Background: Malnutrition and overweight is a common problem in modern societies. Primary abdominal lipectomy is a standard surgical tool in patients with these problems. However, unknown secondary problems result from recent advances in obesity surgery. Plication of the anterior musculoaponeurotic wall is a widely and commonly used operative technique during abdominoplasty. Many different plication techniques have been published. So far no common standard and long-term effectiveness is proven. In addition, there is no sufficient literature dealing with the postoperative risks of plication of the musculoaponeurotic wall. Methods: Four patients with development of pseudotumors were reviewed. All four patients received 12 months in advance a primary abdominal lipectomy including a vertical plication of the musculoaponeurotic wall. Results: All four patients were females with mean age of 61 years and mean body mass index (BMI) of 37 kg/m². All four patients had developed a pseudotumor of the abdomen as a long-term complication more than 12 months after primary abdominal lipectomy including a vertical plication of the anterior rectus sheath. Conclusion: One should be aware of the potential long-term risk of secondary postoperative hematoma formation, with or without partial necrosis of the anterior rectus sheath after vertical plication of the anterior musculoaponeurotic wall. Viewed clinically and radiologically, such sequelas may appear as pseudotumor like masses and require immediate revision.