Cardiovascular and cerebral complications during abdominoplasty and liposuction

Liposuction as a radical technique to combat localized fat deposits is becoming more and more widely used in clinical medicine. The present review study is devoted to the analysis of published data concerning the development of possible complications during abdominoplasty and liposuction surgeries. Particular attention is paid to the study of cardiovascular and cerebral complications, their frequency, clinical spectrum, as well as the peculiarities of management of such cases by representatives of different levels of medical care. Complications during the performance of these procedures are characterized by a wide spectrum, develop in different periods of time and in the majority of cases are resolved safely. However, in some cases they occur in the first day after the operation and can be dangerous for human health. Risk factors for complications of abdominoplasty and/or liposuction are reviewed, including such as the use of general anesthesia, duration of surgical intervention, use of highdose lidocaine, large liposuction volume, inter- and postoperative volume overload or hypohydration, difficult-to-control pain syndrome, multimodal anesthesia, frequent vomiting, and late patient activation, prior use of nonsteroidal anti-inflammatory drugs, smoking, long-term contraception, pelvic inflammatory disease, body mass index ≥ 40 kg/m2, benign prostatic hyperplasia in men, elevated levels of C-reactive protein, fibrinogen, total cholesterol, triglycerides, creatinine, eosinophils, and low blood albumin and lymphocyte counts. Our findings may serve as a basis for the development of effective prevention and risk management strategies in this field of plastic surgery.

1. Gussaova S.S., Bobkova I.N., Yashkov Yu.I. et al. Changes in metabolic parameters and glomerular filtration rate in patients with morbid obesity after bariatric surgery. Therapeutic Archive. 2020;92(6):53–59. (In Russ.). DOI: 10.26442/00403660.2020.06.000674

2. Simonenko V.B., Abashin V.G., Dulin P.A. Military field and naval therapy from the origins to the present day. Klinicheskaya meditsina. 2021;99(7–8):414–419. (In Russ.). DOI:10.30629/0023-2149-2021-99-7-8-414-419

3. Adamskaya N.A. System of specialization in the field of plastic surgery in Europe. Plastic surgery and cosmetology. 2010;(1):1–160:63–65. (In Russ.)

4. Cárdenas-Camarena L., Andrés Gerardo L.P., Durán H. et al. Strategies for Reducing Fatal Complications in Liposuction. Plast. Reconstr. Surg. Glob. Open. 2017;5(10):e1539. DOI: 10.1097/GOX.0000000000001539

5. American Society of Plastic Surgeons, Plastic Surgery Statistics Report. Available from: https://www.plasticsurgery.org/documents/ News/Statistics/2020/plastic-surgery-statistics-fullreport-2020.pdf 6. 2022 ASPS Procedural Statistics Release. Plast. Reconstr. Surg. 2024;153(1S):1-24. DOI: 10.1097/PRS.0000000000011235

6. Furlow L.T. Jr. The ASPRS and reconstructive plastic surgery. American Society of Plastic and Reconstructive Surgeons. Ann. Plast. Surg. 1998;41(3):330; discussion 330–1. DOI: 10.1097/00000637-199809000-00021

7. Albin R., de Campo T. Large-volume liposuction in 181 patients. Aesthetic Plast. Surg. 1999;23(1):5–15. DOI: 10.1007/s002669900235

8. Stein M.J., Weissman J.P., Harrast J. et al. Clinical Practice Patterns in Abdominoplasty: 16-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery. Plast. Reconstr. Surg. 2024;153(1):66–74. DOI: 10.1097/PRS.0000000000010500

9. Folomeeva L.I., Bordan N.S., Ilchenko F.N. et al. Methods of pre venting the development of seroma after abdominoplasty. Tavricheskiy mediko-biologicheskiy vestnik.2025;28:2:100-106. (In Russ.). DOI: 10.29039/2070-8092-2025-28-2-100-106

