Changes in The Pattern of Superficial Lymphatic.15

COSMETIC
Changes in the Pattern of Superficial Lymphatic

Drainage of the Abdomen after Abdominoplasty
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AQ1
Milena Bassalobre, P.T., M.S. Background: The changes in the pattern of lymphatic drainage of the super-
Richard Eloin Liebano, P.T., ficial abdominal wall after abdominoplasty are still unknown. These changes
Ph.D. may increase the risk of numerous complications, including seroma forma-
Milla Pompilio da Silva, P.T., tion. Depending on the alterations, the manual lymphatic drainage technique
M.S. should be modified in postoperative patients. The aim of this study was to map
Mário Luiz Vieira Castiglioni, the pattern of lymphatic drainage of the superficial infraumbilical abdominal
M.D. wall after abdominoplasty.
Adria Yared Sadala, P.T., M.S. Methods: Twenty women with indications for abdominoplasty were selected in
Lydia Masako Ferreira, M.D., the Plastic Surgery Division of the Federal University of São Paulo. Intradermal
Ph.D. lymphoscintigraphy with dextran 500–99m-technetium was performed in 20
Fabio Xerfan Nahas, M.D., female patients in the preoperative phase and 1 and 6 months after abdomino-
Ph.D. plasty to evaluate superficial lymphatic drainage of the abdominal wall.
Results: Before surgery, all patients presented with abdominal lymphatic drain-
04/15/2024
São Paulo and São Carlos, Brazil

