Skip to main content

Advertisement

SpringerLink
Log in

Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis

  • Original Article
  • Body Contouring
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Our main objective is to evaluate the effect of body contouring surgery (BCS) on the magnitude and durability of weight loss after bariatric surgery.

Methods

Medline, EMBASE, Cochrane, and Scopus search were conducted from the time of their inception to June 2020. We included comparative studies that assessed weight progression, in terms of Body Mass Index change (∆BMI), Total Body Weight Loss (TBWL%), and Excess Weight Loss (%EWL) for the post-bariatric patient population and the effect of BCS on weight progression.

Results

Eleven articles were included. The pooled sample size was 2307, of which 691 were cases who underwent BCS post-bariatric surgery, and 1616 were comparative controls. The mean follow-up time for cases and controls were 61.6 ± 23.8 months and 52.2 ± 23.8 months, respectively. Nine studies reported results of BMI changes, six provided %EWL, and five used %TBWL. Significant improvement in weight loss was observed in the BCS group when measured by either ∆BMI (3 kg/m2 points decrease, p 0.023), %TBWL (6% increase, P < 0.0001), or %EWL (14% increase, P < 0.0001). Sub-group analysis showed that increased follow-up time was associated with higher TBWL% (p 0.02).

Conclusion

The evidence provided in this review strongly supports the added long-term benefits of body contouring surgery for selected patients after massive weight loss following bariatric surgery. Having a multidisciplinary team that involves a bariatric and a plastic surgeon as well as nutritionists and psychologists for the management of patients with obesity going through the bariatric pathway is recommended.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

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. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet 384(9945):766–781

    Article  PubMed  PubMed Central  Google Scholar 

  2. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH et al (2005) Meta-analysis: surgical treatment of obesity. Ann Intern Med. 142(7):547–559

    Article  PubMed  Google Scholar 

  3. Hachem A, Brennan L (2016) Quality of life outcomes of bariatric surgery: a systematic review. Obes Surg. 26(2):395–409

    Article  PubMed  Google Scholar 

  4. Raaijmakers LC, Pouwels S, Thomassen SE, Nienhuijs SW (2017) Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms. Eur J Clin Nutr. 71(4):441–449

    Article  CAS  PubMed  Google Scholar 

  5. Altieri MS, Yang J, Park J, Novikov D, Kang L, Spaniolas K et al (2017) Utilization of body contouring procedures following weight loss surgery: a study of 37,806 patients. Obes Surg. 27(11):2981–2987

    Article  PubMed  Google Scholar 

  6. Kinzl JF, Traweger C, Trefalt E, Biebl W (2003) Psychosocial consequences of weight loss following gastric banding for morbid obesity. Obes Surg. 13(1):105–110

    Article  CAS  PubMed  Google Scholar 

  7. Di Gregorio JM, Palkoner R (2001) Quality of life after obesity surgery, an evidence-based medicine literature review: how to improve systematic searches for enhanced decision-making and clinical outcomes. Obes Surg. 11(3):318–326

    Article  PubMed  Google Scholar 

  8. Biörserud C, Olbers T, Fagevik OM (2011) Patients’ experience of surplus skin after laparoscopic gastric bypass. Obes Surg. 21(3):273–277

    Article  PubMed  Google Scholar 

  9. Klassen AF, Kaur M, Breitkopf T, Thoma A, Cano S, Pusic A (2018) Using the BODY-Q to understand impact of weight loss, excess skin, and the need for body contouring following bariatric surgery. Plast Reconstr Surg. 142(1):77–86

    Article  CAS  PubMed  Google Scholar 

  10. Kitzinger HB, Abayev S, Pittermann A, Karle B, Kubiena H, Bohdjalian A et al (2012) The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg. 22(1):8–12

    Article  PubMed  Google Scholar 

  11. Poulsen L, Klassen A, Rose M, Roessler KK, Juhl CB, Støving RK et al (2017) Patient-reported outcomes in weight loss and body contouring surgery: a cross-sectional analysis using the BODY-Q. Plast Reconstr Surg. 140(3):491–500

    Article  CAS  PubMed  Google Scholar 

  12. Colwell AS (2010) Current concepts in post-bariatric body contouring. Obes Surg. 20(8):1178–1182

    Article  PubMed  Google Scholar 

  13. Klassen AF, Cano SJ, Scott A, Johnson J, Pusic AL (2012) Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study. Obes Surg. 22(10):1527–1534

