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Abdominoplasty, commonly referred to as a “tummy tuck,” is a widely performed cosmetic procedure that improves abdominal contour by removing redundant skin and excess subcutaneous fat and, when indicated, addressing rectus muscle laxity. The procedure has seen increasing demand, with over 170,000 cases reported in the United States in 2023, a 37% rise from pre–COVID-19 rates. Techniques vary from full abdominoplasty to mini or lipoabdominoplasty, with attention to flap design, vascular preservation, and aesthetic balance. Complications can include hematoma, seroma, wound dehiscence, infection, and contour irregularities, highlighting the need for careful patient selection, meticulous surgical planning, and structured postoperative management. Consideration of patient comorbidities, prior abdominal surgeries, and expectations is essential for optimizing functional and cosmetic outcomes. Participants in this activity gain comprehensive knowledge of abdominoplasty, including anatomy, surgical approaches, strategies to mitigate complications, and postoperative care. Emphasis is placed on minimally invasive techniques, flap design principles, and evidence-based refinements to enhance safety and aesthetic results. Clinicians also learn to integrate preoperative assessment, operative planning, and postoperative management with interprofessional collaboration among anesthesia, nursing, nutrition, and rehabilitation teams. Coordinated communication supports patient education, risk reduction, and longitudinal follow-up, ultimately improving outcomes, reducing complications, and promoting patient satisfaction across the continuum of care. Objectives: Identify early signs of complications postoperatively and implement timely interventions to mitigate adverse events. Evaluate intraoperative outcomes and adjust surgical technique to accommodate anatomical variations or unexpected findings. Select appropriate operative techniques (eg, full abdominoplasty, mini-abdominoplasty, or adjunctive liposuction) based on patient anatomy and aesthetic goals. Collaborate with the interprofessional healthcare team, including surgeons, anesthesiologists, nurses, nutritionists, and rehabilitation specialists, to achieve optimal patient recovery and long-term outcomes. Access free multiple choice questions on this topic.

Abdominoplasty, commonly referred to as a “tummy tuck,” is a surgical procedure designed to improve the contour and aesthetic appearance of the abdominal wall by removing excess skin and subcutaneous fat (panniculus) and, when indicated, tightening the underlying musculature (see Image. Abdominal Panniculus). Since its first descriptions in the early twentieth century, abdominoplasty has evolved through numerous refinements in technique to enhance safety, minimize complications, and optimize both functional and cosmetic outcomes. Today, it is one of the most frequently performed body-contouring procedures worldwide, addressing concerns related to massive weight loss, postpartum changes, and aging.[1][2][3][4] With the increasing prevalence of bariatric surgery, the widespread use of glucagon-like peptide-1 (GLP-1) agonists, and evolving societal trends, abdominoplasty offers an important opportunity for individuals to address and reduce excess abdominal tissue.[5][6][7]

The overall complication rate following abdominoplasty ranges from 10% to 20%, but can rise to 30% to 50% in patients after massive weight loss. The most common complications include seroma (5%–43%), infection (3%–14%), hematoma (3%–7%), skin necrosis (1.6%), deep vein thrombosis (<1%), and local complications such as scarring, pain, umbilical issues, and suture extrusion.[15][26] A seroma is the accumulation of clear serous fluid beneath the abdominal flap within a surgical cavity. Preservation of the Scarpa fascia during flap elevation and the use of progressive-tension sutures have been found to significantly decrease the risk of seroma compared with drains alone.[23] Risk factors for seroma include high body mass index, extensive weight loss, prior abdominal surgery, low protein intake, wide tissue undermining, and elevated flap thickness.[14][23][26][23][28] Surgical site infections most commonly arise from skin flora, though enteric organisms may also be implicated. Risk factors include intraoperative issues such as hypothermia, inadequate antibiotic prophylaxis, breaches in sterile technique, and prolonged operative time, as well as patient factors including immunosuppression, malnutrition, smoking, and obesity. Rare but life-threatening infections, such as necrotizing fasciitis, can also occur.[15][28] Hematomas, or collections of blood in the subcutaneous or subfascial space, typically result from inadequately controlled bleeding vessels. Intraoperative vasospasm or hypotension may mask bleeding sites that subsequently manifest postoperatively. Hematomas increase the risk of flap necrosis by exerting pressure, provide a medium conducive to bacterial growth, and prolong the inflammatory phase of wound healing.[15]

Hematomas, or collections of blood in the subcutaneous or subfascial space, typically result from inadequately controlled bleeding vessels. Intraoperative vasospasm or hypotension may mask bleeding sites that subsequently manifest postoperatively. Hematomas increase the risk of flap necrosis by exerting pressure, provide a medium conducive to bacterial growth, and prolong the inflammatory phase of wound healing.[15] Skin necrosis is a serious complication, often resulting from intraoperative injury to perforators or excessive tension from skin resection. The area of highest risk is the inferior midline “triple point” where lateral skin flaps converge. Other risk factors include smoking, obesity, diabetes, and hypertension. Necrosis of the umbilicus is particularly concerning because it can compromise the central aesthetic of the abdomen and significantly affect overall results.[29] Meralgia paresthetica is another rare but notable complication, resulting from injury to the lateral femoral cutaneous nerve. Patients may experience numbness, tingling, burning, prickling, or hyperesthesia of the lateral thigh, with an estimated incidence of 1.36% to 1.94%.[30]

Abdominoplasty is a major elective operation with the potential for significant perioperative complications; therefore, meticulous preoperative risk stratification and patient optimization are essential. Identification of modifiable risk factors, including cardiopulmonary disease, nutritional deficiencies, smoking status, and psychosocial readiness, should precede surgical planning. An integrative, team-based model reduces morbidity by incorporating pulmonary and cardiology evaluation through primary care to optimize respiratory and cardiac function, formal anesthesiology assessment to determine fitness for general anesthesia, psychological evaluation to ensure realistic expectations (particularly in post–massive weight loss patients), and nutrition consultation to promote sustained postoperative health behaviors.[31] This structured, multidisciplinary preoperative strategy aligns with evidence-based perioperative planning and risk mitigation principles.[32] Postoperatively, coordinated interprofessional care enhances early recognition and management of complications, thereby directly improving prognosis and safety.[33] Surgeons and advanced practitioners must lead surveillance for hematoma, seroma, venous thromboembolism, flap compromise, and wound infection. At the same time, nurses provide vigilant monitoring, early mobilization support, education on drain management, and reinforcement of discharge instructions. Diagnostic laboratories play a critical role in guiding targeted antimicrobial therapy through culture and susceptibility data when infection is suspected. Pharmacists contribute to multimodal analgesia planning, antimicrobial stewardship, and thromboprophylaxis optimization. Clear communication, shared decision-making, and standardized handoffs across inpatient and outpatient settings ensure continuity of care, reinforce patient education, particularly for home drainage management, and promote patient-centered recovery within an evidence-based framework.[32][33]