10. Martínez M.A., Ballesteros S., Segura L.J., García M. Reporting a fatality during tumescent liposuction. Forensic. Sci. Int. 2008;178(1):e11-6. DOI: 10.1016/j.forsciint.2008.01.013

11. Foula A.S., Ahmed M.A., Foula M.S., Nassar M.W. Sudden cardiac arrest during a prolonged liposuction and lipofilling procedure: a case report. Cureus. 2022;14(6):e25985. DOI: 10.7759/cureus.25985

12. Mrad S., El Tawil C., Sukaiti W.A. et al. Cardiac arrest following liposuction: a case report of lidocaine toxicity. Oman Med. J. 2019;34:341–4. DOI: 10.5001/omj.2019.66

13. Nerobeev A.I., Mala khovskaya V.I., Vissarionov V.A. et al. Surgical liposuction: domestic experience. Bulletin of Aesthetic Medicine. 2010;9:2:52–60. (In Russ.).

14. Terranova C., Sartore D., Snenghi R. Death after liposuction: case report and review of the literature. Med. Sci. Law. 2010;50(3):161–3. DOI: 10.1258/msl.2010.100010

15. Kopytkova N.V. Legal regulation of services in the field of plastic surgery. News of Gomel State University named after F. Skaryna. 2016;2(95):83–88. (In Russ.).

16. Starling J. 3rd., Thosani M.K., Coldiron B.M. Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatol. Surg. 2012;38(2):171–7. DOI:10.1111/j.1524-4725.2011.02206.x

17. Grazer F.M., de Jong R.H. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast. Reconstr. Surg. 2000;105(1):436– 46; discussion 447–8. DOI: 10.1097/00006534-200001000-00070

18. Оvechkin A.M. Pain and plastic surgery: how to avoid problems on the path to perfection. Clin. Experiment. Surg. Petrovsky J. 2016;3:51–63. (In Russ.).

19. Wang G., Cao W. Tumescent liposuction: partitioning of lidocaine at a lower dose (252 mg/l). Dermatology. 2011;222(3):274–7. DOI: 10.1159/000327382

20. Grome L.J., Bartlett E., Izaddoost S. Liposuction fat emboli resulting in myocardial infarction: a case report and review of the literature. Eur. J. Plast. Surg. 2019;42:509–512. DOI: 10.1007/s00238-019-01514-0

21. Harnett P., Koak Y., Baker D. Splenic trauma during abdominal wall liposuction: a case report. J. R. Soc. Med. 2008;101(4):201–3. DOI: 10.1258/jrsm.2008.081010

22. Grazer F.M., de Jong R.H. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast. Reconstr. Surg. 2000;105(1):436– 46; discussion 447–8. DOI: 10.1097/00006534-200001000-00070

23. Kwon S.S., Park B.W., Lee M.H. et al. Role and prognosis of extracorporeal life support in patients who develop cardiac arrest during or after office-based. Cosmetic Surgery. Korean J. Thorac. Cardiovasc. Surg. 2020;53(5):277–284. DOI: 10.5090/kjtcs.19.077

24. Blagova O.V., Aynetdinova D.Kh., Nedostup A.V. et al. Lethal necrotizing granulomatous vasculitis after bariatric surgery and bilateral mammaplasty. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(1):79–92. (In Russ.). DOI: 10.22416/1382-4376-2017-27-1-79-92

25. Shoenfeld Y., Agmon-Levin N. ‘ASIA’ — autoimmune/inflammatory syndrome induced by adjuvants. J. Autoimmun. 2011;36(1):4–8. DOI: 10.1016/j.jaut.2010.07.003

26. Cohen Tervaert J.W., Kappel R.M. Silicone implant incompatibility syndrome (SIIS): a frequent cause of ASIA (Shoenfeld’s syndrome). Immunol. Res. 2013;56(2–3):293–8. DOI: 10.1007/s12026-013- 8401-3

27. Korableva N.P., Romanenkov N.S., Bozhok A.A. et al. Complications of liposuction and lipofilling: diagnosis, treatment and prevention. 2020. (In Russ.).

