Body contouring following massive weight loss

Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.     

Autoprosthesis buttock augmentation during lower body lift

With the increasing popularity of bariatric surgery, patients with multiple body contour deformities have become more common in plastic surgery practice. Most of the deformities involving the abdomen, thighs, and buttocks can be effectively corrected with belt lipectomy and lower body lift. A common problem with this procedure is postoperative loss of gluteal projection and resulting flattened buttock contour, which is directly proportional to the extent of lower body lift achieved. The use of local myocutaneous flaps to provide coverage for the lumbosacral defects is a common plastic surgery procedure. The authors have used these techniques to create an autologous buttock implant for additional projection during a lower body lift. A local myocutaneous flap originating within the regularly excised supragluteal tissue is rotated caudally to function as an autologous buttock implant. This flap has reliable circulation, can be custom designed for each patient, requires minimal additional operating time, and allows the creation of more than one flap if necessary. This article describes the results of this procedure used for 20 consecutive women. There were no major complications, and the most common minor complications included delayed wound healing and local hardness in the area, suggesting fat necrosis, which resolved without intervention in a few months. High patient satisfaction combined with a low complication rate suggests that this reliable, versatile technique nicely complements the lower body lift procedure.     

Aspects of excess skin in obesity,after weight loss,after body contouring surgery and in a reference population

Background

Excess skin is well known after massive weight loss but, there is missing knowledge from various groups.

The Finishing Touch: body contouring after bariatric surgery

With pronounced weight loss, redundant abdominal skin and lax abdominal muscles cause the patients to feel unattractive. Correction of the cosmetic problem is an important step in promoting increased self-esteem, as well as providing relief from the various unpleasant symptoms caused by a large pannus. Body contouring is a procedure bariatric surgeons should provide for their patients. Panniculectomy is the most commonly performed operation. It provides many benefits, not the least of which is markedly improved appearance. Unfortunately, many surgeons fail to tighten the abdominal muscles while performing the panniculectomy. Although the redundant skin is removed, a ‘pot belly’ deformity of the lower abdomen persists. A technique has been developed for tightening the abdominal musculature, resecting the pannus, and on some patients, performing limited liposuction. A nicely flattened abdomen with a narrowed waistline is the result. Ninety-seven patients have undergone this operation in our hands over the past 3 years. The technique is described, and postoperative management discussed.     

Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery

Background

Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results.

Weight loss expectations and weight loss after surgery: the mediating role of body image and weight concerns

BackgroundPreliminary evidence suggests bariatric patients’ unrealistic expectations regarding weight loss after bariatric surgery are related to worse weight outcomes.ObjectivesThis study aimed to examine preoperative weight loss expectations and their association with weight loss, body image, eating behavior, and depressive symptoms.SettingHospital Centers, Portugal.MethodsThis longitudinal study assessed 64 bariatric patients. Participants were asked about their desired postoperative weight and responded to the following set of self-report measures before and 2 years after surgery: Eating Disorder Examination Questionnaire, Beck Depression Inventory, and Body Shape Questionnaire.ResultsThe majority of participants (81.1%) did not reach the desired weight, 10 (13.5%) lost more weight than initially expected, and only 4 (5.4%) obtained the desired weight. More discrepant expectations were associated with more dissatisfaction with the body image and higher scores concerning eating psychopathology after surgery but not presurgery. Postsurgery body dissatisfaction and weight concerns were significant mediators in the relationship between discrepant expectations and poorer weight loss.ConclusionsThis study shows bariatric patients hold preoperative unrealistic expectations about their weight loss, and that they sustain those expectations in the postoperative time. Our findings bring evidence for an interplay between preoperative and postoperative factors to explain weight loss. Educating about flexible weight loss goals before surgery may be a simple strategy to optimize psychological functioning and weight loss after surgery.     

Abdominoplasty and gluteoplasty after massive weight loss: an all-in-one technique*

Introduction: Patients requesting body-contouring surgery after massive weight loss often present with abdominal and lumbar skin excess as well as gluteal ptosis and loss of gluteal projection. In order to restore gluteal projection a circular abdominoplasty in combination with an autologous gluteal augmentation (all-in-one technique) can be performed.

Objective: To compare outcomes for patients who underwent a circular abdominoplasty with or without autologous gluteal augmentation.

Methods: In a retrospective study we analyse 24 patients who underwent a circular abdominoplasty between 2006 until 2014 at the University Hospital of Ghent, Belgium. Fourteen patients underwent a classic circular abdominoplasty (4 men and 10 women). Ten patients underwent the all-in-one technique (all women). Mean age was 43 in the classic abdominoplasty group and 41 in the all-in-one technique group. All the patients endured massive weight loss after bariatric surgery. Gluteal augmentation was performed using lumbar dermal fat rotation flaps based on perforators of the 4th lumbar artery. For statistical analysis a Fisher exact tests was used.

Results: Postoperative photographs showed that gluteal projection had been increased in patients who underwent the all-in-one technique. The mean operation time in this group was 3h49min versus 2h47min in the group who underwent a classic circular abdominoplasty. The mean hospital stay in both groups was 6 days. Complication rate was comparable between both the groups.

Conclusion: The all-in-one technique is an efficient method to improve both abdominal and gluteal body contour in patients who endured massive weight loss.     

Philosophy,technical principles,selection, and indication in body contouring surgery

The experiences of almost three decades of performing various types of body contouring surgery, in both pre- and postlipoplasty periods, using many different techniques are described. Contouring surgery for such body areas as the abdomen, flanks, inner and outer thighs, and buttocks is discussed in detail.     

