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DOI: 10.1055/s-0039-1700482
Body contouring surgery in a massive weight loss patient: An overview
Publication History
Publication Date:
15 January 2020 (online)

ABSTRACT
The number of patients with history of extreme overweight and massive weight loss (MWL) has risen significantly. Majority of patients are left with loose, ptotic skin envelopes, and oddly shaped protuberances, subsequent to weight loss. Redundant skin and fat can be seen anywhere on the body following MWL. This group of population presents many unique problems and challenges. Body contouring surgery after MWL is a new and exciting field in plastic surgery that is still evolving. Conventional approaches do not adequately cater to the needs of these patients. Complete history, detailed physical examination, clinical photographs and lab investigations help to plan the most appropriate procedure for the individual patient. Proper counseling and comprehensive informed consent for each procedure are mandatory. The meticulous and precise markings based on the procedure selected are the cornerstones to achieve the successful outcome. Lower body contouring should be performed first followed six months later by breast, lateral chest and arm procedures. Thighplasty is usually undertaken at the end. Body contouring operations are staged at few months′ intervals and often result in long scars. Staging is important as each procedure can have positive impact on adjacent areas of the body. Secondary procedures are often required. However, proper planning should lead to fewer complications and improved aesthetic outcome and patient satisfaction.
- 1 World Health Organization. Obesity: Preventing and managing the global epidemic. Geneva (IL): World Health Organization; 1998
- 2 National Family Health Survey (NFHS-3). http://mohfw.nic.in/nfhsfactsheet.html.
- 3 Lakka H, Bouchard C. Buchwald Jr HR, Cowan Jr GS, Pories W. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007: 18-28
- 4 Drenick E, Johnson D. Weight reduction by fasting and semi-starvation in morbid obesity: Long-term follow-up. Int J Obestet 1978; 2: 123-32
- 5 Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight loss maintenance: A meta-analysis of US studies. Am J Clin Nutr 2001; 74: 579-84
- 6 Livingston E. Obesity and its surgical management Am J Surg. 2002 184.
- 7 Anderson W, Greene GW, Forse RA, Apovian CM, Istfan N. Weight loss and health outcomes in African Americans and whites after gastric bypass surgery. Obesity 2007; 15: 1455-63
- 8 Mitka M.. Surgery useful for morbid obesity, but safety and efficacy questions linger. JAMA 2006; 296: 1575-7
- 9 Mitka M.. AORN J 2004; 79: 1026
- 10 Shermak M, Chang D, Magnuson T, Schweitzer M. An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Plast Reconstr Surg 2006; 118: 1026-31
- 11 Song A, Jean R, Hurwitz D, Fernstrom M, Scott J, Rubin J. A classification of contour deformities after bariatric weight loss: The Pittsburgh rating scale. Plast Reconstr Surg 2005; 116: 1535-44
- 12 Rohrich R. Mastering shape and from in cosmetic surgery: The Annual Meeting of American Society for Aesthetic Plastic Surgery. Plast Reconstr Surg 2001; 108: 741-2
- 13 Taylor J, Shermak M. Body contouring following massive weight loss. Obeset Surg 2004; 14: 1080-5
- 14 Millard Jr DR. Principalization of plastic surgery.. 1986
- 15 Gonzales-Ulloa M. Belt lipectomy. Br J Plast Surg 1961; 13: 179-86
- 16 Aly A, Cram A, Chao M, Pang J. McKeon M. Belt lipectomy for circumferential truncal excess: The University of Iowa experience. Plast Recontr Surg 2003; 111: 398-413
- 17 Vandeweyer E, Goldschmidt DP, Duchateau J. Circumferential torsoplasy. Br J Plast Surg 1999; 52: 623-8
- 18 Lockwood TE. Lower-body lift. Aesthetic Surg J 2001; 21: 355-70
- 19 Capella JF, Oliak DA, Nemerofsky RB. Body lift: An account of 200 consecutive cases in the massive weight loss patient. Plast Reconstr Surg 2006; 117: 414-30
- 20 Lockwood T.. Superficial fascial system (SFS) of the trunk and extremities: A new concept. Plast Reconstr Surg 1991; 87: 1009-27
- 21 Lockwood T.. Transverse flank-thigh-buttock lift with superficial fascial suspension. Plast Reconstr Surg 1993; 92: 1112-22
- 22 Lockwood T.. High-lateral-tension abdominoplasty lift with superficial fascial suspension. Plast Reconstr Surg 1995; 96: 603-15
- 23 Reichenberger M, Stoff A, Richter D. Body contouring surgery in the massive weight loss patient. Chirurg 2007; 326-34
- 24 Centeno R. Autologous gluteal augmentations with circumferential body lift in the massive weight loss and aesthetic patient. Clin Plast Surg 2006; 33: 482
- 25 Boroud Lj, Colwell AS. Autologous gluteal augmentation after massive weight loss: Aestheitc analysis and role of superior gluteal artery perforator flap. Plast Reconstr Surg 2007; 119: 345-56
- 26 Rubin JP. Mastopexy in the massive weight loss patient: Dermal suspension and total parenchymal reshaping. Aesthet Surg J 2006; 26: 214-22
- 27 Graf R, Biggs T. In search of better shape in mastopexy and reduction mammoplasty. Plast Recontr Surg 2002; 110: 309-17
- 28 Frey M.. A new technique in mammoplasty: Dermis suspension and elimination of medial scars. Br J Plast Surg 1999; 52: 45-51
- 29 Losken A, Holtz DJ. Versatility of the superomedial pedicle in managing the massive weight loss breast: The rotation-advancement technique. Plast Recontr Surg 2007; 120: 1060-8
- 30 Kwei S, Boroud LJ, Lee BT. Mastopexsy with autologous augmentation after massive weight loss: The intercostal artery perforator (ICAP) flap. Ann Plast Surg 2006; 57: 361-5
- 31 Temourian B.. Rejuvenation of the upper arm. Plast Reconstr Surg 1998; 102: 545-52
- 32 Richards ME. Minimal incision brachioplasty: A first choice option in arm reduction surgery. Aesthet Surg J 2001; 21: 301-10
- 33 Abramson DL. Minibrachioplasty: Minimizing scars while maximizing results. Plast Reconstr Surg 2004; 114: 1631-4
- 34 Aly A, Cram AE, Pace D. Brachioplasty in the patient with massive weight loss. Aesthet Surg J 2006; 26: 76-84
- 35 Hurwitz DJ, Holland Sw. The L brachioplasty: An innovative approach to correct excess tissue of the upper arm, axilla and lateral chest. Plast Reconstr Surg 2006; 117: 403-11
- 36 Lewis Jr JR. Correction of ptosis of the thighs: The thigh lift. Plast Reconstr Surg 1966; 37: 494-8
- 37 Lockwood TE. Fascial anchoring technique in medial thigh lifts. Plast Reconstr Surg 1988; 82: 299-304
- 38 Lockwood T.. Lower bodylift with superficial fascial system suspension. Plast Reconstr Surg 1993; 92: 1112-22
- 39 Downey S.. The use of fibrin sealant in the prevention of seromas in the massive weight loss patient. Plast Reconstr Surg 2005; 116: 223
- 40 Stoff A, Reichenberger MA, Richter DF. Comparing the ultrasonically-activated scalpel (Harmonic TM ) versus high frequency electrocautery on postoperative serous drainage in massive-weight-loss surgery. Plast Reconstr Surg 2007; 120: 1092-3