Drainless Vascular-Preserving Lipoabdominoplasty: A Two-Center Retrospective Cohort Study of 101 Consecutive Patients and a Framework for Artificial Intelligence–Assisted Planning and Assessment

Background: Lipoabdominoplasty seeks to improve abdominal contour while preserving flap perfusion, but seroma and wound morbidity remain concerns. This study describes complications and patient-reported outcomes after a standardized drainless, vascular-preserving protocol and examines associations with willingness to recommend. Methods: This retrospective two-center cohort included 101 consecutive adults treated from January 2023 through December 2024. The protocol used Doppler mapping, limited midline undermining, perforator preservation, controlled liposuction, rectus plication, progressive tension sutures, and no routine drains. Thirty-day complications were graded by the Clavien-Dindo system. Patient-reported outcomes were assessed with a study-specific 5-point questionnaire. Correlations and internal consistency (Cronbach alpha) were assessed. Results: Mean age was 41.7 ± 8.3 years and mean body mass index was 27.8 ± 3.2 kg/m². Sixteen patients (15.8%) experienced complications: 12 Grade I, 3 Grade II, and 1 Grade IIIa; no Grade IV or V events occurred. On the 5-point study questionnaire, item means ranged from 2.52 to 3.11 (SD 1.18-1.31); the item on satisfaction with the achieved aesthetic outcome had a mean of 2.93 ± 1.21. Body mass index correlated with skin-tension satisfaction (r = 0.316, P < .01) and willingness to recommend (r = 0.277, P < .01); complications correlated negatively with willingness to recommend (r = -0.234, P < .05). Cronbach alpha for the questionnaire was 0.913. Conclusions: The protocol was associated with predominantly low-grade complications and with item-level patient-reported scores in the middle of the 5-point scale. Without a comparator and a validated outcome instrument, the findings are descriptive and hypothesis-generating rather than evidence of superiority, fewer complications, improved flap perfusion, or a benefit of omitting drains. A human-in-the-loop artificial intelligence (AI) framework for perforator mapping, contour quantification and risk prediction is proposed as a prospective validation agenda; no AI methods were used in this cohort.

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