Postbariatric Body Contouring Research Articles

The Role of Portable Incisional Negative Pressure Wound Therapy (piNPWT) in Reducing Local Complications of Post-bariatric Brachioplasty: A Case-Control Study

BackgroundDue to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty.Patients and Methods26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated.ResultsNone of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery.ConclusionThe piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes.Level of Evidence IVThis 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring.

With a growing obesity epidemic, an increasing number of patients are seeking body contouring procedures (BCP). The aim of this study was to assess the association of morbid obesity (BMI > 40kg/m2) with both clinical and health-related quality of life (H-RQOL) outcomes following BCP. Patients evaluated for post-bariatric BCP at a large academic hospital by one surgeon were retrospectively identified. Patients were surveyed using the BODY-Q© during initial and postoperative visits. Demographic, clinical, operative characteristics, and surgical outcomes data were extracted. BODY-Q domain scores were compared between morbidly obese (MO) and non-morbidly obese (NMO). The absolute change in HR-QOL scores for MO and NMO was also compared. Overall, 59 patients were included (MO 72.9% vs. NMO 27.1%). The median age was 50 years old (Interquartile range [IQR] ± 17); the majority were non-Hispanic (89.8%), non-diabetic (81.4%), non-smokers (67.8%). Assessment of surgical site occurrences, reoperations, and the complication composite outcome revealed no statistical differences between groups (p >0.05). MO patients showed lower net improvement in three HR-QOL domains: satisfaction with body (median 30 [IQR ± 53] vs. 65 [IQR ± 54]; p = 0.036), body image (median 39 [IQR ± 55] vs. 52 [IQR ± 44]; p = 0.025), and social function (median 12 [IQR ± 18] vs. 19 [IQR ± 35]; p = 0.015). Post-bariatric BCP can be safely performed in the MO patient without increased risk of complication. However, the benefit of truncal BCP is less in MO as it pertains to specific QOL domains: satisfaction with body, body image, and social function. 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 .

Quality of Life and Complications in the Morbidly Obese Patient after Post-Bariatric Body Contouring

Quality of Life and Complications in the Morbidly Obese Patient after Post-Bariatric Body Contouring

Fibrin Sealant Artiss Compared to Progressive Tension Sutures With Stratafix in the Management of Wound Drainage Following Post-Bariatric Body-Contouring Surgery.

Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers. We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal. The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group. The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.

A journey through liposuction and liposculture: Review.

IntroductionNowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields.Materials and methodsThis review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique.ResultsLiposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery.ConclusionLiposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery

Following my prior study of long-term results after laparoscopic gastric banding concerning operative outcome and complications involving the gastric band itself, I now focus on long-term quality-of-life improvement in the same study group after body-contouring surgery. As determined from our electronic patient data system, 72 patients from the former study group subsequently sought body-contouring surgery at our hospital after successful weight loss. Patients were enrolled in a telephone interview and asked about their expectations and body image before and after postbariatric aesthetic surgery and how it altered their well-being in addition to the weight loss achieved with the gastric band. All patients undergoing postbariatric aesthetic surgery felt extremely uneasy with the hanging skin resulting from weight reduction. Patients cannot imagine the degree of dissatisfaction they will experience from the sagging skin that comes with weight loss. Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and reported an extreme improvement in body image. Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery, because most patients not forewarned suffer greatly from their body image after weight loss.

Post-Bariatric Body-Contouring Surgery: Fewer Procedures, Less Demand, and Lower Costs.

Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing and placing additional burdens on already strained health care systems. In Austria, medically necessary body contouring is covered by public health care. In a sample of 622 women, we assessed the proportion of patients that underwent post-bariatric surgery at least 2 years after gastric bypass. Former bariatric patients were asked whether they had undergone post-bariatric surgery or were planning to do so by structured telephone interviews. For patients who had undergone body contouring, the degree of satisfaction with the results was inquired. Costs for bariatric and post-bariatric procedures were assessed. Of 622 patients, 93 (14.9 %) had undergone body contouring and 68 (10.9 %) considered a procedure, while 454 (73 %) definitely stated that they did not want plastic surgery. Cost coverage was declined in 7 patients (1.1 %). Plastic procedures (n = 101) included 65 abdominoplasties, 25 lower body lifts without thigh lifts, 7 brachioplasties, and 4 minor procedures. Forty-nine patients were very satisfied with the results, 28 were fairly satisfied, and 16 were not satisfied. Body contouring added about 6 % to the costs of surgical treatment for morbid obesity. Fewer patients than in other studies expressed a desire for post-bariatric surgery, 15 % actually proceeded to this step. The low demand was neither due to denied coverage nor to unfavourable results of plastic surgery. Additional costs for body contouring were less than expected.

