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Lewis JE, Ghogomu M, Hickman SJ, Ashade A, Hollis RJ, Lewis JE, Lee WC. Semaglutide and Postoperative Outcomes in Nondiabetic Patients Following Body Contouring Surgery. Aesthet Surg J 2025; 45:381-386. [PMID: 39665435 PMCID: PMC11913076 DOI: 10.1093/asj/sjae241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 11/27/2024] [Accepted: 12/10/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Semaglutide is a medication for weight loss in obese patients. Recently, many plastic surgeons have recommended semaglutide following bariatric surgery to increase weight loss. However, postoperative complications such as wound dehiscence, delayed healing, and infection pose significant risks. OBJECTIVES In this study we aimed to examine the relationship between preoperative semaglutide and postoperative complications in nondiabetic obese patients undergoing body contouring surgery. We hypothesized that semaglutide would increase the risk of postoperative complications. METHODS In this retrospective cohort study we utilized the TriNetX Research database. Nondiabetic patients who underwent body contouring surgery between 2021 and 2024 after bariatric procedures were included. Patients were divided into 2 cohorts: Cohort A (4215 patients), which received semaglutide for ≥6 months before surgery, and Cohort B (104,927 patients), without semaglutide. Propensity score matching was employed to create comparable cohorts based on age, gender, race, and BMI. The primary outcomes included postoperative complications within 30 days of surgery. RESULTS Significant differences were found between the cohorts. Semaglutide patients had higher rates of wound dehiscence (5.19% vs 2.78%, P < .0001); delayed wound healing (2.58% vs 1.21%, P < .0001); surgical site infections (5.37% vs 2.87%, P < .0001); nausea, vomiting, and diarrhea (11.27% vs 5.34%, P < .0001); hypertrophic scar formation (5.53% vs 3.86%, P = .0011); and surgical site pain (6.05% vs 3.29%, P < .0001). CONCLUSIONS Preoperative semaglutide in nondiabetic patients undergoing body contouring surgery following bariatric procedures is associated with higher rates of adverse postoperative outcomes. These findings highlight the need for enhanced preoperative counseling and surgical planning to minimize risks and improve patient outcomes. LEVEL OF EVIDENCE: 3 (THERAPEUTIC)
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Mahrhofer M, Caputo GG, Fierdel F, Reichert R, Russe E, Wimmer F, Schoeller T, Weitgasser L. Seasonal Impact on Wound Healing and Surgical Site Infections after Reduction Mammoplasty. J Clin Med 2024; 13:5938. [PMID: 39407998 PMCID: PMC11477683 DOI: 10.3390/jcm13195938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/29/2024] [Accepted: 10/03/2024] [Indexed: 10/20/2024] Open
Abstract
Background: The incidence of reduction mammoplasty has been steadily increasing over recent decades. Surgical site infections (SSIs) represent a common yet preventable complication across surgical disciplines. Studies across various surgical specialties have indicated a seasonal influence on SSIs, primarily correlated with higher temperatures and humidity. However, there remains a scarcity of clear data regarding the seasonal effects on complications specifically in breast surgery. Methods: We conducted a retrospective review encompassing all patients who underwent primary bilateral reduction mammoplasties at our institution between 1 June 2016, and 1 September 2019. The data collected included patient demographics, surgical details, and postoperative complications. The rates of SSIs and wound healing disturbances (WHDs) were correlated with local meteorological data at the time of surgery. Results: A total of 808 patients (1616 breasts) met the inclusion criteria. The mean age was 41 ± 14.8 years, with a mean BMI of 28.9 ± 5.2 kg/m2 and a mean follow-up duration of 8.9 ± 9.8 months. Nineteen cases (2.35%) of surgical site infections and 77 cases (9.52%) of wound healing disturbances were reported. No statistically significant increase in the risk of SSIs (p = 0.928) or WHDs (p = 0.078) was observed during the warmer months of the year. Although no specific risk factors were identified for surgical site infections, both resection weight (p < 0.001) and diabetes mellitus (p = 0.001) demonstrated increased risks for wound healing disturbances. Conclusions: While seasonal temperature variations have been shown to impact SSIs and WHDs in body contouring procedures, our findings suggest that breast reduction surgery may not be similarly affected.
