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4.
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. 相似文献
5.
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. 相似文献
6.
BackgroundExcess skin is well known after massive weight loss but, there is missing knowledge from various groups.ObjectivesTo describe and compare excess skin in a reference population during obesity, after obesity surgery, and after reconstructive abdominoplasty.SettingUniversity hospital, Sweden.MethodsThe following 6 groups were included: the reference population, obese adults before obesity surgery, obese adults after obesity surgery, adolescents after obesity surgery, super-obese adults after obesity surgery, and adults after abdominoplasty. All groups filled in the Sahlgrenska Excess Skin Questionnaire (SESQ). Some groups also underwent measurements of ptosis/excess skin on 4 body parts.ResultsAll groups scored significantly higher experience of and discomfort from excess skin compared with the reference population. SESQ scores were significantly higher for obese adults (10.5 ± 8.5) and even higher for adults and adolescents (12.3 ± 8.1 versus 14.4 ± 7.7) after obesity surgery compared with the reference population (1.5 ± 3.5). Abdominoplasty resulted in significantly reduced scores (2.9 ± 5.2). Those undergoing obesity surgery and weight loss had significantly less excess skin measured on arms, breasts, and abdomen compared with before surgery, except for the upper arms on the adolescents. Excess skin increased on inner thighs in both age groups after weight loss. Correlations between objectively measured ptosis/excess skin and the patients’ experience of and discomfort were .16 to .71, and the highest correlations were found among adolescents.ConclusionExcess skin is not a problem for the vast majority of the normal population but is linked to obesity and massive weight loss. The SESQ score illustrates major problems related to excess skin both for obese adults and after obesity surgery for adults and for adolescents, who have problems similar to or worse than adults. Abdominoplasty markedly decreases symptoms. 相似文献
7.
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. 相似文献
8.
BackgroundOverhanging 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.ObjectivesTo evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS.SettingOutpatient clinic.MethodsOne thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model.ResultsThere was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n?=?157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction.ConclusionsThere are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients. 相似文献
10.
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. 相似文献
12.
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. 相似文献
13.
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. 相似文献
14.
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. 相似文献
16.
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/m 2. 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. 相似文献
17.
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. 相似文献
18.
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/m 2. 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). 相似文献
20.
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. 相似文献
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