Post-bariatric Plastic Surgery Research Articles

Postbariatric plastic surgery for body reconstruction

Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery.

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

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. 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. 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. 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. 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 .

Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring.

Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list: a single Plastic Surgery Center investigation.

After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased.

Strategies for early detection of psychopathologies in candidates for post-bariatric plastic surgery

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Reducing complications in post-bariatric plastic surgery: our experience and literature review.

Background: With the rise in obesity, there has been a similar increase in bariatric surgery. This resulted in numerous patients losing significant weight with accompanying circumferential body contouring issues. This has led to an amazing increase in the number of body contouring procedures performed. Methods: The aim of this work is to revise the cases of body contouring in 78 ex-obese patients who underwent body contouring surgery in the Department of Health Life and Environmental Sciences – Plastic Reconstructive and Aesthetic Plastic Surgery Section, from 2007 to 2016. Results: The authors have noticed a deep relationship between adverse events and cigarette smoking and with pre-operative BMI. Regardless of these variables, the authors focused on the protocol for the management of patients, which required a collaboration between medical and nursing staff. Conclusions: Ex-obese patients have an important risk for complications, but the comparison of our personal data with those of the international literature confirms the efficacy of our management protocol with regard to the prevention of complications. (www.actabiomedica.it)

Intravenous iron in post-bariatric abdominoplasty anaemia: a pragmatic approach

There is a paucity of data addressing the use of different iron preparations for the treatment of patients with anaemia in the postoperative period after bariatric surgery and abdominoplasty. This cohort of patients is deemed at higher risk of developing iron deficiency anaemia and associated complications. Iron deficiency is common in these patients because of several factors, including lack of iron intake, reduction in gastric acid secretion, and impaired iron absorption of the duodenal and jejunal segments as a consequence of bariatric surgery. In The Lancet Haematology Juan Carlos Montano-Pedroso and colleagues 1 Montano-Pedroso JC Bueno Garcia E Alcântara Rodrigues de Moraes M Francescato Veiga D Masako Ferreira L. Intravenous iron sucrose versus oral iron administration for the postoperative treatment of post-bariatric abdominoplasty anaemia: an open-label, randomised, superiority trial in Brazil. Lancet Haematol. 2018; 5: e310-e320 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar report the results of a randomised controlled trial that assessed the effect of oral iron polymaltose versus intravenous iron sucrose in patients with anaemia after bariatric and abdominoplasty surgery. Intravenous iron sucrose versus oral iron administration for the postoperative treatment of post-bariatric abdominoplasty anaemia: an open-label, randomised, superiority trial in BrazilPostoperative intravenous administration of iron increased haemoglobin concentrations at 56 days post-operatively and reduced iron deficiency, without adverse events. Although superiority of intravenous iron was not shown, intravenous administration might be useful in post-bariatric patients, especially in those who have body-contouring treatment involving a second surgery within a short period of time. Larger trials, and trials using higher intravenous doses of iron, are needed to further assess the potential efficacy and safety of intravenous iron administration after post-bariatric plastic surgery. Full-Text PDF

Intravenous iron sucrose versus oral iron administration for the postoperative treatment of post-bariatric abdominoplasty anaemia: an open-label, randomised, superiority trial in Brazil

Anaemia and iron deficiency are common after post-bariatric abdominoplasty, which can involve removal of large areas of skin with associated blood loss. Because the oral absorbability of iron is reduced after bariatric surgery (through reduced intake, reduction of gastric acid secretion for conjugation of iron, and separation of the iron-absorptive areas of the duodenum and jejunum), it has been hypothesised that postoperative intravenous iron supplementation might be used to treat anaemia and iron deficiency in patients submitted to post-bariatric plastic surgeries. We aimed to assess whether intravenous iron administered postoperatively in post-bariatric abdominoplasty could result in increased blood haemoglobin concentrations compared with oral iron supplementation. In this open-label, randomised, superiority trial, we recruited women aged 18-55 years undergoing post-bariatric abdominoplasty at two public tertiary referral hospitals in São Paulo, Brazil. Eligible women had been treated for previous obesity with bariatric surgery using the vertical banded gastroplasty technique with Roux-en-Y gastric bypass by laparotomy; had grade III contour deformity via the Pittsburgh rating scale; and had a post-bariatric body-mass index (BMI) lower than 32 kg/m2, with stabilised weight loss for at least 6 months. Women were randomly assigned (1:1) to receive postoperative iron supplementation with two intravenous infusions of 200 mg of iron sucrose (intravenous group) or 100 mg of iron polymaltose complex orally twice a day for 8 weeks (oral group). The primary outcome in both groups was blood haemoglobin concentration at postoperative day 56 after abdominoplasty, with a minimum clinically relevant difference of 1·5 g/dL. Analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT01857011, and the Brazilian Clinical Trials Registry, number RBR-2JGRKQ. The trial is completed. From April 7, 2014, to June 27, 2016, 102 post-bariatric patients were assessed for eligibility. 56 patients were eligible and were randomly assigned, with 28 allocated to each group. Mean baseline haemoglobin concentration was slightly higher in the oral group than in the intravenous group (12·71 g/dL [SD 1·06] vs 12·24 g/L [1·09]), and by post-operative day 56 was 12·54 g/dL (SD 1·18) and 12·80 g/dL (0·81), respectively (mean difference of 0·26 g/dL, 95% CI -0·28 to 0·80; p=0·009 in favour of the intravenous group). The minimum clinically relevant difference in concentrations was not reached. No adverse events were recorded in the intravenous group, whereas in the oral group, constipation was recorded in five (18%) patients, diarrhoea in three (11%), and nausea in one (4%) patient. Postoperative intravenous administration of iron increased haemoglobin concentrations at 56 days post-operatively and reduced iron deficiency, without adverse events. Although superiority of intravenous iron was not shown, intravenous administration might be useful in post-bariatric patients, especially in those who have body-contouring treatment involving a second surgery within a short period of time. Larger trials, and trials using higher intravenous doses of iron, are needed to further assess the potential efficacy and safety of intravenous iron administration after post-bariatric plastic surgery. The São Paulo Research Foundation (FAPESP).

