Skip to main content

Advertisement

Log in

Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body

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

Abstract

Introduction

Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain.

Materials and Methods

We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes.

Results

The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases.

Conclusion

Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes.

Level of Evidence V

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

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chooi YC, Ding C, Magkos F (2019) The epidemiology of obesity. Metabolism 92:6–10. https://doi.org/10.1016/j.metabol.2018.09.005

    Article  CAS  PubMed  Google Scholar 

  2. Hepatology TLG (2021) Obesity: another ongoing pandemic. Lancet Gastroenterol Hepatol 6:411. https://doi.org/10.1016/S2468-1253(21)00143-6

    Article  Google Scholar 

  3. Seidell JC (2000) Obesity, insulin resistance and diabetes: a worldwide epidemic. Br J Nutr 83(S1):S5–S8. https://doi.org/10.1017/S000711450000088X

    Article  CAS  PubMed  Google Scholar 

  4. TGBDO Collaborators (2015) Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 377(1):13–27. https://doi.org/10.1056/NEJMoa1614362

    Article  Google Scholar 

  5. Finkelstein EA et al (2012) Obesity and severe obesity forecasts through 2030. Am J Prev Med 42(6):563–570. https://doi.org/10.1016/j.amepre.2011.10.026

    Article  PubMed  Google Scholar 

  6. Eisenberg D et al (2022) American society for metabolic and bariatric surgery (ASMBS) and international federation for the surgery of obesity and metabolic disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis 18(12):1345–1356. https://doi.org/10.1016/j.soard.2022.08.013

    Article  PubMed  Google Scholar 

  7. Billeter AT, Fischer L, Wekerle A-L, Senft J, Müller-Stich B (2014) Malabsorption as a therapeutic approach in bariatric surgery. Visc Med 30(3):198–204. https://doi.org/10.1159/000363480

    Article  Google Scholar 

  8. Alalwan AA, Friedman J, Park H, Segal R, Brumback BA, Hartzema AG (2021) US national trends in bariatric surgery: a decade of study. Surgery 170(1):13–17. https://doi.org/10.1016/j.surg.2021.02.002

    Article  PubMed  Google Scholar 

  9. Lamoshi A, Chernoguz A, Harmon CM, Helmrath M (2020) Complications of bariatric surgery in adolescents. Semin Pediatr Surg 29(1):150888. https://doi.org/10.1016/j.sempedsurg.2020.150888

    Article  PubMed  Google Scholar 

  10. Baillot A et al (2017) What is known about the correlates and impact of excess skin after bariatric surgery: a scoping review. Obes Surg 27(9):2488–2498. https://doi.org/10.1007/s11695-017-2814-3

    Article  PubMed  Google Scholar 

  11. 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. https://doi.org/10.1097/PRS.0000000000004461

    Article  CAS  PubMed  Google Scholar 

  12. ElAbd R et al (2021) Body contouring surgery improves weight loss after bariatric surgery: a systematic review and meta-analysis. Aesthetic Plast Surg 45(3):1064–1075. https://doi.org/10.1007/s00266-020-02016-2

    Article  PubMed  Google Scholar 

  13. Casella D et al (2022) Controlateral symmetrisation in srm for breast cancer: now or then? Immediate versus delayed symmetrisation in a two-stage breast reconstruction. Curr Oncol 29(12):2022. https://doi.org/10.3390/curroncol29120737

    Article  Google Scholar 

  14. Han J, Cuomo R, Zhao Y, Pan B, Yang Q (2021) The morphology and bending behavior of regenerated costal cartilage with Kawanabe–Nagata method in rabbits–the short term result of an experimental study. J Investig Surg 34(10):1047–1051. https://doi.org/10.1080/08941939.2020.1741744

    Article  Google Scholar 

  15. Sisti A, Sadeghi P, Cuomo R, Alvarez SM (2022) Pre-pectoral one-stage breast reconstruction with anterior coverage using superior anterior biological acellular dermal matrix (adm) and inferior anterior dermal sling support. Medicina (Lithuania) 58(8):992. https://doi.org/10.3390/medicina58080992

    Article  Google Scholar 

  16. Casella D et al (2022) Positive ros (reactive oxygen species) modulator engineered device support skin treatment in locally advanced breast cancer (labc) enhancing patient quality of life. J Clin Med 11(1):126. https://doi.org/10.3390/jcm11010126

    Article  CAS  Google Scholar 

  17. Losco L et al (2022) Helix thigh lift. A novel approach to severe deformities in massive weight loss patients. J Investig Surg 35(3):620–626. https://doi.org/10.1080/08941939.2021.1912220

    Article  Google Scholar 

  18. Cuomo R, Nisi G, Grimaldi L, Brandi C, Sisti A, D’Aniello C (2015) Immunosuppression and abdominal wall defects: use of autologous dermis. In Vivo (Brooklyn) 29(6):753–755

    CAS  Google Scholar 

  19. Sisti A et al (2017) Complications associated with brachioplasty: a literature review. Acta Biomed 88(4):393. https://doi.org/10.23750/abm.v88i4.5609

    Article  PubMed Central  Google Scholar 

  20. Sisti A et al (2015) Complications associated with medial thigh lift: a comprehensive literature review. J Cutan Aesthet Surg 8(4):191. https://doi.org/10.4103/0974-2077.172189

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cuomo R et al (2015) Abdominoplasty in mildly obese patients (BMI 30–35 kg/m2): metabolic biochemical and complication analysis at 1 year. In Vivo (Brooklyn) 29(6):757–761

