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A 31-year-old woman presumed to be healthy is scheduled for a breast augmentation and large-volume liposuction in the plastic surgeon’s office. Which of the following perioperative risks is MOST likely increased in this patient?
A. Hypovolemia X
B. Hyperthermia X
C. Dilutional anemia ✔
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The volume of surgeries performed in an office-based setting has grown significantly and consistently over the last several years. Deciding if a procedure should be done in an office-based setting requires knowledge of both patient-related and procedural factors. These include comorbidities, proximity to the nearest hospital in case of emergency, access to blood products, availability of difficult airway equipment, duration and complexity of the procedure (and if it will allow for same-day discharge), and availability of rescue or emergency medications (eg, dantrolene, lipid emulsion).
One procedure commonly performed in an office-based setting is liposuction, which involves the insertion of hollow tubes via small skin incisions and removal of subcutaneous fat. This suctioned fat is referred to as aspirate. Large volumes of tumescent solution containing either normal saline or Ringer’s lactate, epinephrine, and lidocaine are injected during this procedure. The tumescent solution minimizes blood loss, limits systemic absorption of lidocaine, and provides anesthesia. Liposuction may be performed with general anesthesia or moderate to deep intravenous sedation depending on the patient, volume of the aspirate, and anatomical target of the procedure.
Liposuction is generally considered safe. However, like all procedures, it carries risks that should be considered. Due to the large volume of tumescent solution involved (1 to 4 mL per 1 mL of fat to be suctioned), hypervolemia is a concern, and the fluid and electrolyte balance must be considered. Patients may be at risk for hypothermia, as the tumescent solution is not usually warmed. A typical liposuction procedure does not result in significant changes in postoperative hemoglobin. However, large-volume liposuction (>5 L of aspirate) may result in significant blood loss and dilutional anemia. For this reason, patients with uncorrected anemia should not undergo large-volume liposuction in an office setting. Local anesthetic systemic toxicity must also be considered, given the large doses of local anesthetic contained within the tumescent solution.
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Date of last update: October 22, 2025
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