Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures.

1051e Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures Sir: We read with great interest the article entitled “Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures” by Winocour et al.1 We would like to congratulate the authors on their work and their conclusion that provides for the first time a finding of a high level of evidence-based medicine (Level II). Based on a prospectively filled database, the authors demonstrate using a multivariate analysis that male sex (relative risk, 1.8), age 60 years or older (relative risk, 1.4), body mass index greater than or equal to 30 (relative risk, 1.3), and combined procedures (relative risk, 1.5) are independent risk factors for major postoperative complications. We would like to discuss some points related to this article based on our recent results2 and to provide insight to develop future studies. First, this study is very informative on major complications but does not analyze risk factors for minor complications, such as wound dehiscence and seroma, which are the most frequent ones. Further prospective studies including all complications are necessary to fully inform our patients before surgery and to be able to provide an unbiased message. Second, the study confirmed that male sex and preoperative body mass index impact the complication rate. Neaman et al.3 had already found a correlation between male sex and increased complications during abdominoplasties in a retrospective analysis of 1008 patients. Arthurs et al.,4 Parvizi et al.,5 and Neaman et al.3 found preoperative body mass index greater than 25 or greater than 30 as also being an independent risk factor. Nonetheless, this study led to a highly relevant finding because it identified age as a new risk factor. Because of a larger number of included patients compared with previously cited studies, it showed for the first time that advanced age is associated with an increased operative risk. This correlation was difficult to highlight in smaller samples, as old people represent a small proportion of indications of abdominoplasty. Among these risk factors, we believe that age has to be the only operative exclusion criterion, as neither male sex nor body mass index has to be considered a contraindication. Third, this study confirmed the data of our recent review comparing abdominoplasty versus abdominoplasty and breast surgery, and showing an increased complication rate when combining procedures.2 However, Winocour et al. analyzed various associated procedures with a higher level of evidence design, providing a stronger relevance to the results. In our 3. Swanson E. Limitations of the BREAST-Q as an outcomes measure for evaluation of breast augmentation patients. Plast Reconstr Surg. 2014;134:986e–988e. Reply: Face-Lift Satisfaction Using the FACE-Q Sir: Dr. Swanson’s detailed letter should be addressed in two parts. First is his criticism regarding limitations of the present study.1 We completely agree with Dr. Swanson that ideally preoperative and postoperative evaluations are performed. Our study served to demonstrate that the FACE-Q can be used in face lift patients to successfully acquire information regarding patient satisfaction and our own results. We have found these data to be extremely useful, but we recognize that an ideal study, as mentioned in our Discussion, would include preoperative sampling, a standardized postoperative interval, and larger patient samples. We hope that future studies will aim to achieve these goals. Second is his criticism of the FACE-Q, as well as the BREAST-Q. Dr. Swanson has previously expressed his views on both of these instruments2,3; his current sentiments are not new. While we may never change Dr. Swanson’s opinion, it is our belief that the BREAST-Q and FACE-Q are not only well-designed, tested, and validated outcome measures but also, most importantly, extremely useful clinically. We have experience using both, and as attested by the hundreds of studies that have used the BREAST-Q and will use the FACE-Q, there is so much valuable information to learn from our patients using these priceless tools. DOI: 10.1097/PRS.0000000000002001