    CAS  Google Scholar 

  22. Cuomo R, Grimaldi L, Cesare B, Nisi G, D’Aniello C (2017) Skin graft donor site: a procedure for a faster healing. Acta Biomed 88(3):310. https://doi.org/10.23750/abm.v%vi%i.5736

    Article  PubMed  PubMed Central  Google Scholar 

  23. Song AY, Jean RD, Hurwitz DJ, Fernstrom MH, Scott JA, Rubin JP (2005) A classification of contour deformities after bariatric weight loss: the pittsburgh rating scale. Plast Reconstr Surg 116(5):1535–1544. https://doi.org/10.1097/01.prs.0000182606.92069.13

    Article  CAS  PubMed  Google Scholar 

  24. de Sire A et al (2022) Surgical treatment and rehabilitation strategies for upper and lower extremity lymphedema: a comprehensive review. Medicina (Lithuania) 58(7):954. https://doi.org/10.3390/medicina58070954

    Article  Google Scholar 

  25. Voglino C et al (2021) Controlling nutritional status (CONUT) score and micronutrient deficiency in bariatric patients: midterm outcomes of Roux-en-Y gastric bypass versus one anastomosis gastric bypass/mini gastric bypass. Obes Surg 31(8):3715–3726. https://doi.org/10.1007/s11695-021-05486-8

    Article  PubMed  Google Scholar 

  26. Voglino C et al (2020) cardiovascular benefits and lipid profile changes 5 years after bariatric surgery: a comparative study between sleeve gastrectomy and Roux-en-Y gastric bypass. J Gastrointest Surg 24(12):2722–2729. https://doi.org/10.1007/s11605-019-04482-9

    Article  PubMed  Google Scholar 

  27. Herman CK, Hoschander AS, Wong A (2015) Post-bariatric body contouring. Aesthet Surg J 35(6):672–687. https://doi.org/10.1093/asj/sjv008

    Article  PubMed  Google Scholar 

  28. Sadeghi P et al (2022) Post-bariatric plastic surgery: abdominoplasty the state of the art in body contouring. J Clin Med 11(15):4315. https://doi.org/10.3390/jcm11154315

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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. https://doi.org/10.1097/PRS.0b013e31817081a3

    Article  CAS  PubMed  Google Scholar 

  30. Kitzinger HB et al (2012) “After massive weight loss: patients” expectations of body contouring surgery. Obes Surg 22(4):544–548. https://doi.org/10.1007/s11695-011-0551-6

    Article  PubMed  Google Scholar 

  31. Sarwer DB, Fabricatore AN (2008) Psychiatric considerations of the massive weight loss patient. Clin Plast Surg 35(1):1–10. https://doi.org/10.1016/j.cps.2007.08.006

    Article  PubMed  PubMed Central  Google Scholar 

  32. Khoshnevis J et al (2022) Jump technique versus seton method for anal fistula repair: a randomized controlled trial. J Investig Surg 35(6):1217–1223. https://doi.org/10.1080/08941939.2021.2022252

    Article  Google Scholar 

  33. Gunnarson GL, Frøyen JK, Sandbu R, Thomsen JB, Hjelmesæth J (2015) Plastikkirurgi etter fedmekirurgi. Tidsskrift for Den norske legeforening 135(11):1044–1049. https://doi.org/10.4045/tidsskr.14.0814

    Article  PubMed  Google Scholar 

  34. Vasilakis V, Lisiecki JL, Kortesis BG, Bharti G, Hunstad JP (2021) The effect of obesity bariatric surgery and operative time on abdominal body contouring outcomes. Aesthet Surg J 41(8):NP1044–NP1052. https://doi.org/10.1093/asj/sjab123

    Article  PubMed  Google Scholar 

  35. Romano L, Zoccali G, Orsini G, Giuliani M (2019) Reducing complications in post-bariatric plastic surgery: our experience and literature review. Acta Bio Med: Atenei Parmensis 90(4):475. https://doi.org/10.23750/ABM.V90I4.7405

    Article  Google Scholar 

  36. Chandawarkar RY (2006) Body contouring following massive weight loss resulting from bariatric surgery. In: Vaidya V (ed) Advances in psychosomatic medicine, Basel: KARGER, 2006, pp 61–72. https://www.karger.com/Article/FullText/90964

  37. Marouf A, Mortada H (2021) Complications of body contouring surgery in postbariatric patients: a systematic review and meta-analysis. Aesthetic Plast Surg 45(6):2810–2820. https://doi.org/10.1007/s00266-021-02315-2

    Article  PubMed  Google Scholar 

  38. Cuomo R et al (2021) “Management of skin damage of health workers” face: the role of plastic surgery in the time of Pandemic. Acta Biomed. https://doi.org/10.23750/ABM.V92I2.11006

    Article  PubMed  PubMed Central  Google Scholar 

  39. Pozzi M, Cuomo R, Giardino FR, Brandi C, Nisi G, Grimaldi L (2022) A case of necrotizing fasciitis from a pedicure: when beauty centers become life-threatening. Acta Biomed 93(S1):e2022126. https://doi.org/10.23750/abm.v93iS1.9492

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gianluca Marcaccini.

Ethics declarations

Conflict of interest

The author's declared that they have no conflict of interest

Ethical approval

Not required.

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

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pozzi, M., Marcaccini, G., Giardino, F.R. et al. Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body. Aesth Plast Surg 48, 1790–1796 (2024). https://doi.org/10.1007/s00266-023-03763-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03763-8

Keywords

Navigation