Drainless Lipoabdominoplasty Using Progressive Tension Sutures, Scarpa’s Fascia Preservation, and Minimal Cautery in 350 Consecutive Cases

Abstract Background Lipoabdominoplasty has soared in popularity. Advancements in the procedure have led to improved abdominal contours. Despite improvements in surgical techniques, postoperative complications persist, especially seroma formation. Drains are used to reduce the risk of seroma formation; however, drains are a nuisance for patients and may contribute to long term complications. Many surgical strategies have been proposed to reduce seroma formation in lipoabdominoplasty, including progressive tension sutures (PTS), minimal cautery, and preservation of Scarpa’s fascia; however, these strategies in combination remains underexplored. Objectives The objective of this study is to determine the postoperative seroma rate of lipoabdominoplasty with combined PTS, minimal cautery, and Scarpa’s fascia preservation without postoperative drains. Methods This is a review of 350 patients who underwent drainless lipoabdominoplasty performed by a single surgeon from January 2017 to November 2024 at a single surgery center. Patient demographics, operative characteristics, and post-operative outcomes were collected. Descriptive analysis was performed. Pearson’s chi-square tests and Mann-Whitney U test were used to compare groups. Multiple logistic regression was performed. Statistical significance was set p<0.05. Results Among 350 cases, a total of 287 full abdominoplasties, 50 belt lipectomy, and 14 modified float abdominoplasties were performed. There was a total of 37 (10.5%) complications, with a 2% seroma rate. There were no mortalities. All patients who developed complications recovered with no sequalae. Conclusions The drainless lipoabdominoplasty can be performed safely with a low seroma rate using a multimodality approach that includes progressive tension sutures, minimal cautery, and preservation of Scarpa’s fascia.