Abstract
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.
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References
Kuczmarski RJ, Flegal KM, Campell SM, et al. Increasing prevalence of overweight among US adults. The national health and nutrition examination surveys, 1960 to 1991. Jama. 1994;272(3):205–11.
Eichholzer M, Luthy J, Gutzwiller F. Epidemiology of overweight in Switzerland: results of the Swiss National Health Survey 1992–93. Schweiz Med Wochenschr. 1999;129(9):353–61.
Rickenbach M, Wietlisbach V, Beretta-Piccoli C, et al. Smoking, blood pressure and body weight in the Swiss population: MONICA study 1988–89. Schweiz Med Wochenschr Suppl. 1993;48:21–8.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.
Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.
Karlsson J, Sjostrom L, Sullivan M. Swedish Obese Subjects (SOS)–an intervention study of obesity. Measuring psychosocial factors and health by means of short-form questionnaires. Results from a method study. J Clin Epidemiol. 1995;48(6):817–23.
Mathus-Vliegen EM, de Weerd S, de Wit LT. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss. Surgery. 2004;135(5):489–97.
Fotopoulos L, Kehagias I, Kalfarentzos F. Dermolipectomies following weight loss after surgery for morbid obesity. Obes Surg. 2000;10(5):451–9.
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). 2006;14(9):1626–36.
Fraccalvieri M, Datta G, Bogetti P, et al. Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience. Obes Surg. 2007;17(10):1319–24.
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 570.
Chaouat M, Levan P, Lalanne B, et al. Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results. Plast Reconstr Surg. 2000;106(7):1614–8; discussion 1619–23.
Gmur RU, Banic A, Erni D. Is it safe to combine abdominoplasty with other dermolipectomy procedures to correct skin excess after weight loss? Ann Plast Surg. 2003;51(4):353–7.
van Uchelen JH, Werker PM, Kon M. Complications of abdominoplasty in 86 patients. Plast Reconstr Surg. 2001;107(7):1869–73.
Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13(2):159–60.
Pitanguy I, Gontijo de Amorim NF, Radwanski HN. Contour surgery in the patient with great weight loss. Aesthetic Plast Surg. 2000;24(6):406–11.
Shiri S, Gurevich T, Feintuch U, et al. Positive psychological impact of bariatric surgery. Obes Surg. 2007;17(5):663–8.
Scheufler O, Erdmann D. Current concepts and trends in post-bariatric plastic surgery. Chirurg. 2007;78(4):316–25.
Faintuch J, Matsuda M, Cruz ME, et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg. 2004;14(2):175–81.
Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17(9):1150–8.
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.
Stewart KJ, Stewart DA, Coghlan B, et al. Complications of 278 consecutive abdominoplasties. J Plast Reconstr Aesthet Surg. 2006;59(11):1152–5.
Shermak MA, Chang D, Magnuson TH, et al. An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Plast Reconstr Surg. 2006;118(4):1026–31.
Gravante G, Araco A, Sorge R, et al. Wound infections in post-bariatric patients undergoing body contouring abdominoplasty: the role of smoking. Obes Surg. 2007;17(10):1325–31.
Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.
Sugerman HJ, Kellum JM Jr, Reines HD, et al. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171(1):80–4.
Arribas D, Elia M, Artigas C, et al. Incidence of incisional hernia following vertical banded gastroplasty. Hernia. 2004;8(2):135–7.
Larsen M, Polat F, Stook FP, et al. Satisfaction and complications in post-bariatric surgery abdominoplasty patients. Acta Chir Plast. 2007;49(4):95–8.
Acknowledgement
The authors would like to thank Dr. Franziska Schöni-Affolter, Institute of Evaluative Research, MEM-Center, University of Bern, for her specialist support in the statistical power analysis.
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None of the authors had a commercial interest in the subject of the study or financial benefit from the results.
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de Kerviler, S., Hüsler, R., Banic, A. et al. Body Contouring Surgery Following Bariatric Surgery and Dietetically Induced Massive Weight Reduction: A Risk Analysis. OBES SURG 19, 553–559 (2009). https://doi.org/10.1007/s11695-008-9659-8
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DOI: https://doi.org/10.1007/s11695-008-9659-8