INTRODUCTION
Liposuction of the abdomen is a commonly performed procedure. It reduces subcutaneous fat and can result in conservative skin retraction, so it is a procedure that is not applicable to patients with marked overhanging skin or a large proportion of intra-abdominal, visceral fat. Some have reported use of high-volume liposuction to help reduce subcutaneous fat and potentially treat type II diabetes, but this is controversial and not universally advocated. Liposuction can be performed through tradi- tional tumescent technique by manual syringe liposculpture or with a formal vacuum source. Augmented technologies such as power-assisted liposuction and ultrasound-assisted liposuction are useful to promote fat removal while allow- ing focus on contouring.
Abdominal Liposuction
INDICATIONS
This procedure often applies to young people and athleti-cally fit individuals who have localized fatty deposit in the abdomen resistant to diet and exercise. Abdominal lipo- suction is useful as a secondary procedure after prior abdominoplasty to help further contour the abdomen, as liposuction would have been unsafe to perform at the ini- tial abdominoplasty. Abdominal etching is a form of superficial liposuction performed to simulate the appear- ance of muscle definition. The abdomen is an excellent donor source for fat grafts, and for this, fat is best har- vested through traditional syringe aspiration techniques to minimize trauma and disruption to the adipocytes.
POSTOPERATIVE CARE
Abdominal liposuction may be performed as an outpa-tient, but once volumes aspirated are greater than 4-5 liters, overnight observation is warranted. Foley catheter placement prior to surgery to follow fluid status during surgery and immediately postoperatively is recommended. Patients require hydration to flush their kidneys from fat that may enter their systemic bloodstream and embolize. Fluid status must be monitored and the patient needs to ambulate well. Hydration is encouraged for the first week after liposuction.
Arnica montana herbal pills may be taken immedi- ately preoperatively and then postoperatively to reduce edema and bruising. After initial recovery, the topical ointment or gel may be massaged into the skin while also taking the oral medication.
Physical limitations last for about a week. Patients may shower immediately and foam pads and binder are recom- mended for the first week but not required. Using compres- sion does help optimize reduction of bruising and swelling.
PITFALLS
Abdominal scars may be hiding abdominal hernias, and this is particularly important in the setting of prior abdom- inal radiation treatment or complicated wound healing. Liposuction must not be performed across abdominal scars to avoid potential intra-abdominal perforation which will result in necrotizing fasciitis of the abdominal skin and wall in addition to bowel injury. Patients with round abdomens need to be carefully examined. Particularly in
men, fat may be primarily intra-abdominal and not in the subcutaneous plane.
Abdominal liposuction must be performed cautiously in conjunction with abdominoplasty techniques. Abdom- inal liposuction may impair circulation to the abdominal skin flap, so it should not be performed in undermined skin detached from its blood supply, except for upper midline etching. Liposuction in body regions adjacent to the abdomen such as the hip complements the abdominal contour well and is safe.
Fat emboli are a valid concern with higher volumes of liposuction. Hydration cannot be overemphasized, and 100% supplemental oxygen is required if fat embolism is suspected, particularly with desaturation. These patients are worked up like patients with pulmonary embolism.
Foam with a silicone backing is gentle to the skin and provides excellent compression.
Abdominal liposuction may lead to skin laxity where full subcutaneous fatty pockets existed, particularly in the epigastrium. This results in the skin folding when patients sit and possibly in any position. Discussion with patients prior to surgery must inform them of this possi- bility, and the potential upside/downside of liposuction versus abdominoplasty, allowing for staging of these two procedures as needed.
TIPS
Compression, while not required, helps optimize allevia-tion of bruising and swelling. Foam and binder compres- sion may be substituted by girdle apparel starting a week after surgery.