age toward the inguinal lymph nodes. One and 6 months after abdominoplasty,
only 15 percent exhibited the same drainage pathway. Drainage toward the axil-
lary lymph node chain occurred in 65 percent of the patients, 10 percent dis-
played a drainage pathway toward both the axillary and inguinal lymph nodes,
and lymphatic drainage was indeterminate in 10 percent of the cases.
Conclusions: A significant change in lymphatic drainage pathway occurred in
the infraumbilical region after abdominoplasty. The axillary drainage path was
predominant after the operation, in contrast to the inguinal path observed
in the preoperative period. However, 35 percent of cases exhibited alternative
drainage. No significant changes were documented between 1 and 6 months
postoperatively. (Plast. Reconstr. Surg. 149: 1106e, 2022.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
A
bdominoplasty is one of the five most popu- malpractice lawsuits in Brazil6 because of the risk
lar cosmetic plastic surgery procedures in of complications.7
the world in pursuit of restoring abdominal The most frequent complications in abdomi-
firmness.1 Abdominoplasty improves self-esteem2 noplasty are hematomas, surgical dehiscence,
and sexuality.3 It is commonly performed to repair infections, and seroma formation. The last is
abdominal wall dysfunctions associated with considered the most common postoperative
intrinsic aging, pregnancy, and significant weight complication, ranging from 5 to 43 percent of
loss.4 In addition to removing excess skin and sub- cases.7–10 Seroma is defined as the collection of
cutaneous tissue, it aims to correct deformities of fluid in the space formed between the cutane-
the musculoaponeurotic layer, which is exposed ous abdominal flap and the musculoaponeurotic
by undermining the subcutaneous tissue.5 Despite layer.11 The etiology of seroma formation is still
several advances in surgical techniques in the last unknown, but it is likely caused by an association
two decades, abdominoplasty is among the cos-
metic surgical procedures with the most medical
Disclosure: The authors have no relevant affiliation or AQ2
financial involvement with any organization or entity
with a financial interest in or financial conflict with the
From the Division of Plastic Surgery, Federal University of
subject matter or materials discussed in the article.
São Paulo; and Department of Physical Therapy, Federal
University of São Carlos.
Received for publication April 25, 2020; accepted August
3, 2021. Related digital media are available in the full-text
Copyright © 2022 by the American Society of Plastic Surgeons version of the article on www.PRSJournal.com.
DOI: 10.1097/PRS.0000000000009114
1106e www.PRSJournal.com
Copyright © 2022 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Volume 149, Number 6 • Lymphatic Drainage after Abdominoplasty
of factors, including fluid production and the University of São Paulo. All participating patients
presence of dead space where fluid can accu- provided written informed consent.
mulate. Fluid can be produced by many factors,
such as a postoperative inflammatory reaction Participants
caused by undermining and the use of electro- Participants were 20 women between 20 and
cautery, the shearing forces caused by postopera- 50 years of age with body mass index between
tive abdominal flap mobilization, or when the 20 and 30 kg/m2, type III abdominal deformity
lymphatic route is directed toward the area of (excess skin between the umbilical stalk and
incision or undermining, where lymphatic ves- the pubic area),19 and type B musculoaponeu-
sels have been severed. This last condition could rotic deformity (indicated for correction of dias-
be one of the factors responsible for seroma for- tasis associated with external oblique muscle
mation caused by changes in the postoperative plication), both according to the Nahas classifica-