Funding for postbariatric body-contouring (bariplastic) surgery in England: a postcode lottery.

Background. With the increase in bariatric surgery in the UK, there has been a substantial increase in patients undergoing massive weight loss (MWL) seeking postbariatric body-contouring (bariplastic) surgery. However, there is a wide variation of availability on the National Health Service (NHS). Aims. To (1) review the funding policies of Primary Care Trusts (PCTs) in England for bariplastic surgery and (2) analyse the number of procedures funded in two consecutive financial years. Methods. We sent out questionnaires to all PCTs in England regarding their funding policies for bariplastic surgery and requested the number of procedures funded in 2008-09 and 2009-10. Findings. 121/147 (82%) PCTs replied to our questionnaires. 73 (60%) excluded all bariplastic procedures. 106/121 (87.6%) PCTs had referral guidelines for plastic surgery. 46/121 (38%) PCTs provided the total number of funded abdominoplasty-apronectomy (A-A) in the two financial years: total number of A-A applicants rose from 393 to 531, but approval for funding fell from 24.2% to 19.6%. Only 3 (2%) PCTs indicated increase in their future spending on bariplastic procedures in the next 5 years, with 67% planning to decrease or unsure about future funding. Conclusion. There exists a postcode lottery for bariplastic surgery in England and we feel the need for guidelines on provision of bariplastic procedures following MWL.

Approach to the lower body after massive weight loss: the Innsbruck experience with abdomino-torso and thigh-contouring after massive weight loss

Background The number of patients requiring post-bariatric body-contouring after massive weight loss (MWL) is steadily increasing. The management of this demanding clientele of patients is challenging and requires a structured approach. The aim of this article is to provide a detailed overview of the contouring approach to the lower body after MWL practiced at Innsbruck Medical University, Department of Plastic, Reconstructive and Aesthetic Surgery, along with an analysis of the procedures over a 10-year period. Special attention is given to the surgical challenges, such as patients presenting with pre-existing scars in the upper abdomen.

Hypothermia and Complications in Postbariatric Body Contouring

Postbariatric body contouring represents a rapidly growing field. With long operative times and high rates of minor complications, evidence-based guidelines for operative management are needed. Data analyzing the impact of perioperative factors on patient outcomes are currently limited. Patients who lost 50 pounds or more and underwent body contouring were enrolled in an institutional review board-approved prospective registry over 4 years. All cases were performed by the senior author at two community hospitals and two academic hospitals. Hypothermia was defined as a minimum temperature of 35°C or lower. Three hundred eight patients (272 women and 36 men) were analyzed. The average operative time was 4.7 hours, and 71.4 percent of cases were performed in an academic hospital. The average minimum operative temperature was 35.6±0.63°C (range, 34.0 to 38.0°C), and the average maximum operative temperature was 36.5±0.75°C (range, 34.8 to 39.0°C). On multivariate analysis, a lower minimum temperature was associated with both seroma (p=0.003; odds ratio, 3.1 per 1°C decrease) and transfusion (p=0.005; odds ratio, 2.4 per 1°C decrease). Operative hypothermia was present in one-fifth of cases. Lower intraoperative temperature was associated with an increased risk of seroma formation, blood loss, and the need for transfusion. Despite this, there were few major complications in lengthy cases involving substantial blood loss. Maintaining normothermia is a critical component of perioperative management. The authors have adopted a protocol involving patient prewarming, a higher operating room temperature, and the routine use of warmed fluids. Risk, II.