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Affiliation(s)
- Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 70199 Tuebingen, Germany
| | - Glenda Giorgia Caputo
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy;
| | - Frederic Fierdel
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 70199 Tuebingen, Germany
| | - Raphael Reichert
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 70199 Tuebingen, Germany
| | - Elisabeth Russe
- Department of Plastic and Reconstructive Surgery, Hospital of the Brothers of St. John of God, Paracelsus Medical University Salzburg, 5010 Salzburg, Austria
| | - Florian Wimmer
- Department of Plastic and Reconstructive Surgery, Hospital of the Brothers of St. John of God, Paracelsus Medical University Salzburg, 5010 Salzburg, Austria
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 70199 Tuebingen, Germany
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 70199 Tuebingen, Germany
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Pollhammer MS, Duscher D, Pagani A, Zaussinger M, Wenny R, Zucal I, Schmidt M, Prantl L, Huemer GM. The Clavien-Dindo Classification for Body-Contouring Surgery Complications: Evaluation of 602 Cases. Life (Basel) 2024; 14:1120. [PMID: 39337903 PMCID: PMC11432988 DOI: 10.3390/life14091120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Due to the high frequency of postoperative complications after body-contouring surgeries, the need for a unifying postoperative complication grading system that correlates with outcomes is of key importance. Here we therefore consider the application of the Clavien-Dindo classification to evaluate postoperative complications after body-contouring surgeries. Methods: A retrospective study on 602 patients who underwent body-contouring surgery between 2009 and 2015 at our institution was performed. The length of hospital stays, age, sex, follow-up visits, and postoperative complications were evaluated and classified using the Clavien-Dindo classification. Results: We raised a total of 672 body-contouring procedures on 602 patients (563 female, 39 male). According to the Clavien-Dindo System, the severity of postoperative complications following body-contouring procedures was significantly correlated with the duration of hospitalization (mean 5.8 ± 2.7 days) and the number of follow-up visits (mean 4.4 ± 4.7). Conclusions: The Clavien-Dindo classification offers a valid prediction for postoperative hospital stay and the number of follow-up visits after body-reshaping surgery. By becoming a validated and reliable grading system that correlates patients' outcomes after body-contouring procedures, this classification has the potential to significantly improve patients' healthcare and quality of life.
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Affiliation(s)
- Michael S Pollhammer
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Andrea Pagani
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Maximilian Zaussinger
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
- Doctoral Degree Program in Medial Science (Ph. D.), Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Raphael Wenny
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Isabel Zucal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Manfred Schmidt
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Lukas Prantl
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Georg M Huemer
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
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Hany M, Zidan A, Ghozlan NA, Ghozlan MN, Abouelnasr AA, Sheta E, Hamed Y, Kholosy H, Soffar M, Midany WME, Torensma B. Comparison of Histological Skin Changes After Massive Weight Loss in Post-bariatric and Non-bariatric Patients. Obes Surg 2024; 34:855-865. [PMID: 38277086 PMCID: PMC10899414 DOI: 10.1007/s11695-024-07066-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Changes in the skin structure, including the collagen and elastin content, have been reported with massive weight loss (MWL) following bariatric metabolic surgery (BMS) and have been correlated to a higher risk of complications after body-contouring surgery (BCS). This study aimed at comparing the histological characteristics of the skin of patients having surgical MWL (SMWL) post-BMS to those with non-surgical massive weight loss (NSMWL). METHODS This prospective study compared the epidermal thickness, and collagen and elastin fibers content in 80 skin biopsies obtained from BCS procedures performed to patients who experienced MWL defined more than 50% of excess weight loss (%EWL) either SMWL (40 biopsies) or NSMWL (40 biopsies). Twenty biopsies in each group were obtained from abdominoplasties and 20 from breast reductions. Epidermal thickness was measured in H&E-stained sections, collagen fibers were assessed using Masson trichrome-stained sections, and elastin fibers were assessed using Modified Verhoeff's stained sections. Image analysis software was used to calculate the fractions of collagen and elastin fibers. RESULTS This study included 77 patients, 38 SMWL patients, and 39 NSMWL patients. The SMWL group had a significantly higher age (p < 0.001), a longer time interval from intervention (p < 0.001), higher initial weight (p < 0.001), higher initial BMI (p < 0.001), lower current weight (p = 0.005), lower current BMI (p < 0.001), and significantly higher %EWL than NSMWL group (p < 0.001). No significant differences were detected between the two groups regarding complications after abdominoplasty (p = 1.000). The elastic fibers content in the dermis was significantly higher in the abdominal region of the NSMWL group than SMWL (p = 0.029). All other parameters showed non-significant differences between NSMWL and SMWL in the skin of abdomen and breast. CONCLUSION The SMWL group had a significant reduction in elastic fiber content in the skin of the abdomen compared to the NSMWL group. The collagen content was equally reduced in both groups with non-significant differences in both breast and abdomen regions in both groups.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Madina Women's Hospital, Alexandria University, Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Nasser A Ghozlan