lymphatic pathway.12 tion.5,20 Exclusion criteria were pathologic cutane-
Manual lymphatic drainage aims to reduce ous alterations, previous abdominal scars (except
postoperative edema and favor tissue repair.13,14 cesarean delivery scars) and a lymphatic drainage
It is believed that in a nonoperated abdomen, pathway that could not be detected during preop-
the direction of manual lymphatic drainage erative lymphoscintigraphy.
must follow the orientation of the correspond-
ing lymph nodes. In a nonoperated abdomen, Surgical Procedure: Abdominoplasty
04/15/2024
physical therapists are advised to perform man- All participants received general anesthe-
ual lymphatic drainage of the supraumbilical sia. The skin and subcutaneous incision were
region toward the axillary lymph nodes, whereas extended laterally to the anterior superior
in the infraumbilical region, it should be toward iliac spine, reaching the aponeurosis. Supra-
the inguinal lymph nodes.15,16 The literature aponeurotic dissection was limited superiorly at a
lacks further elucidation regarding the pattern level 2 cm below the xiphoid appendix. A tunnel
of the lymphatic pathway after abdominoplasty. was created superiorly to the umbilicus, limited
To date, it is suggested that the direction of by a vertical line drawn 2 or 3 cm laterally to the
manual lymphatic drainage follow the axillary medial margin of the rectus abdominis muscle.
lymph node route until other lymphatic routes The infraumbilical area was completely under-
are recovered17; however, this needs to be scien- mined, with ample exposure of the myoaponeu-
tifically investigated. Manual lymphatic drain- rotic layer. The rectus diastasis was corrected with
age is largely used in the postoperative period of 2-0 nylon in two layers. An L-shaped plication
several plastic surgery procedures, based on the was performed bilaterally at the external oblique
premise that lymph flow is directed to the corre- muscle aponeurosis. [See Figure, Supplemental
sponding lymph nodes. Digital Content 1, which demonstrates the tech-
With a view to optimizing outcomes, it is nique used. (Left) Supra-aponeurotic undermin-
necessary to investigate the direction of the lym- ing in the infraumbilical region and the creation
phatic system pathway of the abdominal region of a tunnel in the supraumbilical area reaching
in patients who have undergone abdominoplasty. a level 2 cm below the xiphoid. (Right) Rectus
More importantly, it is essential to understand the abdominis muscle plication and L-shaped exter-
possible functional changes and variations in the nal oblique aponeurosis plication, http://links.
lymphatic system of the abdomen. Thus, the aim lww.com/PRS/F53.] This plication was executed
of our study was to map the pattern of lymphatic in the same fashion as that of the anterior rectus
drainage after abdominoplasty. sheath. The abdominal flap was pulled down and
around 30 quilting sutures were applied, attach-
PATIENTS AND METHODS ing the flap to the fascia. The flap was then sutured
to the pubic area and the umbilicus transposed.21
Type of Study and Ethical Considerations The area of the undermined flap was drained
This was an interventional, self-controlled, with a 1-cm Penrose drain, which was removed
longitudinal study conducted at a single center18 after 24 hours. All patients were instructed to
and approved by the research ethics committee use compression garments for 30 days after the
of the Federal University of São Paulo, under surgery (24 hours a day), after which they were
protocol number CAEE 1051/10. The research allowed to resume physical activities. None of
was carried out in the Abdominal Plastic Surgery the patients received manual lymphatic drainage
Unit of the Plastic Surgery Division of the Federal after the operation.
1107e
Plastic and Reconstructive Surgery • June 2022
Evaluation and Intervention Table 1. Study Demographics and Clinical

