Complications from Fat Grafting and Gluteal Augmentation in Outpatient Plastic Surgery: An Analysis of American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF, QUAD A) Data
Allan Weidman1, Jose A. Foppiani*1, Lauren Valentine1, Angelica Hernandez Alvarez1, Nicholas Elmer1, Natalie Hassell1, Nargiz Seyidova2, Paul Hwang3, Marek Paul4, Alberto Arguello5, Samuel Lin1
1Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; 3USU/Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD; 4DSS Lower Silesian Trauma Center im. T. Marciniaka, Wroclaw, Poland; 5American Association for Accreditation of Ambulatory Surgical Facilities, Gurnee, IL
Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure. This study aims to analyze the prevalence and characteristics of complications that accompany these surgeries in ambulatory surgery facilities.
Adults patients who experienced fat grafting complications from 2019- 2021 were identified in the QUAD A, formerly the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF), database. Patients and complications were analyzed based on sociodemographic, surgery and facility-specific variables using descriptive statistics and logistic regression.
Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.93%. Of these complications, 153 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%) with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (p>0.05).
Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety.
Fig. Geographical distribution of known complications including deaths (107 adverse events in 103 patients) over from 2019 to 2021. Numbers represent the number of complications per region. HD instability denotes hemodynamic instability. DVT denotes deep vein thrombosis. PE denotes pulmonary embolism.
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