Outcomes of standardized drain-free abdominoplasty after massive weight loss: A retrospective analysis of 2533 post-bariatric patients

This retrospective study evaluates the outcomes of 2533 standardized drain‑free abdominoplasties performed after massive weight loss, representing one of the largest series reported in post‑bariatric body‑contouring surgery. All procedures were carried out by the same surgical team across two high‑volume centers using a uniform protocol based on progressive tension sutures (PTS), meticulous flap handling, and structured postoperative management. The cohort reflected typical post‑bariatric characteristics, with a strong female predominance, mean BMI in the obese range, and a short average hospital stay. Most patients underwent a low transverse "smile" incision, while the fleur‑de‑lis approach was reserved for combined vertical and horizontal laxity. Diabetes was present in 5.4% of patients and evenly distributed between BMI groups. Overall complication rates were acceptable, supporting the safety and reproducibility of a drain‑free technique in this challenging population. However, BMI emerged as a major determinant of postoperative morbidity. Patients with BMI ≥30 kg/m² experienced significantly higher rates of seroma, umbilical necrosis, wound dehiscence, hematoma requiring re‑intervention, and surgical site infection. These findings highlight the detrimental effects of excess adiposity on perfusion, lymphatic drainage, and wound stability. The similar prevalence of diabetes across groups suggests that BMI itself, rather than unequal metabolic burden, primarily drives the observed differences, although diabetes remains an additional contributor to impaired healing.