Lymphoscintigraphy Characteristics*
Lymphoscintigraphy was applied to evaluate Characteristics Minimum Maximum Mean ± SD
the lymphatic drainage route in the preopera-
Age, yr 26 50 34 ± 6.78
tive phase and in the 1-month and 6-month post- Body mass index, kg/m2 19 28 24 ± 2.56
operative periods. To visualize the lymph nodes Pregnancies, n 1 4 2 ± 0.80
Last pregnancy weight 10 30 17 ± 6.09

responsible for abdominal lymphatic drainage, gain, kg
an intradermal injection of 1 mCi of dextran *Categorical variables are expressed as averages and standard deviations.
500–99m-technetium diluted in 0.2 ml of sterile
saline solution was used. The injection was admin-
istered at two points of the infraumbilical region toward the inguinal lymph nodes, as illustrated in
with the aid of a tape measure, according to the Figure 2. F2
following markings: inferior line corresponding With respect to 1-month and 6-month postop-
to the pubic hair line; superior line 3 cm from the erative lymphoscintigraphy, 15 percent of patients
inferior line; and vertical bilateral line 3 cm from exhibited no changes in the lymphatic drainage
F1
the median line, as shown in Figure 1. Dynamic pattern when compared to its preoperative coun-
images were taken with a gamma camera for 60 terpart. In 65 percent of patients, the lymphatic
AQ3
minutes after injection, followed by the record- drainage pattern was directed toward the axillary
ing of a static image of the corresponding lymph lymph nodes at both postoperative timepoints,
04/15/2024
nodes. The assessments were performed in the whereas 10 percent exhibited two simultaneous
Department of Nuclear Medicine and Diagnostic lymphatic drainage routes (i.e., axillary and ingui-
Imaging of the Federal University of São Paulo. nal) 6 months after surgery, as shown in Figure 3. F3
The preoperative lymphatic drainage patterns
Statistical Analysis per patient and 1 and 6 months after abdomino-
plasty are summarized in Table 2. It is important T2
Statistical analysis was conducted using R
to underscore that the lymphatic drainage routes
3.6.1 software (R Core Team, Vienna, Austria).
remained the same at 1 and 6 months after sur-
Distribution of the lymphatic drainage pat-
gery in all of the patients.
tern at baseline was compared to the 1-month
and 6-month postoperative periods using the
McNemar test.22 Significance was set at 5 percent
(p ≤ 0.05).
RESULTS
A total of 20 women were included in the
study. Their demographic characteristics are
T1 described in Table 1.
In preoperative lymphoscintigraphy, 100 per-
cent of the patients’ lymphatic drainage path-
way of the infraumbilical region was directed
Fig. 2. Lymphoscintigraphy imaging of the standardized injec-

Fig. 1. Standardization of the reference points for the lymphos- tion points and lymphatic drainage pathway directed toward
cintigraphy test. the inguinal lymph nodes on the preoperative period.
1108e
Fig. 4. Lymphoscintigraphy imaging of the preoperative and

04/15/2024
6-month postoperative periods. Visualization of two injection

points and absence of lymphatic paths.
All the patients exhibited lymphatic drainage

