Massive Weight Loss Surgery Research Articles

Cosmetic Procedures After Massive Weight Loss Surgery: A Guide for Prospective Patients

Cosmetic Procedures After Massive Weight Loss Surgery: A Guide for Prospective Patients

Analyzing the Impact of Social and Psychiatric Factors in Patients Who Undergo Body Contouring Procedures.

As the prevalence of obesity increases, the number of patients seeking body contouring procedures after bariatric surgery for massive weight loss is increasing. Although the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have reported on the psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study. The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss. A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed with R statistical software (version 1.3.1093). A total of 1187 patients underwent at least 1 body contouring procedure during the study time frame. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had significantly greater odds of suffering from generalized anxiety disorder (odds ratio [OR] 1.08 [95% CI, 1.02-1.15], P = .008). Patients with spousal support had 1.93 times higher odds of having maintained postbariatric weight loss at their 6-month follow-up (OR 1.93 [95% CI, 1.84-2.01], P = .028). Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures.

Lateral intercostal artery perforator (LICAP) flap for breast volume augmentation: Applications for oncoplastic and massive weight loss surgery

SUMMARYBackgroundLateral intercostal artery perforator (LICAP) flap for breast volume augmentation provides the benefits of addressing axillary tissue excess and avoiding intramuscular dissection. Previous experience with the LICAP flap in patients with prior breast conservation therapy (BCT) has led to the development of an extended version for massive weight loss (MWL) patients as well.MethodsA retrospective review of all cases of LICAP flaps was performed by a single surgeon. Data were subsequently extracted and analyzed including patient demographics, indication and timing of volume augmentation, complications, and follow-up length.ResultsFrom 2016 to 2020, 12 patients underwent 16 LICAP flaps for volume augmentation. Indications for volume augmentation included deficits from prior oncologic surgery (ten patients) and loss of volume due to MWL (two patients). The average BMI was 29.9 kg/m2. Among the oncologic group, eight patients had delayed reconstruction, while two were immediate. Nine patients underwent radiation prior to volume augmentation. Eight of the 14 patients simultaneously received fat grafting. There were 4 cases of delayed wound healing that improved with local wound care. There were no statistically significant differences in complication rates between the oncologic and MWL groups. The average length of follow-up was 11.4 months.ConclusionsThis study supports that the application of the LICAP flap can be effectively broadened from the oncologic population to the MWL population. If needed, extending the flap provides an option to simultaneously address excess axillary and back tissue.

Dorsal median lipectomy (the arrow technique): A new approach for the treatment of the circumferential truncal skin and fatty tissue excess

The increase in the number of patients who undergo massive weight loss surgery has led to an increasing number of patients who complain of circumferential abdominal skin and soft tissue excess. Currently, the only surgical option to treat soft tissue excess is vertical median abdominal lipectomy (fleur-de-lys technique). However, many patients are reluctant to undergo this surgery because of the position of the scar. We presented a new surgical approach to manage circumferential excess -dorsal median lipectomy (arrow technique)- in which the dorsal scar is well-tolerated by patients.

Plastic Surgery After Weight Loss: Current Concepts in Massive Weight Loss Surgery

The authors begin their discussion of current concepts in massive weight loss (MWL) surgery by offering terminological guidelines that help define reconstructive and aesthetic concepts and procedures for the post-MWL patient. Measures for effective preoperative nutritional and metabolic screening include assessment of weight fluctuations over time, constitutional symptoms, and medications and nutritional supplements. Although there is no established body-mass index (BMI) threshold above which surgery should be refused, higher BMIs have been associated with increased complications. Residual medical problems and psychosocial issues require assessment before surgery, with appropriate specialist consultation as necessary. Consultation with patients concerning the different expectations for functional versus aesthetic procedures and issues such as postoperative scarring and the common incidence of wound healing problems is essential. Patient safety is paramount in decisions to combine multiple procedures and plan stages. The authors often recommend combining abdominoplasty and mastopexy. Surgeon experience, operative setting, and a patient's medical status are factors which influence how much surgery should be performed in the same operative setting. Centers of Excellence in body contouring that provide a team approach combining comprehensive patient evaluation, outcomes research, and surgical training may be the optimal approach for treating the massive weight loss patient.

