Skip to main content

Advertisement

SpringerLink
Log in

Operating on the Edge? Body Contouring Procedures in Patients with Body Mass Index Greater 35

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Body contouring surgery after massive weight loss was shown to ameliorate the patient’s quality of life and to enhance physical and psychological well-being. However, numerous patients are still obese when presenting for body contouring surgery, not able to lose additional weight for various reasons. Data regarding general feasibility, outcome, and postoperative complications in obese patients is rare. The aim of this study was to investigate the outcome in body contouring procedures in obese patients.

Methods

A retrospective chart review of 65 cases in 42 patients was performed. Patients with a body mass index (BMI) > 35 kg/m2 at the time of operation were enrolled and all different types of body contouring surgery were included. Complications were classified as major (need for surgical intervention) and minor complications.

Results

The median BMI of all patients was 38 kg/m2 (range 35.1–65.1 kg/m2). The majority of performed types of body contouring was abdominal body contouring (panniculectomy n = 27 (42%), abdominoplasty n = 12 (18%)). Complications occurred in 27 cases (41.5%). Twenty-one cases (32.3%) were classified as minor complications, six (9.2%) as major complications. The most common major complications were hematoma and wound dehiscence; the most common minor complication was seroma.

Conclusion

A reasonable risk for complications is well known in body contouring surgery especially in obese patients. It is imperative to discuss related risks and expected results. Taking several points into account concerning the perioperative management, reduction of major complications is possible even in still obese patients, making body contouring surgery a discussible option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016; 87(10026):1377–96.

  2. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer—viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794–8.

    Article  Google Scholar 

  3. Lementowski PW, Zelicof SB. Obesity and osteoarthritis. Am J Orthop (Belle Mead, NJ). 2008;37(3):148–51.

    Google Scholar 

  4. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8(8):Cd003641.

    Google Scholar 

  5. van der Beek ES, Te Riele W, Specken TF, et al. The impact of reconstructive procedures following bariatric surgery on patient well-being and quality of life. Obes Surg. 2010;20(1):36–41.

    Article  Google Scholar 

  6. Song AY, Rubin JP, Thomas V, et al. Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring, MD). 2006;14(9):1626–36.

    Article  Google Scholar 

  7. Modarressi A, Balague N, Huber O, et al. Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg. 2013;23(1):24–30.

    Article  CAS  Google Scholar 

  8. Klassen AF, Cano SJ, Scott A, et al. Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study. Obes Surg. 2012;22(10):1527–34.

    Article  Google Scholar 

  9. Kavalukas SL, Barbul A. Nutrition and wound healing: an update. Plast Reconstr Surg. 2011;127(Suppl 1):38s–43s.

    Article  CAS  Google Scholar 

  10. Pierpont YN, Dinh TP, Salas RE, et al. Obesity and surgical wound healing: a current review. ISRN Obes. 2014;2014:638936.

    PubMed  PubMed Central  Google Scholar 

  11. Momeni A, Heier M, Bannasch H, et al. Complications in abdominoplasty: a risk factor analysis. J Plast Reconstr Aesthet Surg. 2009;62(10):1250–4.

    Article  Google Scholar 

  12. Dragu A, Schnurer S, Unglaub F, et al. Wide topical negative pressure wound dressing treatment for patients undergoing abdominal dermolipectomy following massive weight loss. Obes Surg. 2011;21(11):1781–6.

    Article  Google Scholar 

  13. Ludolph I, Fried FW, Kneppe K, et al. Negative pressure wound treatment with computer-controlled irrigation/instillation decreases bacterial load in contaminated wounds and facilitates wound closure. Int Wound J. 2018;15:978–84.

  14. Rogliani M, Silvi E, Labardi L, et al. Obese and nonobese patients: complications of abdominoplasty. Ann Plast Surg. 2006;57(3):336–8.

    Article  CAS  Google Scholar 

  15. Vastine VL, Morgan RF, Williams GS, et al. Wound complications of abdominoplasty in obese patients. Ann Plast Surg. 1999;42(1):34–9.

    Article  CAS  Google Scholar 

  16. Neaman KC, Hansen JE. Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital. Ann Plast Surg. 2007;58(3):292–8.

    Article  CAS  Google Scholar 

  17. Arthurs ZM, Cuadrado D, Sohn V, et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg. 2007;193(5):567–70. discussion 70

    Article  Google Scholar 

  18. Ghnnam W, Elrahawy A, Moghazy ME. The effect of body mass index on outcome of abdominoplasty operations. World J Plast Surg. 2016;5(3):244–51.

    PubMed  PubMed Central  Google Scholar 

  19. Troppmann C, Santhanakrishnan C, Kuo JH, et al. Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus: a pilot study. Surgery. 2016;159(6):1612–22.

