15. Comparative Analysis of Abdominoplasty with and without Concurrent Hernia Repair: An Assessment of a Reconstructive Problem in a Cosmetic Patient Population

Abstract

PURPOSE: The risks and benefits of performing small fat-containing ventral or umbilical hernia repair (HR) during cosmetic abdominoplasty remains a reconstructive and aesthetic challenge for plastic surgeons. This study aimed to compare clinical outcomes in patients undergoing abdominoplasty with concurrent HR and abdominoplasty alone. METHODS: Patients (2015-2021) who underwent abdominoplasty with and without a concurrent HR by a single surgeon were identified. Patients were stratified by concurrent HR. All hernia patients underwent primary fascial repair, without the use of mesh reinforcement. Demographics, surgical site occurrences (SSO) and cosmetic complications, including delayed healing and necrosis, were assessed. Risk adjusted modeling was utilized to compare HR with clinical outcomes. RESULTS: One-hundred and eleven patients underwent abdominoplasty, 67 (60.4%) had concurrent HR. No significant difference in demographics was identified between groups including mean BMI (HR=27.5 kg/m2 and No HR= 26.7 kg/m2, P=0.79), and number of previous repairs (P=0.31). After a mean follow-up of 1.4 years, hernia recurrence rate was 3% (n=2), which was exclusive to umbilical defects. After controlling for demographics, there was no difference in risk of SSO (OR 1.02 [0.31-3.36] P=0.978), cosmetic complications (OR 0.80 [0.14-4.57] P=0.805), readmissions (6.06% vs. 0%, P=0.336), reoperations (18.18% vs. 3.03%, P=0.299), or procedure length (-7.23 minutes [-29.40-14.93] P=0.522), compared to patients who underwent abdominoplasty alone. CONCLUSION: Abdominoplasty with concurrent HR can be performed safely and effectively, with no increase in adverse outcomes or cosmetic complications. The value of mesh-free HR with abdominoplasty is the ability to achieve an enhanced aesthetic and mitigate long-term abdominal morbidity.