2024 FSA Podium and Poster Abstracts

P074: COMPLICATIONS OF BODY CONTOURING SURGERY
Aubrey B Greer, MD; Alexandra Plichta, MD; University of Miami / Jackson Memorial Hospital

Introduction/Background: 35 year-old woman who underwent liposuction and gluteal fat grafting procedure earlier in the day was found down by her husband. He performed chest compressions, EMS encountered her in asystole and continued w/ CPR for 9 minutes until ROSC.

On arrival, she is GSC 3, intubated 7.0 ETT, 6mm equal non-reactive pupils, mottled abdomen and ecchymotic submammary folds, small puncture wounds over trunk, breast, buttocks. FAST Exam negative. Large-bore CVC and radial arterial line were placed. Hematocrit 20 on initial ABG and MTP initiated. Intralipid was given empirically in case of LAST. She became progressively hemodynamically unstable and taken to OR for emergent exploratory laparotomy.

Methods: Immediately on arrival transfer to OR table, she went into VFib arrest and chest compressions and defibrillation were initiated. Laparotomy found 300cc hemoperitoneum, grade III liver laceration, right zone 2 and left zone 3 retroperitoneal hematomas. Left thoracotomy found bulging pericardium but no hemopericadium. The RV was severely dilated in diastolic arrest. The LV was empty, hyperdynamic, and fibrillated. Direct cardiac massage and defibrillated were performed. A right thoracostomy tube was placed and output >1L of blood and incision was converted to clamshell thoracotomy. A right diaphgragmatic injury communicating with the right hepatic injuries and zone 2 retroperitoneal hematoma was found. The 9Fr introducer was palpated and confirmed to be in the correct position.

Results: ROSC was briefly achieved, MTP was continued in a balanced fashion, supported with calcium chloride. The patient had copious bloody pulmonary edema backing up the anesthesia circuit requiring new circuit changes 3-4x times. Continued surgical exploration found no clear source of hemorrhagic shock. She reverted to VFib and continued resuscitation was continued with direct cardiac massage, epinephrine, bicarbonate, direct cardioversion without success.

Discussion/Conclusion: Gluteal fat grafting, also known as a “Brazilian Butt Lift” or “BBL” is a two part procedure involving liposuction (fat harvesting) followed by fat injection (grafting) to augment the buttocks. The risks include local anesthetic systemic toxicity, pulmonary edema, and hypothermia due to the large volumes of tumescent solution used during liposuction. There is also the risk of large fluid shifts, internal organ perforation leading to hemorrhage and sepsis, and the risk of fat embolism.

Due to the rise of procedures injecting large volumes of fat, a new phenomenon or type of fat embolism syndrome has been characterized. Microscopic fat embolism is what was classically described – an inflammatory response which was associated with long bone fractures, and presented with the triad of petechiae, altered mental status, and shortness of breath. The newly described macroscopic fat embolism syndrome is caused by mechanical obstruction of medium and large blood vessels by adipocyte clusters, presenting suddenly with altered mental status, hypotension, bradycardia, dyspnea/hypoxia, acute RV failure, and death.

The gluteal fat grafting procedure has exploded in popularity in recent years, particularly in south Florida where half the procedures nationally are performed. Combined with a proliferation of high-volume, low-budget clinics with low safety margins has made gluteal fat grafting by far the deadliest aesthetic procedure.