    Article  PubMed  Google Scholar 

  14. Sarwer DB, Wadden TA, Fabricatore AN (2005) Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 13(4):639–648

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. de Zwaan M, Georgiadou E, Stroh CE, Teufel M, Köhler H, Tengler M et al (2014) Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups. Front Psychol. 5:1310

    Article  PubMed  PubMed Central  Google Scholar 

  17. Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B (2013) Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg. 23(1):24–30

    Article  CAS  PubMed  Google Scholar 

  18. Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF (2015) Trends in weight regain following roux-en-y gastric bypass (RYGB) bariatric surgery. Obes Surg. 25(8):1474–1481

    Article  PubMed  Google Scholar 

  19. Santo MA, Riccioppo D, Pajecki D, Kawamoto F, de Cleva R, Antonangelo L et al (2016) Weight regain after gastric bypass: influence of gut hormones. Obes Surg. 26(5):919–925

    Article  PubMed  Google Scholar 

  20. de Vries CEE, Kalff MC, van Praag EM, Florisson JMG, Ritt M, van Veen RN et al (2020) The influence of body contouring surgery on weight control and comorbidities in patients after bariatric surgery. Obes Surg. 30(3):924–930

    Article  PubMed  Google Scholar 

  21. Agarwal S, Shenaq D, Teven CM, Prachand V, Roughton M, Zachary L (2017) Body contouring after obesity surgery is associated with a weight loss benefit among patients. J Plast Reconstr Aesthet Surg. 70(9):1186–1190

    Article  PubMed  Google Scholar 

  22. Balagué N, Combescure C, Huber O, Pittet-Cuénod B, Modarressi A (2013) Plastic surgery improves long-term weight control after bariatric surgery. Plast Reconstr Surg. 132(4):826–833

    Article  PubMed  CAS  Google Scholar 

  23. Froylich D, Corcelles R, Daigle CR, Aminian A, Isakov R, Schauer PR et al (2016) Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery. Surg Obes Relat Dis. 12(9):1731–1736

    Article  PubMed  Google Scholar 

  24. Wiser I, Heller L, Spector C, Fliss E, Friedman T (2017) Body contouring procedures in three or more anatomical areas are associated with long-term body mass index decrease in massive weight loss patients: a retrospective cohort study. J Plast Reconstr Aesthet Surg. 70(9):1181–1185

    Article  PubMed  Google Scholar 

  25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  26. McGuire C, Samargandi OA, Corkum J, Retrouvey H, Bezuhly M (2019) Meta-analyses in plastic surgery: can we trust their results? Plast Reconstr Surg. 144(2):519–530

    Article  CAS  PubMed  Google Scholar 

  27. Samargandi OA, Hasan H, Thoma A (2016) Methodologic quality of systematic reviews published in the plastic and reconstructive surgery literature: a systematic review. Plast Reconstr Surg. 137(1):225e-e236

    Article  CAS  PubMed  Google Scholar 

  28. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 73(9):712–716

    Article  PubMed  Google Scholar 

  29. Center for Evidence Based Medicine, Oxford. Level of evidence. OCEBM Levels of Evidence Working Group*. The Oxford Levels of Evidence 2. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence

  30. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med Zagreb. 22(3):276–282

    Article  PubMed  PubMed Central  Google Scholar 

  31. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wiser I, Avinoah E, Ziv O, Parnass AJ, Averbuch Sagie R, Heller L et al (2016) Body contouring surgery decreases long-term weight regain following laparoscopic adjustable gastric banding: a matched retrospective cohort study. J Plast Reconstr Aesthet Surg. 69(11):1490–1496

    Article  PubMed  Google Scholar 

  33. Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration. www.cochrane-handbook.org

  34. Tremp M, Delko T, Kraljević M, Zingg U, Rieger UM, Haug M et al (2015) Outcome in body-contouring surgery after massive weight loss: a prospective matched single-blind study. J Plast Reconstr Aesthet Surg. 68(10):1410–1416

    Article  PubMed  Google Scholar 

  35. Monpellier VM, Antoniou EE, Mulkens S, Janssen IMC, van der Molen ABM, Jansen ATM (2018) Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery. Surg Obes Relat Dis. 14(10):1507–1515

    Article  PubMed  Google Scholar 

  36. Smith OJ, Hachach-Haram N, Greenfield M, Bystrzonowski N, Pucci A, Batterham RL et al (2018) Body contouring surgery and the maintenance of Weight Loss following Roux-En-Y gastric bypass: a retrospective study. Aesthet Surg J. 38(2):176–182

