The Prevalence of Body Contouring Surgery After Gastric Bypass Surgery

Background  

As bariatric surgery has become more popular, more patients are undergoing body contouring surgery after massive weight loss. Many of the surgical procedures performed on the massive weight loss patient are complex and labor-intensive. Therefore, the plastic surgery unit needs to be prepared for a patient's demand. Little literature is available on how frequently patients who have undergone gastric bypass surgery receive body contouring surgery.     

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.     

Dermalipectomy for Body Contouring after Bariatric Surgery in Aegean Region of Turkey

Background: The only proven effective long-term treatment for morbid obesity is bariatric surgery. After surgery, additional problems may arise such as redundant hanging skin and a poor body image. The patient's quality of life and social acceptance may thus still be hindered. Body contouring operations remain the only hope here. Methods: Body contouring surgery was performed on 11 patients out of 38 who had had vertical banded gastroplasty. General self-consciousness, social self-consciousness of appearance and sexual and bodily self-consciousness of appearance were measured with a retrospective questionnaire. Results: Timing of body contouring surgery was determined according to the demand of the patient and stabilization of the patient's weight status. On average the first plastic surgery operation was performed after 17 (12-25) months. Mean age was 37.4 (34-65) and mean excess weight loss was 57.6 (37-129). In the 11 patients who underwent plastic procedures, a total of 23 such operations were performed, and 8 complications were encountered in these 23 operations. General self-consciousness and sexual bodily self-consciousness of appearance showed improvement after bariatric surgery and further improvement after the plastic surgery. Conclusion: For markedly redundant skin after massive weight loss, dermalipectomy is the only treatment. This improves the patient's general, sexual and bodily self-consciousness.     

Body Contouring Surgery Following Bariatric Surgery and Dietetically Induced Massive Weight Reduction: A Risk Analysis

Background  This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction. Methods  All patients presenting with a maximal BMI ≥35 kg/m² before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) ≥ 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results. Results  A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data. Conclusion  Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction. None of the authors had a commercial interest in the subject of the study or financial benefit from the results.     

Plastic Surgery After Gastric Bypass Improves Long-Term Quality of Life

Background

Excess skin after massive weight loss impairs patient’s health-related quality of life (HRQoL). Therefore, body-contouring surgeries can be proposed. However, few data exist concerning the effect of body contouring after bariatric surgery on HRQoL, including control group with a long-term follow-up.

Methods

In a prospective study, 98 consecutive patients who had body contouring after gastric bypass for obesity (BMI > 40) were included (group A). A matched control-group containing 102 patients who had only gastric bypass was selected (group B). HRQoL was measured by Moorehead–Ardelt questionnaire before (group A1) and after (A2) body contouring, and at different time points for group B until 8 years post-gastric bypass. To evaluate the effect of body contouring by two parallel methods, HRQoL was compared between groups A1 and A2, and between A2 and B.

Results

We found that body contouring procedures improved significantly patients’ HRQoL, in comparison to those who had only gastric bypass. Of the patients who had body contouring (group A2), 57 % evaluated their HRQoL “much better” in comparison to only 22 % of patients before body contouring (group A1) or those who never had body contouring (group B) (p?<?0.001). The improvement was significant in all sub-domains of HRQoL: self-esteem, social life, work ability, sexual activity and physical activity (p?<?0.001), and remained stable over time.

Conclusions

Our study confirms the important role of plastic surgery in treatment of patients after massive weight loss. We demonstrated that body contouring, despite important scars, significantly improves satisfaction and HRQoL of patients after gastric bypass. Therefore, the treatment of morbid obesity should not be deemed achieved unless plastic surgery has been considered.     

Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients

Background

This study was done to analyze the problems of post-bariatric patients with excess skin and to determine their interest in body contouring surgery. The self-administered Sahlgrenska Excess Skin Questionnaire (SESQ) was used together with a study-specific questionnaire.

Methods

The patients who were operated with bariatric surgery at Sahlgrenska University Hospital between 1999 and 2008 were identified and sent the SESQ and a study-specific questionnaire.

Results

The response rate was 65 % (23 % men). The most common problem in both men and women was the feeling of having an unattractive body (91 and 67 %, respectively). The most frequently reported sites of excess skin were the upper arms in women (91 %) and the abdomen in men (78 %). In both women and men, excess skin on the abdomen was reported to cause the most discomfort (median 7 and 3, respectively, on a scale from 0 to 10). Women reported significantly more problems, discomfort, and amount of excess skin (p?<?0.05) than men. There was a strong correlation between the amount of excess skin and the degree of discomfort for all body parts. Seventeen percent of the responders had been operated with body contouring surgery of one body part and 5 % of two or more. Fourteen percent desired body contouring surgery of one body part and 61 % of two or more.

Conclusions

Most post-bariatric patients, but women in particular, experience significant problems of excess skin and request body contouring surgery.     

Satisfaction and Quality-of-Life Issues in Body Contouring Surgery Patients: a Qualitative Study

Background

Body contouring, which encompasses a range of surgical procedures on different areas of the body, is one of the most rapidly growing areas of plastic surgery. Little is known about outcomes from the perspective of post-weight loss body contouring patients. The aim of our qualitative study was to identify the health and aesthetic concerns of such patients through in-depth patient interviews.