- Plastic and Reconstructive Surgery - Alexandria University, Alexandria, Egypt
| | - Mohamed N Ghozlan
- Department of Plastic Surgery, Alexandria University, Alexandria, Egypt
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Eman Sheta
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Hamed
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Hassan Kholosy
- Department of Plastic Surgery, Alexandria University, Alexandria, Egypt
| | - Mohammed Soffar
- Department of Plastic Surgery, Alexandria University, Alexandria, Egypt
| | | | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Pazouki A, Shahabi S, Yarigholi F, Fathi M. Previous Body-Contouring Surgery Before Metabolic and Bariatric Surgery: Does It Matter? Obes Surg 2023; 33:4168-4169. [PMID: 37833488 DOI: 10.1007/s11695-023-06873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Fahime Yarigholi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Mohammad Fathi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran.
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Facchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V. Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic Plast Surg 2023; 47:2479-2485. [PMID: 36820862 PMCID: PMC10784373 DOI: 10.1007/s00266-023-03287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Due to the high demand of post-bariatric surgeries, the number of litigation cases is rapidly growing. Even if surgical mistakes still represent one of the main causes of medico-legal issues, many disputes depend on what happens in the post-operative course. In this article we analyzed the litigation cases that occurred in our Plastic Surgery Department, the current literature about medico-legal disputes and the importance of the doctor-patient relationship. PATIENTS AND METHODS The medical records of 788 post-bariatric surgeries, the post-operative complications and the related litigation cases from January 2015 to December 2019 were collected, analyzed and compared. RESULTS We performed 380 abdominoplasties, 28 torsoplasties, 65 breast reductions, 99 mastopexies, 94 brachioplasties, 52 thighplasties, 65 liposuctions and 5 facelifts between 2015 and 2019. Eight patients complained of medical issues and claimed for litigation. Despite in all cases the judges highlighted the risk of consent misinterpretation, the payout was granted only in one case. CONCLUSION Post-bariatric patients often mistake their preoperative condition and consider body contouring procedures as an aesthetic surgery treatment. Patients should be therefore clearly informed about the complexity of body contouring procedures after massive weight loss, which should never be compared to aesthetic surgery. Surgeons should always promote the communication with their patients and build a strong and trustworthy relationship. This attitude will allow to deal more easily with complications and, in the worst situations, with medico-legal litigations. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Federico Facchin
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
- Plastic Surgery Unit, San Bortolo Hospital, 36100, Vicenza, Italy.
| | - Andrea Pagani
- Clinic and Polyclinic of Plastic and Hand Surgery, Technical University of Munich, 81675, Munich, Germany
| | - Filippo Andrea Giovanni Perozzo
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Carlotta Scarpa
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Weber J, Kalash Z, Simunovic F, Bonaventura B. Prolonged postoperative antibiotic administration reduces complications after medial thigh lift. J Plast Surg Hand Surg 2022; 56:361-368. [PMID: 34928776 DOI: 10.1080/2000656x.2021.2010738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is widespread consensus that there is no indication for postoperative antibiotic administration after elective surgery. However, medial thigh lift (MTL) remains a procedure with a notoriously high rate of wound-healing disorders and infections. This study investigates the correlation between prolonged antibiotic administration and complications after MTL in massive weight loss patients. We performed a single-institution retrospective review of 121 patients undergoing MTL between 2009 and 2020. Data on postoperative outcome, demography, surgery and comorbidities were collected. All patients received intravenous antibiotics preoperatively. One group was continued on oral antibiotics for two weeks postoperatively. Complications and surgical site infections were observed and evaluated. There was no difference between the groups regarding age, BMI, or presence of obesity-associated risk factors. We observed complications in 76 patients (71%), with 60 (56%) minor and 16 (15%) major complications. The group without prolonged antibiotic administration had a higher number of total complications (OR 3.5; p = 0.0037), major complications (OR 4; p = 0.01), and wound infections (OR 6.8; p = 0.0004). Logistical regression analysis showed that this effect was independent of type of weight loss, resection volume, and age. Reduction of major infections by prolonged antibiotics was, however, dependent on BMI Δ. No side-effects associated with antibiotics were registered in this series. This study suggests that prolonged antibiotic administration may decrease complications in MTL. We thus continue to use prolonged antibiotic administration after MTL. Further research is needed to determine the optimal duration of antibiotic treatment. Level of Evidence: Level IV: therapeutic study.
