Abdominoplasty outcomes after massive weight loss: a comparative analysis across 4 bariatric procedures.

BACKGROUND: As bariatric practice shifts toward sleeve gastrectomy (SG) and mini gastric bypass (MGB), the impact of bariatric procedure type on subsequent body contouring outcomes remains unclear. OBJECTIVES: To compare abdominoplasty complication profiles across 4 bariatric procedure types and identify independent predictors of postoperative complications. SETTING: Single tertiary academic medical center, Shamir Medical Center, Tzrifin, Israel. METHODS: A retrospective cohort study reviewed 102 patients undergoing abdominoplasty following massive weight loss (2020-2024). Patients were stratified by antecedent bariatric procedure: SG (n = 39), MGB (n = 34), laparoscopic adjustable gastric banding (LAGB) (n = 25), and Roux-en-Y gastric bypass (n = 4). The primary outcome was 90-day complication rate. Multivariate logistic regression identified independent predictors adjusting for age, smoking, diabetes, and total body mass index change. RESULTS: Overall 90-day complication rate was 23.5%, with no difference between procedure types (P = .99). MGB patients presented earliest (median 2.0 years) and LAGB latest (12.5 years; P < .001). Surgical site infection occurred only in restrictive groups (SG 10.3%, LAGB 8.0%; 0% in malabsorptive groups, P = .27) and MGB showed a nonsignificant hematoma trend (14.7% versus 5%-8%, P = .47). Total body mass index change was the sole independent predictor of complications (odds ratio: 1.12 per kg/m2; 95% confidence interval: 1.03-1.22; P = .007). Subgroup and complication-subtype comparisons were underpowered; nonsignificant procedure differences should be regarded as hypothesis-generating. CONCLUSIONS: Abdominoplasty complication risk is determined by magnitude of weight loss rather than bariatric procedure type. Procedure-specific differences in infection and hematoma patterns merit further investigation.