Seroma Development following Body Contouring Surgery for Massive Weight Loss: Patient Risk Factors and Treatment Strategies

The most common complications following body contouring surgery for massive weight loss include delayed wound healing and seroma. The authors investigated risk factors for seroma in this patient population and describe treatment strategies. A retrospective review of 222 patients who underwent body contouring surgery for massive weight loss from March of 1997 to December of 2005 was performed. Risk factors assessed included age, sex, medical conditions, tobacco use, body mass index, weight of skin excised, and surgery performed. Within this group, there were 187 women and 35 men, with a mean age of 42 years. Weight loss was achieved by open (n = 167) or laparoscopic (n = 35) gastric bypass surgery, or diet (n = 20). Average body mass index at contouring was 33, ranging from 20 to 69. Surgical areas addressed alone or in combination included the abdomen (n = 205), thigh (n = 71), arm (n = 69), back (n = 59), and chest (n = 57). Average weight of skin excised at surgery was 9.6 lb, ranging up to 49 lb. Seroma occurred in 31 patients, placing the risk at 14 percent in this series. Seroma risk in abdominal panniculectomy was 12 percent; in circumferential belt lipectomy, the risk was 18 percent; and in thigh lift, the risk was 4 percent. On multivariate statistical analysis, the major risk factor for seroma formation was weight of skin excised, with seroma risk increasing 9 percent for each additional pound of skin excised. The most important risk factor for seroma is weight of skin excised at the time of surgery. Treatment strategies include aspiration, drain placement, sclerosis, and surgery.

Maintenance of Weight Loss after Body Contouring Surgery for Massive Weight Loss

Weight loss can be achieved through gastric bypass surgery or diet. Surgery has been reported to be more effective in achieving long-term weight loss. The authors aimed to determine whether massive weight loss is maintained or improved after body contouring. Seventy patients underwent body contouring surgery after massive weight loss from January of 2001 to January of 2005. Data collected included age; gender; mode of massive weight loss; body mass index before massive weight loss, at contour surgery, and at follow-up; and weight of skin excised. Weight loss was achieved by open (n = 57) or laparoscopic gastric bypass surgery (n = 7), or by diet (n = 6). Average weight loss at contour surgery was 152 lb for open gastric bypass, 139 lb for laparoscopic gastric bypass, and 140 lb for the diet group. Mean weight of excised skin was 12.8 lb. Gastric bypass patients on average gained 2.3 lb, whereas nonsurgical patients gained 22 lb after body contouring, netting out skin excised. On multivariate analysis, weight loss did not differ between laparoscopic and open gastric bypass (p = 0.9); however, surgery led to a 27-lb greater weight loss compared with diet (p = 0.03). This effect was more remarkable with follow-up less than or equal to 18 months compared with more prolonged follow-up. Every year increase in age was associated with an 0.8-lb weight gain (p = 0.03). Gastric bypass surgery patients maintain massive weight loss better than "diet" patients. Weight loss tapers over time for gastric bypass surgery patients, with ultimate weight gain, comparable to that seen in the general population as it ages.

Comparing the Ultrasonically Activated Scalpel (Harmonic) with High-Frequency Electrocautery for Postoperative Serous Drainage in Massive Weight Loss Surgery