Complications in Postbariatric Body Contouring Based on Different Weight Loss Methods

Sir:FigureIt was with great interest that we read the article “Complications in Postbariatric Body Contouring: Postoperative Management and Treatment” by Dr. Michaels and colleagues.1 We congratulate the authors for their carefully described general and specific strategies with which to prevent several complications that could develop in post–bariatric surgery body contouring cases. We completely agree with them that more attention should be given to the postoperative management of these patients. In addition to their large database incidence rates, we want to contribute our 7-year experience in this field of quick growth in plastic surgery. Furthermore, to complete this essay, it can be useful to classify complications according to the type of bariatric procedure previously performed as done by Dr. Gusenoff et al. in 2009.2 In this regard, analyzing our 158 cases retrospectively, we observed a significant difference in postoperative complication rates between patients who lost weight by diet and/or exercise [n = 18 (11 percent)], those who received predominantly restrictive procedures such as gastric banding [n = 21 (13 percent)] or sleeve gastrectomy [n = 23 (15 percent)], and those who received mixed procedures such as gastric bypass surgery [n = 96 (61 percent)]. Body contouring procedures performed were, in order, abdominoplasty, thigh lift, brachioplasty, and male or female breast contouring. Average weight loss was 161 lb. The overall rate of complications was 38 percent, including postoperative anemia (defined as a decrease in the hemoglobin value of at least 3 points), which was the most common one. We observed increased incidence rates not only between patients after bariatric surgical procedures and those who received nonsurgical treatment, but also within surgical techniques themselves. Patients who underwent mixed procedures appeared to have an overall incidence rate of complications after body contouring of 55 percent versus 30 percent following restrictive surgery and 15 percent of patients who lost weight by diet or exercise. Complications mentioned by Dr. Michaels and other authors are comparable to those we came up against3,4: hematoma (2 percent), seroma (6 percent), wound problems (9 percent), anemia (14 percent), skin necrosis (1 percent), scar revision (2 percent), and infection (4 percent). The infection rate was more frequent among surgical patients too, regardless of what Dr. Gusenoff found about infection rates in patients who had body contouring after massive weight loss. No cases of venous thromboembolism or lymphedema were found. According to the authors' conclusions, complications may always occur. Therefore, a correct plan of action, beginning with the most suitable bariatric procedures for each patient, the immediate identification and discussion of complications that could follow the surgical treatment, the proper post–bariatric surgery management, and the prevention of complications, should always be pursued. Paolo Persichetti, M.D., Ph.D. Campus Bio-Medico University of Rome Pierluigi Gigliofiorito, M.D. Campus Bio-Medico of Rome University Beniamino Brunetti, M.D. Tiziano Pallara, M.S. Campus Bio-Medico University of Rome Giovanni Francesco Marangi, M.D. Campus Bio-Medico University of Rome, Rome, Italy

Complications in Postbariatric Body Contouring: Postoperative Management and Treatment

Proper postoperative management of body contouring patients is essential to satisfactory long-term outcomes. Standard issues such as drain management, nutrition, and activity limitations will be relevant to all patients. Although major complications are infrequent, effective strategies for management of common minor wound complications are invaluable.

Complications in Postbariatric Body Contouring: Strategies for Assessment and Prevention

Massive weight loss patients present specific challenges to the plastic surgeon. Review of these issues may be valuable for the surgeon who does not specialize in this area. Obtaining excellent results involves a comprehensive perioperative approach, beginning with proper patient selection and appropriate expectations. Operative considerations such as hypothermia prevention and thromboembolic prophylaxis can play a role in improving outcomes and reducing morbidity. Appropriately focused postoperative care completes the surgical plan, leading to satisfying results for both patient and surgeon.

