Plastic Surgery Improves Long-Term Weight Control after Bariatric Surgery

Abstract

Sir: We read the recently published article by Dr. Balagué et al.1 entitled “Plastic Surgery Improves Long-Term Weight Control after Bariatric Surgery” with much interest. In their work, the authors demonstrated better long-term weight control in patients following bariatric plastic surgery restoration. We congratulate Dr. Balagué and colleagues on their work. Based on our experience in the multistage management of post–bariatric surgery patients, we would like to contribute to their findings reporting the validity of the sequential approach in the consolidation of weight stability. Body contouring after massive weight loss is an emerging field of plastic surgery, with 45,534 operations performed in 2012 in the United States alone.2 Psychosocial issues are of paramount importance, often being the main motivation underlying the request for both bariatric and postbariatric operations. It has been demonstrated that self-esteem, depression, and body image improve in the first year after bariatric surgery. However, these benefits gradually decrease with the passage of time and the onset of weight instability associated with postoperative binge eating.1,3 Although several studies focused attention on different complication rates following single or combined procedures,4 a thorough analysis of the differences between the two approaches, with regard to the postoperative motivation to maintain weight stability, has not been clearly reported in the medical literature. In our surgical practice, we prefer a sequential approach for operations: abdominoplasty, flankplasty, breast remodeling, thigh lift, and brachioplasty are consecutively performed. The patient is thoroughly informed that postbariatric procedures are elective and that the risk-to-benefit ratio is strictly assessed before selecting candidates for surgery: weight has to be stable for at least 6 months, body mass index has to be 32 or less, smoking has to be discontinued or drastically reduced, and comorbidities have to be kept under control. We apply a multidisciplinary approach, involving a psychologist, an endocrinologist, an internist, a nutritionist, a bariatric surgeon, and a plastic surgeon. In our opinion, this approach shows several advantages. First, it is helpful in reducing the intraoperative time, a risk factor for complications5 such as seroma, dehiscence, tissue necrosis, and infection.4 Second, it shortens the postoperative downtime and lessens patients’ discomfort, thus resulting in a faster return to social life, with psychological benefits. The sequential approach also stimulates the motivational drive, as the need to repeatedly meet the inclusion criteria leads patients to a prolonged, more responsible, and healthier lifestyle. As a consequence, weight loss maintenance is strengthened and the health-related quality-of-life domains (self-esteem, social life, work, and physical and sexual activity) are improved. Dr. Balagué et al.1 emphasized that plastic surgery improves long-term weight control after bariatric surgery. In our opinion, the sequential approach further enhances the long-term weight control. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. No funding was received for this work. Francesco Segreto, M.D. Pierfranco Simone, M.D. Luca Piombino, M.D. Paolo Persichetti, M.D., Ph.D. Department of Plastic, Reconstructive and Aesthetic Surgery Campus Bio-Medico of Rome University Rome, Italy