Methods

Forty-three bariatric surgery post-weight loss body contouring patients were recruited between September 2009 and January 2011 from the offices of five plastic surgeons located in the USA and Canada. Interviews were used to explore the impact that obesity, weight loss, and body contouring surgery had on all aspects of the patient??s life. Interviews were transcribed and data analysis involved coding and the use of the constant comparison method to develop categories and themes. Interviewing continued until no new themes emerged.

Results

Patients described a range of important health and aesthetic concerns related to body contouring surgery following massive weight loss, including the following: appearance-related concerns, physical health concerns, sexual health concerns, psychological health concerns, and social health concerns. Body contouring surgery played an instrumental role in the completion of the entire weight loss process for patients.

Conclusions

The removal of excess skin leads to improvements in a patient??s appearance and enhanced physical, psychological, and social health and well-being. In order to appropriately measure the impact of body contouring procedures from the patient??s perspective, a well-developed psychometrically sound patient-reported outcome instrument is needed.     

Body lift

The body in the patient who has lost a massive amount of weight presents an extreme form of traditional esthetic and functional body contour concerns. Routine body contouring procedures usually produce only suboptimal results in this patient population. The body lift described herein is an excellent alternative to treat the body contour deformity of the patient who has undergone bariatric surgery. As with every technique, careful patient selection, education, and preparation are critical to minimizing complications and optimizing outcome.     

Body Taping for Contour Surgery

Background  Preoperative marking is of primary importance in body contouring and when precise simulation of skin excisions is difficult. Because the “cut as you go” principle can be delicate, especially in patients after massive weight loss, a simple and quick method is needed for preoperative planning. We suggest an approach that helps visualize the optimal skin incision lines and simulates the postoperative result by body taping. Methods  Twelve patients who underwent abdominal contouring, including classic and vertical abdominoplasties as well as dog ear and scar revision, were prospectively analyzed. The skin to be excised was preoperatively folded, taped, and then marked. The area marked was measured and compared with the actual intraoperatively resected area and the postoperative result was evaluated after 1 year by the patients and three surgeons. Results  With body taping, an 83% congruence between the preoperative planning and the surgery was obtained and only two patients had additional skin resected. No wound dehiscence and flap necrosis occurred and patients as well as surgeons scored the final body contour positively. Conclusion  Body taping is a simple, quick, and economic method for planning contour surgery with high accuracy as demonstrated by the low rate of intraoperative changes of the planned resection and low complication rate.     

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.     

Health and appearance: Factors motivating the decision to seek bariatric surgery

BackgroundFew studies have examined the motivating factors and people that lead patients to seek bariatric surgery. Bariatric surgery helps to improve body image, but little is known about patients’ desired changes in the appearance of specific body parts.ObjectivesTo identify key factors and people motivating patients’ decision to seek bariatric surgery, and to assess body dissatisfaction and desire for surgery to change the appearance of specific body parts.SettingU.S. university-based hospital clinic.MethodsPatients seeking bariatric surgery (N = 208, 78.4% women, 52.4% black, mean age = 42.0 ± 12.3 yr, mean body mass index = 46.7 ± 8.5 kg/m²) completed the Reasons for Bariatric Surgery questionnaire before their preoperative Psychosocial–behavioral evaluation. Participants rated (1–10) the importance of 15 potential reasons and 7 potential people motivating their decision to seek bariatric surgery. Participants also rated their dissatisfaction and desire for surgery to change the appearance of 11 body parts.ResultsMean scores of motivating factors were highest for Physical Health (9.9 ± .4), followed by Longevity (9.7 ± .9). Patients reported high body dissatisfaction and desire for surgery to change the appearance of several body parts, including stomach and thighs. “Myself” was the highest-rated motivating person, followed by healthcare providers, family, and someone who had undergone bariatric surgery.ConclusionsHealth is the primary reason reported by patients for seeking bariatric surgery. Patients also report a strong desire for surgery to change the appearance of their body. Patients are self-driven to pursue surgery but are also influenced by healthcare providers, family, and people who have undergone surgery. (Surg Obes Relat Dis 2019;X:XXX–XXX.) © 2019 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

Attitudes of Morbidly Obese Patients to Weight Loss and Body Image following Bariatric Surgery and Body Contouring

Background The authors evaluated body image attitudes in post-obese persons following bariatric surgery who require cosmetic and body contouring operations. Methods We studied 20 morbidly obese women prior to biliopancreatic diversion (BPD) (OB group), 20 post-obese women at >2 years following BPD (POST group), 10 post-obese women following BPD who required cosmetic procedures (POST-A group), 10 post-obese women after BPD and subsequent cosmetic surgery (POST-B group), and 20 healthy lean controls. Attitudes to weight and shape were evaluated by means of the Body Uneasiness Test (BUT). Results In comparison with the obese patients in the POST group, lower BUT scores were observed, while in the POST-A group the values were very similar to those observed in the non-operated obese individuals. In the individuals having received cosmetic surgery, the BUT findings were similar to those recorded in the POST group patients, the values approaching data found in the controls. Conclusion Despite a fully satisfactory weight loss and maintenance, the post-BPD individuals requiring aesthetic surgery showed some disparagement of body image; in these subjects, cosmetic and body contouring procedures may actually improve body weight and shape attitudes towards normality.     

