Postoperative Seroma After Abdominoplasty Risk Factors and Prevention Strategies: A Structured Narrative Review

Background: Seroma is a common local complication after abdominoplasty, but reported frequencies vary with operative technique, patient selection, and whether diagnosis is clinical or ultrasound-based. Drain output and seroma requiring treatment are related but distinct outcomes. Objective: To critically evaluate patient and operative risk factors and the evidence supporting seroma prevention after abdominoplasty. Methods: A targeted PubMed-based narrative review examined randomized trials, prospective studies, comparative cohorts, and systematic reviews available through October 24, 2026. Evidence was interpreted with attention to outcome definitions, cointerventions, and the distinction between seroma-specific and overall complication risk. Results: Higher body mass index and greater operative tissue disruption are associated with seroma in several cohorts, while the contribution of liposuction varies according to dissection and dead-space management. Progressive tension or quilting sutures and preservation of Scarpa fascia have the most consistent supportive evidence, although effect sizes are influenced by study design and technique. A comparative meta-analysis reported a seroma risk ratio of 0.34 for progressive tension suturing versus conventional drains; a 2026 Scarpa-preservation synthesis reported a similar pooled association, driven predominantly by observational evidence. More drains have not consistently improved outcomes. A small randomized trial found no additional seroma-prevention benefit from abdominal binders after quilting-suture abdominoplasty. Adhesives, energy devices, tranexamic acid, and negative-pressure dressings require outcome-specific interpretation. Conclusions: Prevention should address dead space, shear, tissue injury, and patient risk. A reproducible operative and follow-up protocol is more defensible than assuming that any single adjunct universally prevents seroma.