    Article  PubMed  Google Scholar 

  37. Stuerz K, Piza H, Niermann K, Kinzl JF (2008) Psychosocial impact of abdominoplasty. Obes Surg. 18(1):34–38

    Article  PubMed  Google Scholar 

  38. Singh D, Zahiri HR, Janes LE, Sabino J, Matthews JA, Bell RL et al (2012) Mental and physical impact of body contouring procedures on post-bariatric surgery patients. Eplasty. 12:e47

    PubMed  PubMed Central  Google Scholar 

  39. Pecori L, Serra Cervetti GG, Marinari GM, Migliori F, Adami GF (2007) Attitudes of morbidly obese patients to weight loss and body image following bariatric surgery and body contouring. Obes Surg. 17(1):68–73

    Article  PubMed  Google Scholar 

  40. Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H (2018) Does body contouring after bariatric weight loss enhance quality of life? a systematic review of QOL studies. Obes Surg. 28(10):3333–3341

    Article  PubMed  PubMed Central  Google Scholar 

  41. Gusenoff JA, Messing S, O’Malley W, Langstein HN (2008) Temporal and demographic factors influencing the desire for plastic surgery after gastric bypass surgery. Plast Reconstr Surg. 121(6):2120–2126

    Article  CAS  PubMed  Google Scholar 

  42. Kitzinger HB, Abayev S, Pittermann A, Karle B, Bohdjalian A, Langer FB et al (2012) After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg. 22(4):544–548

    Article  PubMed  Google Scholar 

  43. Sarwer DB, Fabricatore AN (2008) Psychiatric considerations of the massive weight loss patient. Clin Plast Surg. 35(1):1–10

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dunne JA, Wormald JC, Ghedia R, Soldin M (2017) Implementation of national body contouring surgery guidelines following massive weight loss: a national cross-sectional survey of commissioning in England. J Plast Reconstr Aesthet Surg. 70(1):54–59

    Article  PubMed  Google Scholar 

  45. Aldaqal SM, Samargandi OA, El-Deek BS, Awan BA, Ashy AA, Kensarah AA (2012) Prevalence and desire for body contouring surgery in postbariatric patients in saudi arabia. N Am J Med Sci. 4(2):94–98

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ngaage LM, Elegbede A, Pace L, Rosen C, Tannouri S, Rada EM et al (2020) Review of insurance coverage for abdominal contouring procedures in the postbariatric population. Plast Reconstr Surg. 145(2):545–554

    Article  CAS  PubMed  Google Scholar 

  47. Warner JP, Stacey DH, Sillah NM, Gould JC, Garren MJ, Gutowski KA (2009) National bariatric surgery and massive weight loss body contouring survey. Plast Reconstr Surg. 124(3):926–933

    Article  CAS  PubMed  Google Scholar 

  48. Gilmartin J, Bath-Hextall F, Maclean J, Stanton W, Soldin M (2016) Quality of life among adults following bariatric and body contouring surgery: a systematic review. JBI Database Syst Rev Implement Rep. 14(11):240–270

    Article  Google Scholar 

  49. Bolton MA, Pruzinsky T, Cash TF, Persing JA (2003) Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. Plast Reconstr Surg. 112(2):619–625 (discussion 26 7)

    Article  PubMed  Google Scholar 

  50. Colwell AS, Borud LJ (2008) Optimization of patient safety in postbariatric body contouring: a current review. Aesthet Surg J. 28(4):437–442

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was obtained.

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait city, Kuwait

    Rawan ElAbd & Salman AlSabah

  2. Department of Surgery, Jaber Al-Ahmed Hospital, Kuwait city, Kuwait

    Khalifa AlGhanim, Salma Alhamad, Sulaiman Almazeedi, Salman AlSabah & Sarah AlYouha

  3. Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Room 4447, Halifax Infirmary, 4th Floor, Plastic Surgery, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada

    Osama A. Samargandi & Jason Williams

  4. Division of Plastic Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

    Osama A. Samargandi

Authors
  1. Rawan ElAbd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Osama A. Samargandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khalifa AlGhanim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Salma Alhamad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sulaiman Almazeedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salman AlSabah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sarah AlYouha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osama A. Samargandi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study informed 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

ElAbd, R., Samargandi, O.A., AlGhanim, K. et al. Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis. Aesth Plast Surg 45, 1064–1075 (2021). https://doi.org/10.1007/s00266-020-02016-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-02016-2

Keywords

Search

Navigation