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery.

to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

Removal of excess skin after massive weight loss: challenges and solutions

Removal of excess skin after massive weight loss: challenges and solutions Salvatore Giordano Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland Abstract: The advent of bariatric surgery has led to a subspecialty in plastic surgery for skin and fat contouring which remain after massive weight loss. The author discusses the preoperative assessment, surgical treatment plan, postoperative management, possible complications, and benefits of postbariatric surgery. Preoperative planning includes medical history and patient assessment. Surgical procedures for brachioplasty, upper back lift, breast reshaping, abdominoplasty, panniculectomy, lower back lift, and thigh lift are discussed. Indications, postoperative complications, and benefits are also discussed. The best candidates for postbariatric plastic surgery are those who have achieved weight loss stability with a BMI of 32 or less and who have adequate nutrition in order to heal the surgical excisions. Abdominal and truncal deformity are the most common presenting complaints in massive weight loss patients, and the procedure of choice to address this region is a body lift. Postoperative care focuses on patient safety, prioritizing in deep venous thrombosis (DVT) prophylaxis and seroma prevention. Postbariatric body contouring aims to correct the deformity due to the excess of skin after massive weight loss and to restore a sense of normalcy. Keywords: morbid obesity, bariatric surgery, weight loss, massive weight loss, body contouring, panniculectomy

Plastic surgery after bariatric surgery.

Massive weight loss after bariatric surgery often results in excess skin, which can lead to stigma due to appearance and pronounced physical and psychological impairments. This review considers the evidence base for post-bariatric plastic surgery and the treatment options that are available. The article is based on a literature search in PubMed with the keywords «bariatric surgery» AND «plastic surgery», in addition to the authors' experience with a large number of patients. Body contouring surgery after massive weight loss is offered primarily for the treatment of troublesome skin conditions. The surgery can help to improve quality of life and functional status. However, there is little scientific evidence regarding indications for surgery, choice of surgical techniques and risk of complications, and the surgeon's own opinions and clinical experience often play a major role. Many plastic surgeons limit body contouring surgery to those with BMI < 28 kg/m². However, most patients who have undergone bariatric surgery have BMI ≥ 30 kg/m², and requests for body contouring surgery for these individuals are often denied, except when there are compelling medical grounds. Plastic surgery can lead to improved functioning and increased quality of life. The evidence base with respect to indications, treatment methods and outcomes should be strengthened through well-planned prospective studies and a patient registry. There is a particular need for documentation of treatment outcomes in the large group of patients with BMI ≥ 30 kg/m².

Postbariatrische plastische Chirurgie

Postbariatric plastic surgery after major weight loss can improve quality of life through functional reconstruction and restoration of a normal body contour. Comorbidities associated with obesity necessitate individual indications and precise preoperative planning in order to reduce the rate of postoperative complications. Postbariatric plastic surgery includes a variety of sophisticated surgical techniques and therefore requires profound knowledge and experience in this special field. Satisfactory results can be achieved by complying with basic principles and through the use of established methods. The present article provides an overview of current concepts and trends in postbariatric plastic surgery.