Current Concepts in Post-bariatric Body Contouring

The advent of bariatric surgery has led to a new subspecialty in plastic surgery for contouring the skin and fat remaining after massive weight loss. This field is increasingly recognized as a vital component to the multi-disciplinary treatment approach to care for the obese patient. The author sought to review key concepts in patient selection, technical advancements, and post-operative care in body contouring following weight loss surgery. A literature review in PubMed identified articles relevant to the care of massive weight loss patients presenting for plastic surgical contouring. These articles were combined with a retrospective review of the author's personal experience in management of these patients. The best candidates for post-bariatric plastic surgery are those who have achieved weight loss stability with a BMI of 35 or less and who have adequate nutrition to heal the surgical excisions. Truncal deformity is the most common presenting complaint of massive weight loss patients, and the procedure of choice to address this region is a lower body lift. Post-operative care focuses on patient safety prioritizing in DVT prophylaxis and seroma prevention. Bariatric procedures routinely achieve sustained decreases in body mass index; however, the remaining skin in the massive-weight-loss patient serves as a reminder of their previous obese existence. Post-bariatric body contouring aims to correct this deformity and restore a sense of normalcy. By reshaping the body into its ideal proportions, the true success of the weight loss surgery is fully realized.

Optimization of Patient Safety in Postbariatric Body Contouring: A Current Review

Postbariatric body contouring is a major growth field in plastic surgery as a direct result of the increasing incidence of bariatric surgery performed in the United States. As experience has accumulated in this subspecialty, technical procedures have been refined and dramatic aesthetic benefits have been seen in postoperative results. However, few objective guidelines exist on the optimization of patient care and safety in this complex patient population. This study sought to review the literature on body contouring after massive weight loss and patient safety to provide the reader with a summary of current recommendations. A literature review was performed with PubMed and MEDLINE. Eighty relevant articles, ranging from case reports and expert opinions to prospective randomized trials, were identified and reviewed in detail. Literature consensus guidelines included completion and stabilization of weight loss before surgery with a body mass index ideally less than 32, smoking cessation, nutritional assessment, anemia screening, usage of mechanical prophylaxis against thromboembolism, and strong consideration for usage of chemoprophylaxis with low molecular weight or unfractionated heparin. Procedures should be performed in accredited facilities with appropriately trained staff, and special intraoperative consideration should be given to patient positioning and avoidance of hypothermia. Postoperative management is optimized by the development of clinical pathways involving the surgeon, patient, and support staff.

Completing the Metamorphosis

Postbariatric body contouring is an expanding and rapidly evolving specialty within plastic surgery. To best address the many clinical issues related to the safe and effective care of the postbariatric patient, the authors have established a dedicated multidisciplinary treatment center. Team building efforts have brought together attending plastic surgeons who specialize in body contouring, nurses focused on body contouring after weight loss, and an administrative staff well trained in the issues related to managing these specific types of cases. Through core partnerships, nutritionists, lifestyle counselors, and psychologic professionals are present in the clinic to evaluate patients alongside the plastic surgeon. A dedicated physician assistant and body-contouring fellow work in both the clinic and the operating room (OR). This team approach has allowed for the establishment of defined screening procedures and patient care algorithms. Outreach and patient education initiatives have allowed the center to forge strong alliances with the regional bariatric surgeons and make patients aware of the role of plastic surgery as they start the process of weight loss. A strong research mission is demonstrated by an IRB-approved clinical registry and database that facilitate outcomes studies.

Dennis J. Hurwitz, M.D., F.A.C.S.

I want to thank Dr. Dennis J. Hurwitz for serving as guest editor of this issue of Seminars in Plastic Surgery on the topic of “Post-Bariatric Body Contouring” and the group of outstanding authors who contributed to this issue. Dr. Dennis J. Hurwitz is a Clinical Professor of Surgery (Plastic) at the University of Pittsburgh School of Medicine. He is also Director of the Hurwitz Center for Plastic Surgery in Pittsburgh. He has treated thousands of individuals with cosmetic concerns, structural defects, and congenital deformities. Dr. Hurwitz has innovated new techniques in obesity surgery and is well known for the “total body lift” procedure that he pioneered. He is a diplomat of the American Board of Plastic Surgery and a member of numerous plastic surgery societies. Dr. Hurwitz lectures internationally and throughout the nation and has published more than 100 articles on plastic surgery and most recently published a book on total body lift surgery.

Combined postbariatric body contouring and incisional hernia repair: A multidisciplinary approach

Combined postbariatric body contouring and incisional hernia repair: A multidisciplinary approach