After Massive Weight Loss: Patients’ Expectations of Body Contouring Surgery

Background  

Massive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass body changes, and to learn about the expectations and impairments related to body contouring surgery.     

Bariatric surgery and work-up of the massive weight loss patient

Bariatric surgery remains the treatment of choice for the extremely obese patient, with an exponential growth in the number of procedures performed in response to the obesity epidemic. There are a variety of bariatric procedures available, which differ according to the method in which they achieve sustained weight loss. Plastic surgeons are beginning to see large numbers of patients who have undergone bariatric surgery and who have sustained massive weight loss (MWL) for evaluation of complex and lengthy-body contouring procedures. Proper evaluation of the patient who has sustained MWL requires an understanding of the physiologic impact of different bariatric procedures with particular knowledge of potential long-term nutritional complications.     

Histological Alterations Following Bariatric Surgery: Pilot Study

Background  Macroscopic clinical evidence of tissue damaging following bariatric surgery pushed plastic surgeons to presume microscopic alterations as well. Methods  Five preliminary cases studied randomly, and compared with healthy tissues, confirmed these initial suspects. A deeper and wider study has then been structured. Results  Preliminary results are so evident to encourage us to carry on an estimated 2–3 years multidisciplinary study. Conclusions  What we want to study is if histological post-bariatric alterations are confirmed, and if these can be considered responsible for higher complication rate in body contouring following bariatric surgery.     

Current Concepts in Post-bariatric Body Contouring

Background  

The advent of bariatric surgery has led to a new subspecialty in plastic surgery for contouring the skin and fat remaining after massive weight loss. This field is increasingly recognized as a vital component to the multi-disciplinary treatment approach to care for the obese patient. The author sought to review key concepts in patient selection, technical advancements, and post-operative care in body contouring following weight loss surgery.     

A Nomogram for Predicting Surgical Complications in Bariatric Surgery Patients

Background  

To minimize morbidity and mortality associated with surgery risks in the obese patient, algorithms offer planning operative strategy. Because these algorithms often classify patients based on inadequate category granularity, outcomes may not be predicted accurately. We reviewed patient factors and patient outcomes for those who had undergone bariatric surgical procedures to determine relationships and developed a nomogram to calculate individualized patient risk.     

Prevalence of Obesity Among Children and/or Grandchildren of Adult Bariatric Surgery Patients

Background  Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children and grandchildren (≤12 years of age) of adult bariatric surgery patients. Methods  Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May 2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected. The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined as BMI percentile ≥95. Statistical significance was set at p < 0.05. Results  One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m²). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile ≥95. Only 29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027). Conclusions  This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese children, interventions aimed at all family members merit consideration.     

Outcomes of Laparoscopic Bariatric Surgery after Renal Transplant

Obesity has been associated with poor graft and patient survival after kidney transplantation, requiring functional increase of anti-rejection drugs. Weight loss surgery may be a good alternative in this clinical scenario. The aim of this report is to describe the outcomes of bariatric procedures performed in patients after kidney transplantation at our institution. A retrospective chart review of a prospectively collected database was conducted to analyze the outcomes of morbidly obese patients after kidney transplantation who underwent laparoscopic bariatric procedures between November 2004 and October 2007. Our series included five patients who underwent a bariatric procedure following kidney transplantation. All patients were females, with a mean age of 40.8 years (range 30–48) and mean body mass index (BMI) of 52.2 (range 48–69). Percent of excess weight loss (%EWL) at 2 years was over 50% for all patients; other comorbidities that might affect postoperative renal function were diabetes mellitus in 2/5 patients, hypertension in 5/5 patients, and chronic heart failure in 1/5 patients. Four patients had laparoscopic Roux-en-Y gastric bypass and one had laparoscopic sleeve gastrectomy. There were no postoperative complications in any patients, and no alteration to the dosages of the immunosuppressant drugs were recorded after bariatric surgery. Laparoscopic bariatric surgical techniques may be used safely and effectively to control obesity in renal transplant patients.     

Körperstraffung nach morbider Adipositas

An increasing number of patients desire body contouring surgery after massive weight loss, whether from bariatric surgery or a change in lifestyle. The fact that many body regions lose their elasticity and tissue-tension has led to stepwise treatments including abdominoplasty, thigh lift, buttocks and hip lift or liposuction. However, these procedures often do not treat the reason for the deformities. The lower body lift first described by Ted Lockwood in 1993 is a procedure that allows simultaneous skin resection and tightening of different regions including the abdomen, buttocks, hips, and thighs. In this article the authors present their 10-year experience with the body lift. Patient selection, technical details, pre- and postoperative care, complications, and expected results are all discussed.