Abdominoplasty outcomes after massive weight loss: a comparative analysis across 4 bariatric procedures.

BACKGROUND

As bariatric practice shifts toward sleeve gastrectomy (SG) and mini gastric bypass (MGB), the impact of bariatric procedure type on subsequent body contouring outcomes remains unclear.

OBJECTIVES

To compare abdominoplasty complication profiles across 4 bariatric procedure types and identify independent predictors of postoperative complications.

SETTING

Single tertiary academic medical center, Shamir Medical Center, Tzrifin, Israel.

METHODS

A retrospective cohort study reviewed 102 patients undergoing abdominoplasty following massive weight loss (2020-2024). Patients were stratified by antecedent bariatric procedure: SG (n = 39), MGB (n = 34), laparoscopic adjustable gastric banding (LAGB) (n = 25), and Roux-en-Y gastric bypass (n = 4). The primary outcome was 90-day complication rate. Multivariate logistic regression identified independent predictors adjusting for age, smoking, diabetes, and total body mass index change.

RESULTS

Overall 90-day complication rate was 23.5%, with no difference between procedure types (P = .99). MGB patients presented earliest (median 2.0 years) and LAGB latest (12.5 years; P < .001). Surgical site infection occurred only in restrictive groups (SG 10.3%, LAGB 8.0%; 0% in malabsorptive groups, P = .27) and MGB showed a nonsignificant hematoma trend (14.7% versus 5%-8%, P = .47). Total body mass index change was the sole independent predictor of complications (odds ratio: 1.12 per kg/m2; 95% confidence interval: 1.03-1.22; P = .007). Subgroup and complication-subtype comparisons were underpowered; nonsignificant procedure differences should be regarded as hypothesis-generating.

CONCLUSIONS

Abdominoplasty complication risk is determined by magnitude of weight loss rather than bariatric procedure type. Procedure-specific differences in infection and hematoma patterns merit further investigation.