toward the inguinal lymph nodes in the preopera-
tive period, and only 15 percent maintained the
same pathway 1 month after surgery. This result
Fig. 3. Lymphoscintigraphy imaging of the 6-month postop- persisted 6 months after abdominoplasty. Patient
erative period, showing the lymphatic routes toward bilateral distribution and the lymphatic drainage pat-
axillary lymph nodes and simultaneous axillary and inguinal tern observed in the preoperative and 1-month
lymphatic pathways: visualization of the ascendant pathway and 6-month postoperative periods are shown in
toward axillary lymph nodes and visualization of the single Figure 5 (data are expressed as a percentage). The F5
route to the inguinal lymph node. Both images are from the results of the McNemar test, which compared dis-
same patient. tributions at baseline and 1 month and baseline
and 6 months, were both statistically significant
Furthermore, in 10 percent of patients, the (p = 0.009). There were no changes in the lym-
lymphatic drainage pathway and correspond- phatic drainage pattern from 1 to 6 months.
ing lymph nodes were indeterminate during the
F4 protocol period, as demonstrated in Figure 4. In DISCUSSION
these cases, drainage to the abdominal cavity may
It is essential to identify the changes in the abdom-
have occurred. Another possibility is that there
inal lymphatic pathway that occur after abdomino-
was very slow lymphatic drainage of the lower
plasty. These changes will determine the direction
abdomen, precluding pathway identification dur-
in which physical therapists perform manual lym-
ing lymphangiography.
phatic drainage and may influence the occurrence
of seroma. To the best of our knowledge, this is the
first study to compare superficial lymphatic drainage
Table 2. Lymphatic Drainage Patterns per Patient of the abdomen before and after abdominoplasty.
Preoperatively and 1 and 6 Months Postoperatively
Although it was not the purpose of this study, it is
for Abdominoplasty*
relevant to understand why identifying the changes
After 1 After 6 in the lymphatic pathway after abdominoplasty is
Preoperative Month Months
so important. The lymphatic system is crucial to
Lymph Node No. % No. % No. % maintaining tissue homeostasis, and its impairment
Inguinal 20 100 3 15 3 15 after abdominoplasty may have numerous circula-
Axillary 0 0 13 65 13 65
Axillary/inguinal 0 0 2 10 2 10 tory-related consequences, such as the formation of
Not documented 0 0 2 10 2 10 edema, lymphoedema, and seroma, among others.
*Categorical variables are expressed as percentage. Seroma formation, a common complication after
1109e
04/15/2024
Fig. 5. Presentation of lymphatic drainage patterns per patient preoperatively and 1 and 6 months after
abdominoplasty. Categorical variables are expressed as a percentage.
abdominoplasty,7 is defined as the collection of of the anterior portion of the trunk is divided,
fluid in the subcutaneous tissue, located between with the umbilicus as the central point. The ingui-
the muscle aponeurosis and the abdominal flap.23 nal lymph nodes, located inferiorly to the ingui-
This fluid collection may not be diagnosed through nal ligament,26 are responsible for the lymphatic
physical assessment,24 and as a consequence, there drainage of the abdominal wall inferior to the
is a large number of cases of undiagnosed sero- umbilicus,26 whereas the axillary lymph nodes
mas after abdominoplasty.23 Although the causes are responsible for the lymphatic drainage of the
of seroma formation are not fully understood, it is supraumbilical portion of the abdomen.16
believed to be associated with the interruption of Lymphoscintigraphy is the accepted standard
lymphatic vessels caused by trauma following surgi- for assessing the anatomy of the lymphatic system,27
cal dissection.8,9 Fluid accumulation is facilitated by and it is commonly indicated to map the area of
the dead space resulting from significant tissue dis- lymphatic drainage. Technetium-99m is widely
placement.5,7 High-volume seromas under the sub- used and marked with radiocolloids, with dextran
cutaneous abdominal flap may lead to increased 500 being the most appropriate colloid due to its
pressure in the infraumbilical area, causing dehis- good performance and ideal particle size.28
cence, necrosis, spontaneous drainage through the Before the present study, it was believed that,
surgical incision, delayed healing, and infection.11 during the early postoperative period, superficial
Furthermore, when not properly treated, chronic infraumbilical lymphatic drainage occurred toward
seromas may contribute to the formation of a sur- the axillary lymph nodes in all cases. This was the
rounding fibrotic capsule, known as pseudobursa. prevailing opinion, because after abdominoplasty,
In some cases, contraction in the newly formed infraumbilical tissue originated in the supraumbili-
capsule may cause deformities in the abdominal cal region. The axillary lymph nodes continue to
wall that can only be corrected through a new sur- be predominantly responsible for the lymphatic
gical procedure.23 Thus, a better understanding drainage of the abdomen. Alternative drainage
of the lymphatic system and seroma development pathways are created during the first month, how-
may minimize or prevent seroma formation. ever. With a longer follow-up (i.e., 6 months), this
It is known that lymph flow is centripetal and pattern could have been maintained or a new lym-
moves unidirectionally from the lymphatic vessel phatic path reorganized in the inguinal region
to the corresponding lymph node.25 In the nonop- through lymphatic neoformation, returning to the
erated abdomen, superficial lymphatic drainage original lymphatic pattern. The pattern detected in