Truncal body contouring surgery in the massive weight loss patient

Body contouring of massive weight loss patients is the latest frontier in plastic surgery. It is important to become familiar with the presentation of these patients and with the delineation and effective treatment of their deformities. Because they usually present with circumferential excess, circumferential belt lipectomy treats their truncal contour as a unit. This article details the preoperative work-up, intraoperative technique, and postoperative course for the belt-lipectomy patient. Results and how to predict them are discussed. Complications are enumerated and suggestions offered for avoiding them.     

Clinical outcome of patients undergoing abdominoplasty after massive weight loss

BackgroundAbdominoplasty is one of the most commonly performed surgical procedures to reshape the body contour in patients who have undergone massive weight loss.ObjectivesThis study was undertaken to assess the clinical outcome, complication rates, and risk factors for complications of patients undergoing abdominoplasty after massive weight loss.SettingUniversity Medical Centre Hamburg-Eppendorf, Hamburg, Germany.MethodClinical outcome was retrospectively analyzed in 121 patients, who underwent abdominoplasty. The retrospective analysis included demographic data of patients, such as sex, age, body mass index (BMI), and pre-existing illnesses. Moreover, postoperative complications including seroma, hematoma, wound infection, and tissue necrosis were analyzed.ResultsIn our study cohort, the median age was 43.7 years, the median weight was 94.7 kg, and the median BMI was 32.3 kg/m². The majority of included patients were women (70.3%). Death occurred in none of the patients. Among individuals, wound infection occurred in 3.3%, tissue necrosis in 1.7%, seroma in 7.4%, and hematoma in 3.3% of patients during the postoperative course. Reoperations were necessary in 2 patients (1.7%) due to postoperative bleeding and tissue necrosis of the navel. Tissue necrosis was significantly more often seen in a subset individual with type 2 diabetes (P = .006). Moreover, the rate of reoperations was significantly higher in patients with pre-existing cardiovascular illnesses compared with cardiovascular healthy patients (P = .036). Multivariate analysis analyzing risk factors for postoperative complications, including sex, age, BMI, diabetes, pulmonary disease, and cardiovascular disease, revealed strong independent relevance for type 2 diabetes (P = .024).ConclusionsWe found that abdominoplasty is a safe operative procedure. In addition, the risk for complications is significantly increased in the subgroup of diabetic patients and patients with cardiovascular diseases.     

After weight loss,what skin removal procedure has the most effect using Body Q metrics?

BackgroundAlthough postbariatric body contouring procedures have the ultimate goal of restoring quality of life, there currently exist minimal data assessing the effect of these procedures.ObjectivesTo identify the most important body contouring procedure for quality of life (QoL).SettingUniversity Hospital, Online Questionnaire, Germany.MethodsA cross-sectional study was designed using a validated version of the internet-based Body Q questionnaire, which was distributed among patients using social media and patient events.ResultsA total of 460 patients (443 female, 17 male) participated and fulfilled inclusion criteria. Of those patients, 191 (41.5%) had already undergone surgery, and the rest served as the control group. Patients in a postoperative status had a significantly (P < .05) higher QoL regarding all body regions. Additionally, patients who underwent body contouring surgery showed significantly higher QoL in regard to sexuality, society, body image, and psychosocial metrics. Abdominoplasty represents the most important procedure for QoL. The control group showed the greatest dissatisfaction in the area of the inner thighs.ConclusionBody contouring procedures have been shown to significantly restore and enhance a patient’s QoL. Conducting contouring surgeries is specifically associated with an increase in body image satisfaction as well as patient acceptance of certain body regions.     

Limb Contouring after Massive Weight Loss: Functional Rather than Aesthetic Improvement

Background  After massive weight loss, both upper and lower limbs show a similar deformity which consists of redundancy and ptosis of the cutaneous mantle. Many disturbances are associated with this abnormality, which can be treated surgically. A retrospective review of limb-contouring procedures after massive weight loss is presented. Methods  Thigh lift and arm lift procedures are described. All surgeries of upper and lower limbs contouring performed between 2003 and 2006 are reviewed with regard to quantity of tissue removed, comorbidities, complications and patients’ satisfaction, which was surveyed through a questionnaire exploring functional and esthetic results (maximum score 3). Results  Among 48 bilateral limb-contouring procedures, medial thigh lifts were 35 (73%) and brachioplasties were 13 (27%). Mean age was 46 and average body mass index variation was 20 kg/m². The most frequent comorbidity was gallstones (28%). In 46% of the whole group of patients, there was no complication to mention. The most frequent complication was acute anaemia in both procedures (43% in thigh lift and 54% in arm lift). Mean quantity of adipose–dermoid tissue removed was 766 g in thigh lift and 463 g in arm lift. In case of surgery combined with liposuction, the average aspirated volume was 1,933 ml (thighs) and 1,117 ml (arms). Patients’ satisfaction was 2.7 for thighs and 2.6 for arms, as average. Conclusion  The rate of complications in limb contouring after weight loss is higher than the analogue esthetic procedures. Nevertheless, due to the rehabilitative significance of limb surgery after weight loss, this step is to be included as fundamental in obese patients’ surgical therapy. Data partially presented at the XVI Conference of the Italian Society of Obesity Surgery (Capri, May 14–16, 2008).     

Body contouring in adolescents after bariatric surgery

BackgroundBariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown.ObjectivesDescribe the incidence and effect of BCS following bariatric surgery among adolescents.SettingUniversity Hospitals.MethodsTeen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin–related symptoms between those who did and those who did not undergo BCS.ResultsAmong the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n = 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P = .04 and P = .03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS.ConclusionFew adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.