28. Timerbulatov M.V., Shornina A.S., Lihter R.A., Kaipov A.E. Evaluation of liposuction as a part of abdominoplasty and simultaneous hernioabdominoplasty. Creative surgery and oncology. 2023;13(4):278–283. (In Russ.). DOI: 10.24060/2076-3093-2023-13-4-278-283

29. Edwards E.A. Surgical anatomy of the breast. In: Plastic and Reconstructive Surgery of the Breast / Ed. Goldwyn R. Boston: Little, Brown and Co., 2000:37–57.

30. Sotnikov A.A., Minayeva O.L. Clinical aspects of peculiarities of vascular ans nervous components of mammary gland papillary-areolar complex in women. Siberian Medical Journal. 2008;4:(1):26–27. (In Russ.).

31. Wang L., Yu G., Zhang R. et al. Positive effects of neuromuscular exercises on pain and active range of motion in idiopathic frozen shoulder: a randomized controlled trial. BMC Musculoskelet. Disord. 2023;24(1):50. DOI: 10.1186/s12891-023-06173-8

32. Arcanjo F.L., Martins J.V.P., Moté P. et al. Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis. Complement. Ther. Clin. Pract. 2022;46:101505. DOI: 10.1016/j.ctcp.2021.101505

33. Ovechkin A.M., Zvizhuleva A.A. Postoperative analgesia in plastic surgery. Regionarnaya anesteziya i lechenie ostroy boli = Regional Anesthesia and Acute Pain Management, Russian journal. 2016;10(2):82–96. (In Russ.). DOI: 10.18821/1993-6508-2016-10-2-82-96

34. Macrae W.A. Chronic post-surgical pain: 10 years on. Br. J. Anaesth. 2008;101(1):77–86. DOI: 10.1093/bja/aen099

35. von Sperling M.L., Høimyr H., Finnerup K. et al. Persistent pain and sensory changes following cosmetic breast augmentation. Eur. J. Pain. 2011;15(3):328–32. DOI: 10.1016/j.ejpain.2010.07.004

36. Medvedev V.E. Dysmor phic disorders: clinical and nosological heterogeneity. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuro psychiatry, psychosomatics. 2016;(8)1:49–55. (In Russian). DOI: 10.14412/2074-2711-2016-1-49-55

37. Murkamilov I., Aitbaev K., Ymankulov D. et al. Thera peutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery. Bulletin of Science and Practice. 2024;10(7):188-228. (In Russ.). DOI: 10.33619/2414 2948/104/22

38. Yu Z., Zhang Z., Wang X. et al. Psychological evaluation of Asian female patients with rhinoplasty. J. Plast. Reconstr. Aesthet. Surg. 2024;88:112–118. DOI: 10.1016/j.bjps.2023.10.127

39. Spit K.A., Azahaf S., de Blok CJM. et al. A rare observation of silicone-associated scleroderma-like syndrome: how to recognize and diagnose similar cases. AIM Clinical Cases. 2023;2:e221290. DOI: 10.7326/aimcc.2022.1290

40. Spit K.A., Scharff M., de Blok CJ. et al. Patient-reported systemic symptoms in women with silicone breast implants: a descriptive cohort study. BMJ Open. 2022;12(6):e057159. DOI: 10.1136/bmjopen-2021-057159

41. Brawer A.E. Destiny rides again: the reappearance of silicone gel-filled breast implant toxicity. Lupus. 2017;26:1060–3. DOI: 10.1177/0961203317690241

42. Balk E.M., Earley A., Avendano EA. et al. Long-term health outcomes in women with silicone gel breast implants: a systematic review. Ann. Intern. Med. 2016;164:164–75. DOI: 10.7326/M15-1169