1110e
the first month persisted 6 months after surgery. be conducted to identify whether such a pattern
Over longer periods, most cases demonstrated is definitive.
that the abdominal flap maintained the previous The absence of a preoperative pathway to
supraumbilical condition and the lymphatic vessels document superficial lymphatic drainage was an
were not redirected to the inguinal lymph nodes. exclusion criterion, as it would preclude com-
Since these lymphatic vessels feature valves toward parison between the preoperative and postop-
the axillary lymph nodes, their direction will not erative images. Two patients, however, presented
change after surgery. Thus, neovascularization of with inguinal lymph nodes in their preoperative
the lymphatics may explain the results observed examinations but exhibited no drainage pathways
in some cases of the present study. Lymph velocity in postoperative lymphoscintigraphy. A possible
and volume drained were not evaluated, and future explanation may be that superficial lymphatic ves-
research should investigate these parameters. The sels were redirected to deeper vessels toward the
most surprising finding was that drainage did not abdominal cavity after not finding any axillary or
follow the expected pattern in 35 percent of cases, inguinal pathways. In this case, a local injection
demonstrating that further research regarding the would occur in front of the documented lymph
behavior and impact of the lymphatic pathways after nodes, leading to an inconclusive result. Another
plastic surgery is required. Some authors observed possible explanation for these cases is that lym-
that the lymphatic drainage pathway of the abdo- phatic drainage would be too slow to document
men in immediate postoperative abdominoplasty during the protocol period. The relationship
04/15/2024
is channeled to the axillary lymph nodes.17 In addi- between two lymphatic systems (deep in the
tion, the authors indicate that, because of tissue abdominal cavity and superficial) in postoperative
trauma, this is considered a temporary accessory abdominoplasty needs to be better elucidated.
pathway, whereby the system would subsequently Three patients maintained the same pre-
redirect drainage to the inguinal lymph nodes. operative lymphatic drainage pattern, in which
The authors, however, did not specify the tempo- the inguinal lymph nodes continued to perform
ral parameters. A case report demonstrated that at infraumbilical lymph drainage. This result dem-
both timepoints (30 and 72 days after abdomino- onstrates that the lymphatic system was capable
plasty), the direction and pathway of infraumbilical of crossing the abdominal scar barrier, directing
abdominal lymphatic drainage changed.29 In these lymph to the inguinal lymph nodes in a short post-
cases, the axillary lymph nodes were responsible for operative period. It is believed, however, that scar
postoperative lymphatic drainage of the abdominal tissue impairs normal lymphatic drainage.
flap. Since this was observed only in one patient, Manual lymphatic drainage is often per-
however, the postabdominoplasty lymphatic pat- formed to reduce postoperative edema and
tern of a larger number of patients was evaluated. should be applied in the physiological direction
Lymphoscintigraphy has been widely utilized of the lymphatic system. If incorrectly applied,
to locate the sentinel lymph node in patients with however, there is no available pathway capable of
cutaneous melanoma. This is the first lymph node connecting the fluids and the lymphatics, gener-
to receive lymphatic drainage from the primary ating adverse outcomes and even postoperative
tumor. In this respect, between 6 and 58 per- complications, such as seroma. Some surgeons
cent of melanomas exhibit more than one lym- advise patients to begin manual lymphatic drain-
phatic pathway, depending on the location of the age 1 week after suture removal, whereas others
injury.30 Furthermore, according to an evaluation discourage such treatments, especially in patients
of patients with melanoma, there is high asym- with increased risk of postoperative complications.
metry and ambiguity in trunk lymphatic drain- In clinical practice, reverse manual lymphatic
age, especially in the infraumbilical region.31 The drainage is often applied within the first postopera-
present study also found more than one infraum- tive month.32 The term “reverse” indicates manual
bilical lymphatic drainage pathway (i.e., axillary lymphatic drainage performed from the infraum-
and inguinal) in two patients between preopera- bilical skin toward the axillary lymph nodes, direct-
tive and postoperative abdominoplasty using lym- ing finger movement to the axilla.33 It is currently
phoscintigraphy. Although the inguinal route recommended to resume conventional manual lym-
was observed, the lymphatic system may adopt a phatic drainage of the lower abdomen (toward the
dual-route lymphatic drainage pattern, aiming to inguinal lymph nodes) 1 month after abdomino-
reestablish the previous pathway. Such an unex- plasty, when neoformation of the lymphatic vessels
pected second route may be temporary. Future is complete. This has yet to be scientifically vali-
studies with longer postoperative follow-up could dated, however. The present study demonstrated
1111e
that this phenomenon does not exist, bearing in edema in the subcutaneous tissue of the lower
mind that most patients presented with 6-month abdomen that can, in some cases, last for up to 6
postoperative images showing lymphatic drainage months after surgery.
toward the axilla. How long these results will be
maintained remains to be determined. Prospective

