weight loss by a single surgeon. The main comparison was bariatric procedures (gastric sleeve, bypass, banding; n=118) versus diet and exercise (n=47). Complications were re-examined and reclassified. Logistic regression adjusted for BMI, resection weight, and diabetes.

Thirty-one patients (17.6%) experienced major complications (readmission or return to theatre). major complications were more common after bariatric than diet and exercise weight loss (22.0% vs. 8.5%; OR 3.04, p=0.046). Gastric bypass had the highest risk (39.1%; OR 6.91, p=0.007), based on a small subgroup (n=23), and is hypothesis-generating. After adjustment for BMI, resection weight, and diabetes, the difference was not significant (adjusted OR 2.33, p=0.16). Discrimination was modest for any complication (AUC 0.550) and better for major complication (0.674).

Major complication rates are higher after bariatric than after diet and exercise weight loss, but this difference is largely explained by residual obesity at surgery. Body mass index was the most consistent modifiable factor. Gastric bypass patients should be counselled specifically about the elevated risk.

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