Risk factors for seroma formation following abdominoplasty: a systematic review and meta-analysis

Abstract Background Seroma is the most common complication following abdominoplasty. However, the risk factors associated with its development remain unclear, with inconsistent findings across studies. Objective To systematically evaluate and quantitatively synthesize risk factors related to seroma formation following abdominoplasty. Methods This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and CINAHL was conducted up to March 2026. Studies evaluating risk factors for seroma formation following abdominoplasty were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results Thirty studies involving 16,280 patients were included. Scarpa fascia preservation (OR 0.25; 95% CI 0.15–0.42) and progressive tension or quilting sutures (OR 0.08; 95% CI 0.03–0.23) were significantly associated with lower odds of seroma formation, whereas conventional drain-based closure was associated with higher seroma odds than a drainless progressive tension suture strategy (OR 4.72; 95% CI 2.00–11.14). BMI ≥ 30 kg/m² was not significantly associated with seroma in the primary analysis, and concomitant liposuction was not significantly associated with seroma formation. Conclusions Modifiable surgical factors play a more important role in seroma formation than patient-related factors. Techniques targeting dead space reduction may effectively reduce seroma risk. Further well-designed studies with standardized outcome definitions are needed to strengthen the evidence. PROSPERO registration number: CRD420261351599