Everything You Need to Know About Abdominoplasty Complications

Like any procedure performed under general anaesthesia, an abdominoplasty carries risks. With more Australians choosing body contouring operations after pregnancy or weight loss, it is important to understand the potential complications before proceeding.

What is an Abdominoplasty?

An abdominoplasty is a surgical procedure designed to remove redundant abdominal skin and fat while also tightening the underlying muscles and connective tissues. The aim is to restore strength to the abdominal wall and address tissue laxity that may result from pregnancy, ageing, or major weight loss.

How Common is Abdominoplasty in Australia?

A 2022 Finder report estimated that more than 1.2 million Australians underwent some form of plastic surgery in the preceding 12 months. Among these, abdominoplasty ranked as the fourth most common operation. Despite its popularity, published studies show abdominoplasty carries higher complication rates compared to other cosmetic procedures, which makes understanding risks essential.

Can Abdominoplasty Cause Complications?

Even in the hands of a highly trained FRACS-qualified specialist surgeon, abdominoplasty is a significant undertaking. Research published in Plastic and Reconstructive Surgery® has shown that approximately 4% of abdominoplasty patients experience a major complication. This compares with an average complication rate of 1.4% for other cosmetic operations.

Minor complications such as temporary discomfort, scarring, and anaesthetic reactions are more common and generally manageable, but serious complications also need to be considered.

Major Complications of Abdominoplasty

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

One of the most serious complications is Deep Vein Thrombosis (DVT), where blood clots form in deep veins of the legs. Research involving 129,007 aesthetic procedures reported up to a 2% risk of thrombosis after elective operations such as abdominoplasty.

• DVT symptoms may include swelling in one leg, persistent pain, skin colour changes, and warmth.
• If a clot travels to the lungs, it can cause a Pulmonary Embolism (PE), which is potentially life-threatening. Signs include chest pain, dizziness, shortness of breath, or coughing blood.

Treatment often involves blood thinners, clot-dissolving medications, or, in severe cases, surgical interventions.

Seroma Formation

Because a large tissue flap is created during abdominoplasty, fluid accumulation (seroma) is one of the most frequent complications. A systematic review found the global prevalence of seroma formation to be around 10.9%.

• Minor seromas may resolve naturally, but persistent or infected seromas require aspiration or surgical drainage.
• Signs of infection include fever, elevated heart rate, and abnormal discharge. Left untreated, a seroma can evolve into an abscess, raising the risk of sepsis.

Necrosis of Skin or Fat

When skin and fat lose blood supply, necrosis (tissue death) can occur. This complication usually appears a few days after surgery.

• Mild necrosis can be managed with local excision and primary closure.
• Severe necrosis may require surgical debridement, skin grafting, and use of negative-pressure dressings.

The extent of necrosis determines recovery time and the degree of scarring.

Haematoma

A haematoma is a localised collection of blood under the skin caused by ruptured blood vessels. Studies show an incidence of around 12% in some patient series.

• Small haematomas may resemble bruises and resolve with conservative measures.
• Larger or expanding haematomas need surgical evacuation and haemostasis to stop bleeding.

Other Recognised Complications

Not all complications are life-threatening, but they can still affect recovery and satisfaction with results. Examples include:

• Postoperative pain, numbness, and weakness
• Delayed wound healing
• Skin discolouration
• Localised tissue excess sometimes referred to as “dog ears”
• Scarring problems such as hypertrophic, keloid, or asymmetrical scars
• Anaesthetic reactions
• Wound infection

Risk Factors That Increase Complication Rates

Not every patient has the same risk profile. Studies have identified several factors that make complications more likely:

• Age over 60 years
• Undergoing abdominoplasty combined with other procedures
• Obesity (BMI over 30)
• Previous medical conditions
• Male sex (men are statistically more likely than women to develop complications)
• Smoking, which significantly reduces healing capacity

Long-Term Complications

Some patients may face long-term issues such as:

• Persistent numbness in the abdominal skin
• Chronic nerve-related pain
• Scarring problems including hypertrophic or keloid scars
• Asymmetrical scars requiring revision

These complications may require secondary surgery.

Frequently Asked Questions

What are the most common complications of abdominoplasty?

The most frequent issues include seromas, delayed wound healing, haematomas, and postoperative bleeding. Less commonly, necrosis or DVT may occur.

How many people experience complications?

Around 4% of patients undergoing abdominoplasty report major complications, which is higher than many other cosmetic operations. Minor complications are more common but often manageable.

What are the long-term problems?

Long-term complications can include scarring irregularities, persistent numbness, and chronic pain syndromes. These may affect comfort and appearance, sometimes necessitating revision surgery.

What red flags should I look for after surgery?

For the first six weeks, discomfort and swelling are expected. Seek urgent review if you develop chest pain, shortness of breath, excessive swelling, sudden pain, high fever, or abnormal wound discharge.

Final Thoughts

Abdominoplasty is one of the most effective procedures to remove redundant abdominal tissue, but it carries higher risks than many other cosmetic surgeries. Understanding these risks helps patients make informed choices.

Before committing, it is essential to have a detailed consultation with a FRACS-qualified surgeon, discuss your health history, and carefully weigh the potential benefits and complications.

Sources

1. Wolters Kluwer Health: Lippincott Williams and Wilkins. 2015. ”’Tummy tuck’ complications: Study looks at rates and risk factors.” Plastic and Reconstructive Surgery, 2015
2. Julian Winocour, Varun Gupta, Christodoulos Kaoutzanis, Hanyuan Shi, R Bruce Shack, James C Grotting, K Kye Higdon. 2017. “Venous Thromboembolism in the Cosmetic Patient: Analysis of 129,007 Patients” Aesthetic Surgery Journal, Volume 37, Issue 3
3. Nader Salari, Behnaz Fatahi, Yalda Bartina, Mohsen Kazeminia, Mohammadbagher Heydari, Masoud Mohammadi, Mahvan Hemmati, Shamarina Shohaimi. 2021. “The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis” Aesthetic Plastic Surgery, 2021 Dec
4. Mohan Rangaswami. 2013. “Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps” Indian Journal of Plastic Surgery, v.46(2); May-Aug 2013
5. Michele Grieco, Eugenio Grignaffini, Francesco Simonacci, Edoardo Raposio. 2015. “Analysis of Complications in Postbariatric Abdominoplasty: Our Experience” Plastic Surgery International, v.2015
6. Arash Momeni, Mathias Heier, Holger Bannasch, G. Björn Stark. 2008. “Complications in abdominoplasty: A risk factor analysis” Journal of Plastic, Reconstructive, and Aesthetic Surgery, 2009 Oct

Resources for Research (For your reference)

1. Finder.com. May 2, 2022. “Plastic Surgery Statistic Australia” [Accessed June 23, 2023] https://www.finder.com.au/plastic-surgery-statistics-australia
2. TheVictorianCosmeticInstitute.com.au. January 16, 2020. “Cosmetic Surgery Statistics Australia & Around the World” [Accessed June 23, 2023] https://www.thevictoriancosmeticinstitute.com.au/2020/01/cosmetic-surgery-statistics-australia-around-the-world/