Abdominoplasty Following Massive Weight Loss

Jordan M. S. Jacobs; Steven Schechner; Jonathan S. Jacobs

doi:10.1055/s-2006-932445

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2006; 20(1): 015-023
DOI: 10.1055/s-2006-932445

Abdominoplasty Following Massive Weight Loss

Jordan M.S Jacobs¹ , Steven Schechner² , Jonathan S. Jacobs²

¹Department of Surgery, New York University School of Medicine, New York, New York
²Associates in Plastic Surgery, Inc., Virginia Beach, Virginia

Abstract

ABSTRACT

Bariatric surgery has become an effective treatment for severe obesity. Various techniques have evolved over the years, with the most common now being the Roux-en-Y gastric bypass. Patients who experience massive weight loss are left with disfiguring skin laxity that warrants surgical excision of the redundant tissue. Our experience comes from 400 abdominoplasties performed on patients with massive weight loss over the past 20 years. Special consideration must be given to this subset of patients when designing their abdominoplasties because of compromised vascularity from previous surgeries and persistent volumes of subcutaneous adipose tissue. In particular, the groin flap or cross-abdominal flap or both are presented as options for the postbypass patient in whom subcostal and midline scarring is present. The reverse abdominoplasty remains an option in special circumstances. In addition, we focus on complications these patients are more likely to develop, mainly related to associated incisional hernias and a disrupted vascular anatomy.

KEYWORDS

Massive weight loss - groin flap - cross-abdominal flap

Full Text

References

^REFERENCES

1 Olshansky S J, Passaro D J, Hershow R C et al.. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005; 352 1138-1145
2 Must A, Spadano J, Coakley E H et al.. The disease burden associated with overweight and obesity. JAMA. 1999; 282 1523-1529
3 Pi-Sunyer F X. Medical hazards of obesity. Ann Intern Med. 1993; 119 655-660
4 Koplan JP, Liverman CT, Kraak VI Preventing Childhood Obesity: Health in the Balance. Washington, DC; National Academic Press 2005
5 Allison D B, Fontaine K R, Manson J R et al.. Annual deaths attributable to obesity in the United States. JAMA. 1999; 282 1530-1538
6 NHLBI Obesity Education Initiative .The practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Rockville, MD; National Institutes of Health 2000 (NIH publication no. 00-4084)
7 Flegal K M, Carroll M D, Odgen C L, Johnson C L. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002; 288 1723-1727
8 National Institutes of Health . Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Panel. Ann Intern Med. 1991; 115 956-961
9 Buchwald H, Avidor Y, Braunwald E et al.. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292 1724-1737
10 Balsiger B M, Poggio J L, Mai J et al.. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000; 4 598-605
11 DeMaria E J, Sugerman H J, Meador J G et al.. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001; 233 809-818
12 Sugerman H J, Kellum J M, Engle K M. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992; 55 560S-566S
13 Brolin R E, Gorman J H, Gorman R C et al.. Are vitamin B-12 and folate deficiency clinically important after Roux-en-Y gastric bypass?. J Gastrointest Surg. 1998; 2 436-442
14 Savage R C. Abdominoplasty following gastrointestinal bypass surgery. Plast Reconstr Surg. 1983; 71 500-507
15 Kelly H A. Report of gynecological cases (excessive growth of fat). Johns Hopkins Med J. 1899; 10 196-197
16 Kelly H A. Excision of fat of the abdominal wall lipectomy. Surg Gynecol Obstet. 1910; 10 229-231
17 Passot R. Chirurgie Esthetique Pure. Paris; Doin 1931: 261-267
18 Vernon S. Umbilical transplantation upward and abdominal contouring in lipectomy. Am J Surg. 1957; 94 490-492
19 Pitanguy I. Abdominal lipectomy: an approach to it through an analysis of 300 consecutive cases. Plast Reconstr Surg. 1967; 40 384-391
20 Gonzalez-Ulloa M. Abdominal wall disfigurement. Ann Plast Surg. 1980; 4 357-369
21 Grazer F M. Abdominoplasty. Plast Reconstr Surg. 1973; 51 617-623
22 Regnault P. Abdominoplasty by the W technique. Plast Reconstr Surg. 1975; 55 265-274
23 Babcock W W. The correction of the obese and relaxed abdominal wall with special reference to the use of the buried silver chain. Am J Obstet. 1916; 74 596
24 Elbaz J S, Flageul G. Plastic Surgery of the Abdomen. New York; Masson 1979
25 Castanares S, Goethel J A. Abdominal lipectomy: a modification in technique. Plast Reconstr Surg. 1967; 40 378-383
26 Dufourmental C, Mouly R. Chirurgie Plastique. Paris; Flammarion 1959: 381-389
27 Brown R G, Vasconez L O, Jurkiewicz M J. Transverse abdominal flaps and the deep epigastric arcade. Plast Reconstr Surg. 1975; 55 416-421
28 Regnault P, Daniel R K. Aesthetic Plastic Surgery. Boston, MA; Little, Brown 1984
29 Marques A, Brenda E, Pereira M D, de Castro M, Abramo A C. Abdominoplasty with two fusiform plications. Aesthetic Plast Surg. 1996; 20 249-251
30 Psillakis J M. Plastic surgery of the abdomen with improvement in body contour. Clin Plast Surg. 1984; 11 465-477
31 Appiani E. Muscular plastic for the aesthetic conformation of the abdominal girdle. Ann Plast Surg. 1984; 13 97-106
32 Jackson I T, Downie P A. Abdominoplasty: the waistline stick and other refinements. Plast Reconstr Surg. 1978; 61 180-183
33 Vastine V L, Morgan R F, Williams G S et al.. Wound complications of abdominoplasty in obese patients. Ann Plast Surg. 1999; 42 34-39
34 Regnault P. Abdominal dermolipectomies. Clin Plast Surg. 1975; 2 411-429
35 Juri J, Juri C, Raiden G. Reconstruction of the umbilicus in abdominoplasty. Plast Reconstr Surg. 1979; 63 580-582
36 Hurwitz D J, Zewert T. Body contouring after bariatric surgery. Operative Techniques in Plastic Reconstructive Surgery. 2002; 8 87-95
37 Nahai F, Brown R G, Vasconez L O. Blood supply to the abdominal wall as related to planning abdominal incisions. Am Surg. 1976; 42 691-695
38 Hurwitz D J. Single stage total body lift after massive weight loss. Ann Plast Surg. 2004; 52 435-441
39 Lockwood T E. Maximizing aesthetics in lateral-tension abdominoplasty and body lifts. Clin Plast Surg. 2004; 31 523-537
40 Lockwood T E. Fascial anchoring technique in medial thigh lifts. Plast Reconstr Surg. 1988; 82 299-304

Jonathan S JacobsD.M.D. M.D.

935 First Colonial Road

Virginia Beach, VA 23454