CONCLUSIONS
studies with a longer follow-up and other associated
The lymphatic pathway of the abdominal
surgical procedures, such as liposuction, lipoab-

dominoplasty, and abdominoplasty after massive wall after abdominoplasty is not the same in all
weight loss, might provide an answer. patients. Although the axillary pathway is predom-
Seroma can be prevented by applying quilting inant, some cases presented with inguinal and
sutures to attach the abdominal flap to the myo- other pathways in the postoperative period. No
aponeurotic layer,34 a technique used in all patients significant changes were documented between
of this study. Quilting sutures promote flap stabi- the first and sixth postoperative month.
lization, thereby decreasing shearing forces and Fabio Xerfan Nahas, M.D., Ph.D.
reducing dead space. The present study sheds Division of Plastic Surgery AQ4
light on an important issue regarding seroma Federal University of São Paulo
formation, namely, the possible consequences Rua Napoleao de Barros, 715, 4th Floor
involving cases in which the infraumbilical lym- Vila Clementino
São Paulo, SP 04021-001, Brazil
phatic drainage pattern after abdominoplasty
04/15/2024
fabionahas@outlook.com
is not directed to the axillary region. In 35 per-
cent of patients, lymphatic drainage is totally or
partially directed to the inguinal lymph nodes REFERENCES
or abdominal cavity in the first postoperative 1. Surgery C, Data N. Cosmetic Surgery National Data Bank
month. Within the first 30 days, a considerable Statistics. Aesthetic Surg J. 2018;38:1–24.
part of the lymphatic vessels that connect the dis- 2. de Brito MJ, Nahas FX, Barbosa MV, et al. Abdominoplasty
tal abdominal flap to the inguinal region, as well and its effect on body image, self-esteem, and mental health.
as the vessels that drain lymph to the abdominal Ann Plast Surg. 2010;65:5–10.
3. de Brito MJ, Nahas FX, Bussolaro RA, Shinmyo LM, Barbosa
cavity, have yet to be formed. In these cases, the MV, Ferreira LM. Effects of abdominoplasty on female sexu-
lymph is not totally drained to the axillary lymph ality: A pilot study. J Sex Med. 2012;9:918–926.
nodes and likely accumulates in the subcutane- 4. Matarasso A, Matarasso DM, Matarasso EJ. Abdominoplasty:
ous and in the third space between postoperative Classic principles and technique. Clin Plast Surg. 2014;41:655–672.
days 10 and 30, resulting in seroma formation. 5. Nahas FX, Ferreira LM. Concepts on correction of the mus-
culoaponeurotic layer in abdominoplasty. Clin Plast Surg.
This hypothesis should be evaluated in a future 2010;37:527–538.
study. According to the natural history of seroma 6. Vila-Nova Da Silva DB, Nahas FX, Bussolaro RA, De Brito
formation, peak fluid collection occurs between MJA, Ferreira LM. The increasing growth of plastic surgery
days 11 and 25 and decreases over time.35 In this lawsuits in Brazil. Aesthetic Plast Surg. 2010;34:541–542.
premature period, the neoformation of lymphatic 7. Seretis K, Goulis D, Demiri EC, Lykoudis EG. Prevention of
seroma formation following abdominoplasty: A systematic
vessels is not complete. Another relevant finding review and meta-analysis. Aesthet Surg J. 2017;37:316–323.
of the same study35 is the 33.3 percent incidence 8. Stewart KJ, Stewart DA, Coghlan B, Harrison DH, Jones BM,
of seroma in abdominoplasty without the use of Waterhouse N. Complications of 278 consecutive abdomino-
quilting sutures on the postoperative day 11. This plasties. J Plast Reconstr Aesthet Surg. 2006;59:1152–1155.
result is very close to the percentage of cases that 9. Ardehali B, Fiorentino F. A meta-analysis of the effects of
abdominoplasty modifications on the incidence of postop-
do not exhibit drainage to the axillary region in erative seroma. Aesthet Surg J. 2017;37:1136–1143.
the postoperative period (35 percent). This may 10. Neaman KC, Armstrong SD, Baca ME, Albert M, Vander
be a mere coincidence; however, a question arises: Woude DL, Renucci JD. Outcomes of traditional cosmetic
will the cases with a postoperative pathway toward abdominoplasty in a community setting: A retrospective anal-
the inguinal chain and the abdominal cavity (35 ysis of 1008 patients. Plast Reconstr Surg. 2013;131:403e–410e.
11. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma
percent) be those that develop seroma (33.3 formation and prevention in breast cancer surgery. ANZ J
percent)? Although there are more unanswered Surg. 2006;76:1088–1095.
questions than answers in the present study, we 12. Gutowski KA. Evidence-based medicine: Abdominoplasty.
believe we have explained one possible contrib- Plast Reconstr Surg. 2018;141:286e–299e.
uting factor to seroma formation. This is only a 13. Bongi SM, Del Rosso A, Passalacqua M, Miccio S, Cerinic
MM. Manual lymph drainage improving upper extrem-
hypothesis, and it is not the focus of the present ity edema and hand function in patients with systemic
study. In addition, the findings of this study may sclerosis in edematous phase. Arthritis Care Res (Hoboken)
directly impact the formation of swelling and 2011;63:1134–1141.
1112e
14. Bertelli DF, de Oliveira P, Gimenes AS, Moreno MA. Postural 26. De Carvalho JPM, Patrício BF, Medeiros J, Sampaio FJB,
drainage and manual lynfiphatic drainage for lower linfib Favorito LA. Anatomic aspects of inguinal lymph nodes
edema in women with morbid obesity after bariatric surgery. applied to lymphadenectomy in penile cancer. Adv Urol.
Am J Phys Med Rehabil. 2013;92:697–703. 2011;2011.
15. Gurdal SO, Kostanoglu A, Cavdar I, et al. Comparison of 27. Kafejian-Haddad AP, Garcia AP, Mitev AG, et al. Avaliação
intermittent pneumatic compression with manual lymphatic linfocintilográfica dos linfedemas dos membros inferiores.
drainage for treatment of breast cancer-related lymph- Correlação com achados clínicos em 34 pacientes. J Vasc
edema. Lymphat Res Biol. 2012;10:129–135. Bras. 2005;4:283–289.