    Article  Google Scholar 

  20. Bailey CM, Troppmann C, Kuo J, et al. Panniculectomy in end-stage renal disease: six-year experience of performing panniculectomy in preparation for renal transplant. Ann Plast Surg. 2015;74(Suppl 1):S9–11.

    Article  CAS  Google Scholar 

  21. Kuo JH, Troppmann C, Perez RV, et al. Panniculectomy in preparation for renal transplantation: a new indication for an old procedure to reduce renal transplantation-associated wound complications. Plast Reconstr Surg. 2011;128(6):1236–40.

    Article  CAS  Google Scholar 

  22. Zuelzer HB, Ratliff CR, Drake DB. Complications of abdominal contouring surgery in obese patients: current status. Ann Plast Surg. 2010;64(5):598–604.

    CAS  PubMed  Google Scholar 

  23. Mericli AF, Drake DB. Abdominal contouring in super obese patients: a single-surgeon review of 22 cases. Ann Plast Surg. 2011;66(5):523–7.

    Article  CAS  Google Scholar 

  24. Giordano S, Victorzon M, Stormi T, et al. Desire for body contouring surgery after bariatric surgery: do body mass index and weight loss matter? Aesthet Surg J. 2014;34(1):96–105.

    Article  Google Scholar 

  25. Evers Larsson U, Mattsson E. Functional limitations linked to high body mass index, age and current pain in obese women. Int J Obes Relat Metab Disord. 2001;25(6):893–9.

    Article  CAS  Google Scholar 

  26. Powell JL, Kasparek DK, Connor GP. Panniculectomy to facilitate gynecologic surgery in morbidly obese women. Obstet Gynecol. 1999;94(4):528–31.

    CAS  PubMed  Google Scholar 

  27. Pearl ML, Valea FA, Disilvestro PA, et al. Panniculectomy in morbidly obese gynecologic oncology patients. Int J Surg Investig. 2000;2(1):59–64.

    CAS  PubMed  Google Scholar 

  28. Rasmussen RW, Patibandla JR, Hopkins MP. Evaluation of indicated non-cosmetic panniculectomy at time of gynecologic surgery. Int J Gynaecol Obstet. 2017;138(2):207–11.

    Article  Google Scholar 

  29. Nemerofsky RB, Oliak DA, Capella JF. Body lift: an account of 200 consecutive cases in the massive weight loss patient. Plast Reconstr Surg. 2006;117(2):414–30.

    Article  CAS  Google Scholar 

  30. Coon D, Gusenoff JA, Kannan N, et al. Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases. Ann Surg. 2009;249(3):397–401.

    Article  Google Scholar 

  31. Manahan MA, Shermak MA. Massive panniculectomy after massive weight loss. Plast Reconstr Surg. 2006;117(7):2191–7. discussion 8-9

    Article  CAS  Google Scholar 

  32. Dragu A, Horch RE. Concept of reconstructive body shaping in obesity. Evidence-based therapy algorithm. Chirurg. 2014;85(1):37–41. Plastische Korperkorrektur im Gesamtkonzept der Adipositastherapie. Evidenzbasierter Therapiealgorithmus ger

    Article  CAS  Google Scholar 

  33. Hillenbrand A, Henne-Bruns D, Wolf AM. Panniculus, giant hernias and surgical problems in patients with morbid obesity. GMS Interdiscip Plast Reconstr Surg DGPW. 2012;1:Doc05.

    PubMed  PubMed Central  Google Scholar 

  34. Birgisson G, Park AE, Mastrangelo Jr MJ, et al. Obesity and laparoscopic repair of ventral hernias. Surg Endosc. 2001;15(12):1419–22.

    Article  CAS  Google Scholar 

  35. Tsereteli Z, Pryor BA, Heniford BT, et al. Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia. 2008;12(3):233–8.

    Article  CAS  Google Scholar 

  36. Novitsky YW, Cobb WS, Kercher KW, et al. Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg. 2006;141(1):57–61.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Anja M. Boos

    Present address: Department of Plastic Surgery, Hand and Burn Surgery, University Hospital of Aachen, RWTH University of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

Authors and Affiliations

  1. Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Germany

    Theresa Hauck, Marweh Schmitz, Raymund E. Horch, Andreas Arkudas, Anja M. Boos, Aijia Cai & Ingo Ludolph

Authors
  1. Theresa Hauck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marweh Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymund E. Horch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Arkudas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anja M. Boos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aijia Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ingo Ludolph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theresa Hauck.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hauck, T., Schmitz, M., Horch, R.E. et al. Operating on the Edge? Body Contouring Procedures in Patients with Body Mass Index Greater 35. OBES SURG 29, 1563–1570 (2019). https://doi.org/10.1007/s11695-018-03697-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-03697-0

Keywords

Search

Navigation