The Skin's Neurological Function Evaluation in Post-Bariatric Plastic Surgery

Sir Rieger,With great enthusiasm we read your letter about our article[1] because we share the same points of view, consideringquestionsaboutpossiblepreservationofabdominalcutaneoussensation after post-bariatric abdominoplasties without flapundermining as previously studied [2]. The skin's neurolog-ical function refers directly to the sensorial function [3]. Theconventional abdominosplasty causes hypoesthesia [4]thatexposes the patients to traumas and accidental burn injuries[5].Rieger et al. [6, 7] present a logical way (algorithm) toelect the most suitable technique for each formerly obeseindividual. One of the best clinical trials in post-bariatricplastic surgery that intended to find some possible causes ofpostoperative complications did not study the skin'sneurological function [8].It is well known that tegument's denervation damagesthe wound healing [9]. Future studies will investigate somepossible correlation among skin's sensorial/neurologicalfunction and complications after post-bariatric plasticsurgeries. Believing that tegument's neurological functionshould be maintained when possible, we keep studying andencouraging new researches about this subject.

Wide Topical Negative Pressure Wound Dressing Treatment for Patients Undergoing Abdominal Dermolipectomy Following Massive Weight Loss

Postbariatric plastic surgery is considered to be a high-risk procedure, which entails such frequent minor complications as postoperative seroma, bleeding and wound dehiscence. These occur with a high incidence, especially, following postbariatric abdominal dermolipectomy. In order to reduce these complication rates, a new type of dressing with wide abdominal topical negative pressure (TNP) application was applied. We performed abdominal dermolipectomy in 23 obese patients. The average body mass index was 32.8kg/m(2), and the median age of the patients was 42.9years. Ten patients received conventional standard dressings (control group I), whereas the other 13 patients received a wide TNP dressing including the ventral and lateral trunk (negative pressure group II). Postoperative exudate volumes were collected, tallied and documented for each group separately until all drains could be removed. The conventionally treated control group (I) showed a significantly higher postoperative secretion volume compared with the negative pressure group (II). In addition, the average time to postoperative final drain removal was significantly lower in the negative pressure group (II) compared with the control group (I). The results indicate that widely applied external TNP wound dressing on the ventral and lateral trunk following postbariatric abdominal dermolipectomy leads to a significant reduction in exudate formation, enables early drain removal and thus, decreases length of hospitalization.

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.

Körperformende plastisch-chirurgische Eingriffe nach massiver Gewichtsreduktion

With the advent of bariatric surgery, body contouring has grown to a new speciality in plastic surgery. Following massive weight loss, patients generally have skin redundancy on the trunk, buttocks, breast, upper arms, thighs and face, leading to a poor quality of life and social acceptance. This condition motivates many patients to consult a plastic surgeon to address these problems. Thus, plastic surgery has become an integral part of the surgical treatment of the morbidly obese. The aim of post-bariatric plastic surgery should be to restore a normal body image of the patient with as few surgeries as possible and with a tolerable risk. This article addresses different plastic surgery procedures that can be successfully applied in order to correct various body contouring deformities. Patient selection, technical details, pre- and postoperative care, possible complications and expected results are all discussed.

Postbariatrische Plastische Chirurgie

Approximately 1.7 billion people around the world are defined as being overweight or obese. Various surgical options to treat obesity have quite recently been developed. Following efficient and lasting weight loss, up to one-third of the patients will require plastic and reconstructive surgery. Plastic surgery will thus be the final part of a modern bariatric treatment plan. Postbariatric plastic surgery interventions do not treat obesity but rather remove excess skin and restore the normal body contour and function of the bariatric patient. The presented work summarizes current concepts and limitations in modern plastic and reconstructive surgery of the bariatric patient population.

Plastische Chirurgie nach forcierter Gewichtsreduktion „Kosmetik“ oder Rekonstruktion?

The epidemic-like increase of obesity in all western countries is associated with a growing incidence of morbid obesity. Here, efficient and lasting weight loss is mostly obtained by surgical interventions today performed in a reliable and safe manner. In that way comorbidities associated with obesity can be reduced or abolished. Treating the sequelae of bariatric surgery, with frequent massive weight loss and generalized skin excess, is challenging for the plastic surgeon. The goal is to restore a normal body contour as a prerequisite for complete psychosocial integration of the patients, who are often stigmatized by their outward appearance not only before but also after the weight loss. The present work provides an overview of current concepts and trends in post-bariatric plastic surgery.

53: PSEF 2006 Scientific Essay Contest Junior Award ??? Clinical Research, Integra Foundation: Post-bariatric Plastic Surgery: Patient Care Algorithms, Technical Advances, and Outcomes in an Academic Center

53: PSEF 2006 Scientific Essay Contest Junior Award ??? Clinical Research, Integra Foundation: Post-bariatric Plastic Surgery: Patient Care Algorithms, Technical Advances, and Outcomes in an Academic Center