16. Lengelé B, Nyssen-Behets C, Scalliet P. Anatomical bases for 28. Xavier NL, Masiero PR, Spiro BL, et al. Comparação da lin-
the radiological delineation of lymph node areas. Upper focintilografia com dextrano 500 com a do fitato na pesquisa
limbs, chest and abdomen. Radiother Oncol. 2007;84:335–347. do linfonodo sentinela no câncer de mama. Rev Bras Ginecol
17. Jaimovich CA, Mazzarone F, Fernando J, Parra N, Pitanguy e Obs. 2005;27:340–346.
I. Semiology of the abdominal wall: Its value in planning 29. Bassalobre M, Altomare M, Madeira JC. Drenagem linfática
abdominoplasty. Rev Soe Bras Cir Plást. 1999;14:21–38. abdominal pré e pós-abdominoplastia: análise por linfocinti-
18. Hochman B, Nahas FX, De Oliveira Filho RS, Ferreira LM. lografia. Fisioter Ser. 2005;2:30–30.
Desenhos de pesquisa. Acta Cir Bras. 2005;20:2–9. 30. Wainstein AJA, Belfort FA. Conduta para o melanoma cutâ-
19. Nahas FX. A pragmatic way to treat abdominal deformities neo. Rev Col Bras Cir. 2004;31:204–214.
based on skin and subcutaneous excess. Aesthetic Plast Surg. 31. Reynolds HM, Dunbar PR, Uren RF, Thompson JF, Smith NP.
2001;25:365–371. Mapping melanoma lymphoscintigraphy data onto a 3D ana-
20. Nahas FX. An aesthetic classification of the abdomen tomically based model. Ann Biomed Eng. 2007;35:1444–1457.
based on the myoaponeurotic layer. Plast Reconstr Surg. 32. da Silva RMV, de Sousa Martins ALM, Florêncio Maciel
2001;108:1787–1795; discussion 1796. SLCF, da Cunha Resende RAR, Meyer PF. Protocolo fisioter-
04/15/2024
21. Nahas FX. How to deal with the umbilical stalk during apêutico para o pós- operatório de abdominoplastia. Ter
abdominoplasty. Plast Reconstr Surg. 2000;106:1220–1221. Man. 2012;10:294–299.
22. Agresti A. Categorical data analysis. 2nd edition. New York, 33. Chi A, Lange A, Guimarães MVTHN, dos Santos CB.
N.Y.: John Wiley & Sons, Inc.; 2002. Prevenção e tratamento de equimose, edema e fibrose no
23. Di Martino M, Nahas FX, Barbosa MVJ, et al. Seroma in lipoab- pré, trans e pós-operatório de cirurgias plásticas. Rev Bras Cir
dominoplasty and abdominoplasty: A comparative study Plástica (Brazilian J Plast Surg.) 2018;33:343–354.
using ultrasound. Plast Reconstr Surg. 2010;126:1742–1751. 34. Nahas FX, Ferreira LM, Ghelfond C. Does quilting suture
24. Kim J, Stevenson TR. Abdominoplasty, liposuction of the prevent seroma in abdominoplasty? Plast Reconstr Surg.
flanks, and obesity: Analyzing risk factors for seroma forma- 2007;119:1060–1064; discussion 1065.
tion. Plast Reconstr Surg. 2006;117:773–779; discussion 780. 35. Di Martino M, Nahas FX, Kimura AK, Sallum N, Ferreira LM.
25. Schmid-Schönbein GW. The second valve system in lymphat- Natural evolution of seroma in abdominoplasty. Plast Reconstr
ics. Lymphat Res Biol. 2003;1:25–29; discussion 29. Surg. 2015;135:691e–698e.
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COSMETIC

Changes in the Pattern of Superficial Lymphatic

São Paulo and São Carlos, Brazil

Evaluation and Intervention Table 1. Study Demographics and Clinical

Last pregnancy weight 10 30 17 ± 6.09

Fig. 2. Lymphoscintigraphy imaging of the standardized injec-

Fig. 4. Lymphoscintigraphy imaging of the preoperative and

6-month postoperative periods. Visualization of two injection

All the patients exhibited lymphatic drainage

maintained remains to be determined. Prospective

surgical procedures, such as liposuction, lipoab-

edema. Lymphat Res Biol. 2012;10:129–135. Bras. 2005;4:283–289.

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