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Affiliation(s)
- J Weber
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Z Kalash
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - F Simunovic
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - B Bonaventura
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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ElAbd R, AlMojel M, AlSabah S, AlRashid A, AlNesf M, Alhallabi B, Burezq H. Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study. Obes Surg 2022; 32:3847-3853. [PMID: 36208387 DOI: 10.1007/s11695-022-06309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods. METHODS This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone. RESULTS A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05). CONCLUSION Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.
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Affiliation(s)
- Rawan ElAbd
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, Jaber Al Ahmed Hospital, Kuwait City, Kuwait
| | - Malak AlMojel
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Salman AlSabah
- Department of Surgery, Jaber Al Ahmed Hospital, Kuwait City, Kuwait.
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | - Abdulaziz AlRashid
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Meshari AlNesf
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Becher Alhallabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
- Division of Plastic and Reconstructive Surgery, Hôpital De Saint-Jérôme, Saint-Jérôme, QC, Canada
| | - Hisham Burezq
- Al-Babtain Center for Burns and Plastic Surgery, Shuwaikh City, Kuwait
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Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring. J Clin Med 2022; 11:jcm11154315. [PMID: 35893406 PMCID: PMC9330885 DOI: 10.3390/jcm11154315] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Wilson A, Raafat S. One key to fit all locks? Routine internal drainage to minimize seromas during thigh lift surgeries. ANN CHIR PLAST ESTH 2022; 67:153-161. [DOI: 10.1016/j.anplas.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
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de Macedo JLS, Rosa SC, Canedo LR, Casulari LA. What Is the Impact of Residual Obesity on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients? Obes Surg 2021; 30:4149-4154. [PMID: 32451919 DOI: 10.1007/s11695-020-04711-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are an increasing number of patients presenting for plastic surgery after massive weight loss, and many of these patients have residual obesity that may compromise outcomes. The impact of residual obesity on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures is unclear. METHODS We report the outcomes of 207 patients who underwent plastic surgery following RYGB from January 2011 to December 2018. RESULTS Two hundred and seven patients (196 females, 11 males) with a mean age of 42 years underwent 335 separate operations. The average BMI at the time of plastic surgery was 27.43 kg/m2. The average weight loss was 47.08 kg. The prevalence of comorbidities was 26.6% and the most important presurgery comorbidities were arterial hypertension (10.1%) and diabetes mellitus (4.8%). Of the 207 patients who underwent surgery, 78.3% (168/207) underwent abdominoplasty and 45.0% underwent mammoplasty. The overall rate of complications was 27.5%. The prevalence of postoperative complications was not significantly different between patients with a BMI ≥ 30 kg/m2 and patients with a BMI < 30 kg/m2 (33.3% vs 25.9%, respectively; p = 0.344). CONCLUSION In this group of patients, with specified anthropometric and clinical profiles, the residual obesity did not influence the incidence of postoperative complications in postbariatric patients after plastic surgery.