Sir: Ultrasonic dissection using the Harmonic scalpel has recently emerged as a safe and reliable alternative to high-frequency electrocautery. The Harmonic ultracision scalpel and scissor has been used successfully by surgeons in laparoscopic and open surgical procedures, including cholecystectomy and breast cancer dissections.1–4 The aim of this prospective, single-blinded, two-arm study was to investigate the clinical merits of the ultrasonic scalpel (Harmonic) versus high-frequency electrocautery in body lift operations with regard to postoperative serous drainage time and volume. Lower body lift procedures without simultaneous tightening of the medial aspect of the thigh were carried out in 20 patients with two treatment arms. Tissue dissection and resection were performed using the ultrasonic scalpel (Harmonic) on one side (treatment arm 1, n = 20) and electrocautery on the other (treatment arm 2, n = 20). All operations were performed by the senior author (D.F.R.). Drainage days (i.e., number of days until drain removal) and total drainage (i.e., postoperative wound secretion via the individual drains) were assessed as primary endpoints. In addition, operative time (from first skin incision until last skin suture), postoperative complications, and the difference in preoperative and postoperative thigh circumference were recorded; the pain score (per day) was measured using a 10-point visual analog scale, with 0 = no pain and 10 = the worst imaginable pain (secondary endpoints). Student t tests for independent samples were used for inferential statistical analysis. Total serous drainage volume was significantly lower in the Harmonic scalpel group (891.67 ± 392.09 ml) compared with the electrocautery group (1414.38 ± 656.90 ml) (p = 0.007). Similarly, the number of drainage days was significantly lower in the Harmonic scalpel group (5.35 ± 1.14 days, compared with 7.04 ± 1.92 days for electrocautery; p = 0.002). Patients in the Harmonic scalpel group reported lower pain intensity scores (mean score ± SD for postoperative days 1 through 15, 1.84 ± 0.58, compared with 2.44 ± 0.71 for electrocautery; p = 0.011). The incidence of complication was assessed for each side of the body. On the electrocautery side, seroma formation was observed in five patients (25 percent) and treated by aspiration [Harmonic side, two patients (10 percent)]. Two of these five patients presented with bilateral seroma formation in the area of the lateral thigh, and the other three patients showed a unilateral mass formation that required treatment by aspiration. No patient had postoperative bleeding, but one patient (5 percent) required a postoperative blood transfusion due to extensive intraoperative blood loss that included both the electrocautery and Harmonic sides. Three patients (15 percent) had delayed wound healing due to local wound infections that involved both sides. No wound necrosis requiring treatment was assessed in this study. The Harmonic scalpel allows for safe and efficient tissue dissection in massive weight loss procedures. In addition, the results show that use of the Harmonic scalpel in tissue dissection significantly reduces the postoperative serous drainage time and volume as well as postoperative pain in comparison with electrocautery, with increased patient comfort postoperatively. DISCLOSURES Drs. Reichenberger and Stoff have no financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Richter has a consulting agreement with Ethicon. Alexander Stoff, M.D. Matthias A. Reichenberger, M.D. Dirk F. Richter, M.D. Department of Plastic and Reconstructive Surgery Dreifaltigkeits Hospital Wesseling, Germany

Seroma Development Following Body Contouring Surgery for Massive Weight Loss: Patient Risk Factors and Treatment Strategies.

Seroma Development Following Body Contouring Surgery for Massive Weight Loss: Patient Risk Factors and Treatment Strategies.

Factors Impacting Thromboembolism after Bariatric Body Contouring Surgery

The purpose of this study was to define the risk of venous thromboembolism within the massive weight loss population undergoing body contouring procedures. Retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and September of 2004 was performed. Patient factors studied included age, gender, medical comorbidities including history of thromboembolic complications, depression, tobacco use, preoperative/postoperative body mass index, surgery, and transfusion. There were 138 cases, and the female-to-male ratio was 5:1. Procedures were often combined: 128 patients had abdominal surgery, 36 had a back lift, 41 had brachioplasty, 29 had chest surgery, and 47 had a thigh lift. The most common complications were related to healing (n = 28) and seroma (n = 18). Three patients had postoperative deep venous thrombosis requiring anticoagulation, and one had a fatal pulmonary embolism, making the overall venous thromboembolism risk 2.9 percent. The mean body mass index at contour was 48.5 for patients with venous thromboembolism versus 31.8 for patients who did not develop venous thromboembolism (p = 0.01). Looking at this subgroup of 45 patients, the risk of venous thromboembolism was 8.9 percent, with no risk found in patients with a body mass index less than 35 (p = 0.01). The risk of venous thromboembolism with contouring surgery for massive weight loss is comparable to that for gastric bypass surgery. Body mass index in the obese range appears to be a leading risk factor. The authors' data support routine prophylaxis against venous thromboembolism. Recommendations for high-risk patients are discussed.

P74: Seroma Development Following Body Contouring Surgery for Massive Weight Loss: Patient Risk Factors and Treatment Strategies

P74: Seroma Development Following Body Contouring Surgery for Massive Weight Loss: Patient Risk Factors and Treatment Strategies