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‘Safe’ Liposuction Amounts Vary by Body Weight

Study proposes ‘relative liposuction volume threshold’ based on BMI

What is the “safe” amount of fat to remove in liposuction patients? The answer depends on the patient’s body mass index (BMI), according to a new report in the official medical journal of the American Society of Plastic Surgeons (ASPS).

The volume of fat that can be safely removed by liposuction has long been debated. Current ASPS guidelines define 5 liters as “large-volume liposuction,” potentially associated with a higher risk of complications. However, the ASPS guidelines acknowledge that there is no scientific data to support an absolute cutoff point.

Data from more than 4,500 patients analyzed

ASPS Member Surgeon John Y.S. Kim of the Northwestern University Feinberg School of Medicine in Chicago and colleagues analyzed data on more than 4,500 liposuction patients from the ASPS’s Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. They evaluated the relationship between liposuction volume and complication risk, including interactions with the patient’s BMI.

The overall complication rate was 1.5%, with few serious complications and no deaths. The most common complication by far was a fluid collection (seroma) requiring drainage. Average liposuction volume was about 2 liters.

“Our study shows that liposuction is associated with a very low complication rate, with major complications occurring in less than 1 in 1,000 patients,” Dr. Kim said. “It also calls into question the concept of simple absolute thresholds for lipoaspirate volume. The amount of liposuction that can be performed safely seems to depend in part on how much fat content a person begins with.”

Patients with complications had larger liposuction volumes, averaging 3.4 liters, and higher BMIs. Patients undergoing “large-volume” liposuction of more than 5 liters had an overall complication rate of 3.7% versus 1.1%, resulting almost entirely from an increase in seromas.

There was also a significant interaction between liposuction volume and BMI. When patients with higher BMIs had a greater liposuction volume, the complication rate was actually somewhat lower.

Dr. Kim and colleagues introduced the concept of a “relative liposuction volume threshold” based on BMI. Dr. Kim and co-researcher Dr. Karol Gutowski emphasized that this provides a relative threshold where complications start to increase, but does not imply an absolute limit on liposuction volumes. Other considerations such as length of surgery, adjunct procedures and the patient’s overall health status are also important to consider when evaluating liposuction risk.

“Our risk assessment tool can further aid shared decision-making between the surgeon and patient by linking BMI and liposuction volumes,” said Dr. Kim.

Dr. Gutowski points out that these finding are possible due to the surgery data contributed by board-certified plastic surgeons. “By developing the TOPS database, ASPS is leading the way in safe and effective plastic surgery which benefits both patients and plastic surgeons,” he said.

Source: American Society of Plastic Surgeons

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