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Affiliation(s)
- Jefferson Lessa Soares de Macedo
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, CEP, Brasília, DF, 70 292-080, Brazil.
| | - Simone Corrêa Rosa
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, CEP, Brasília, DF, 70 292-080, Brazil.,Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil
| | | | - Luiz Augusto Casulari
- Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil
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12
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Restifo RJ. Abdominoplasty in the Massive Weight Loss Patient: Are Aesthetic Goals and Safety Mutually Exclusive? Aesthet Surg J Open Forum 2021; 3:ojab013. [PMID: 34212144 PMCID: PMC8240744 DOI: 10.1093/asjof/ojab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background The goals of abdominoplasty in massive weight loss (MWL) patients are often functional, with a greater emphasis on safety than on aesthetic rejuvenation. As important as functional improvements and safety are, however, there may be room for increasing the aesthetic potential of abdominoplasties in these patients. Objectives To determine the safety of the pursuit of aesthetic goals for abdominoplasty in MWL patients. Methods This is a retrospective study examining 910 consecutive female patients consisting of 3 groups: postpartum (n = 718), dietary MWL (n = 65), and bariatric MWL (n = 127). All patients were approached with a well-defined set of aesthetic goals which were pursued as needed and as feasible. Results The utilization of aesthetic abdominoplasty components was similar in all groups, supporting the assertion that the groups were subjected to a similar aesthetic emphasis. Logistic regression showed that a history of bariatric MWL was an independent risk factor for multiple complications (odds ratio 2.738, P = 0.014) and that elevated body mass index (BMI), smoking, diabetes, and age were likewise independent risk factors for complications. Propensity score-matched case-control pairs showed that bariatric MWL patients were more likely than dietary MWL patients to experience multiple complications (9.52% vs 0%, P = 0.031). Conclusions Bariatric MWL patients but not dietary weight loss patients seem to have a higher risk than postpartum patients. Other comorbidities (elevated BMI, smoking, diabetes, and age) seem to be more important predictors of complications than MWL status. Select MWL patients can likely be approached with an emphasis on aesthetic goals, without increasing risks as compared with the postpartum population. Level of Evidence: 2
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Affiliation(s)
- Richard J Restifo
- Corresponding Author: Dr Restifo, 620 Racebrook Road, Orange, CT 06477, USA. E-mail: ; Instagram: @DrRestifo
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13
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De Paep K, Van Campenhout I, Van Cauwenberge S, Dillemans B. Post-bariatric Abdominoplasty: Identification of Risk Factors for Complications. Obes Surg 2021; 31:3203-3209. [PMID: 33796972 DOI: 10.1007/s11695-021-05383-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim was to evaluate the complication rate after abdominoplasty procedures performed in a high volume post-bariatric center and to identify predictors of complications. MATERIAL AND METHODS A retrospective analysis was performed and included all abdominoplasty procedures performed between January 2011 and December 2019. Complications classified according to the Clavien-Dindo classification were documented and potential risk factors were statistically evaluated. RESULTS A total of 898 patients were included. Overall complication rate was 29.8%. Type I complications (minor wound problems) occurred in 15.8% (n = 140). Type II complications requiring medical intervention occurred in 10% (n = 90). Five patients had deep venous thrombosis or pulmonary embolism; others received antibiotic treatment for wound infections. In total 42 type III complications occurred in 36 patients, with re-intervention for wound problems (n = 16), seroma (n = 16), umbilical necrosis (n = 4), and bleeding (n = 6). The weight of tissue resected (p < 0.001), the interval between bariatric and body contouring surgery (p < 0.05), preoperative BMI (p < 0.05), male gender (p < 0.05), diabetes mellitus type 2 (p = 0.05), and smoking (p < 0.05) were important predictors for developing complications. CONCLUSION In this large retrospective post-bariatric abdominoplasty series, the overall complication rate is low compared to other published series as a consequence of our completely standardized approach and technique. Our analysis shows a significant linear correlation between the amount of skin tissue resected and postoperative complications. Moreover, the longer the interval between bariatric surgery and abdominoplasty, the higher the complication rate. High preoperative BMI, diabetes mellitus type 2, smoking, and male gender were identified as independent significant risk factors for complications.
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Affiliation(s)
- Karen De Paep
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Ilia Van Campenhout
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Sebastiaan Van Cauwenberge
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium.
| | - Bruno Dillemans
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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14
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Schlosshauer T, Kiehlmann M, Jung D, Sader R, Rieger UM. Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications. Aesthet Surg J 2021; 41:59-71. [PMID: 32162655 DOI: 10.1093/asj/sjaa067] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. OBJECTIVES The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. METHODS A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. RESULTS A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. CONCLUSIONS This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4.
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Affiliation(s)
- Torsten Schlosshauer
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Marcus Kiehlmann
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Diana Jung
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Robert Sader
- Dr Sader is the Head of the Department, Oral, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
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15
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Soares de Macedo JL, Corrêa Rosa S, Ribeiro Canedo L, Leão CCA, Marques da Silva FM, Farias do Nascimento Rocha JL, Vieira YO, de Rezende Filho Neto AV. The Impact of the Weight of Removed Tissue on the Development of Postoperative Complications in Patients Undergoing Abdominoplasty after Gastric Bypass. Obes Surg 2020; 31:2324-2329. [PMID: 33145721 DOI: 10.1007/s11695-020-05104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients who undergo Roux-en-Y gastric bypass (RYGB) have significant weight loss, and abdominoplasty is an effective corrective surgery for removing excess skin. This study aimed to evaluate the impact of the weight of removed tissue on the development of postoperative complications in patients undergoing abdominoplasty without lipoaspiration after gastric bypass at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS Data were analyzed from a prospective registry of patients who underwent abdominoplasty without lipoaspiration after gastric bypass from January 2011 to December 2018. The variables examined included body mass index (BMI) before RYGB and before plastic surgery, weight loss, weight of the excised abdominal flap, comorbidities, and medical complications. Analysis of the role of the weight of the removed tissue after abdominoplasty was performed to assess outcome measures. RESULTS One hundred sixty-three patients were included. The mean age of the patients was 42 years. Their BMI at the time of abdominoplasty was 27.49 kg/m2, and the average weight loss before abdominoplasty was 47.13 kg. The preweight loss BMI was 45.27 kg/m2, and the ∆BMI was 17.78 kg/m2. The overall complication rate was 29.4%. An amount of removed tissue from the abdomen ≥ 2000 g significantly increased the rates of postoperative complications (46.7% vs. 19.4%; p = 0.002; OR = 3.13). CONCLUSIONS Removal of ≥ 2000 g of tissue from the abdomen led to significantly more complications in patients who underwent abdominoplasty after gastric bypass. In addition, this group of patients was significantly associated with the presence of higher anthropometric variable values (BMI, weight loss, max BMI, and ∆BMI) and not associated with the presence of comorbidities.
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Affiliation(s)
- Jefferson Lessa Soares de Macedo
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil. .,Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil. .,Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.
| | - Simone Corrêa Rosa
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil.,Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil
| | - Lucas Ribeiro Canedo
- Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.,Department of General Surgery, Asa Norte Regional Hospital, Brasília, DF, Brazil
| | - Cássio Cesar Arrais Leão
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - Fernando Marinho Marques da Silva
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - João Lucas Farias do Nascimento Rocha
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil.,Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.,Department of General Surgery, Asa Norte Regional Hospital, Brasília, DF, Brazil
| | - Yasmine Oliveira Vieira
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - Altino Vieira de Rezende Filho Neto
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
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16
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Brito ÍM, Meireles R, Baltazar J, Brandão C, Sanches F, Freire-Santos MJ. Abdominoplasty and Patient Safety: The Impact of Body Mass Index and Bariatric Surgery on Complications Profile. Aesthetic Plast Surg 2020; 44:1615-1624. [PMID: 32342171 DOI: 10.1007/s00266-020-01725-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominoplasty is a frequent aesthetic surgical procedure. Despite its popularity, patient safety requires further attention because of an important risk of complications. Obesity and bariatric surgery are potential risk factors. This study evaluated the impact of body mass index (BMI) and bariatric surgery on complications profile. METHODS A retrospective review of patients undergoing abdominoplasty over a 5-year period was conducted. Patient demographics, comorbidities, BMI, bariatric surgery, complications (minor and major) and drainage outcomes were evaluated. Univariate and multivariate logistic regression analyses were performed for risk assessment. RESULTS The 191 study patients showed an overall complication rate of 32.5%, comprising minor (27.7%) and major complications (7.9%). Seroma was the most common complication (20.9%). Mean BMI was 27.1 kg/m2. Obesity was present in 14.1%, and bariatric surgery in 53.4%. Obese patients had significant higher rates of overall complications (74.1%, p < 0.001), minor complications (66.7%, p < 0.001), seroma (51.9%, p < 0.001) and drainage outputs (p < 0.001). Bariatric patients showed an increased time (p = 0.003) and volume of drainage (p < 0.001), without significant differences in complications. Obesity and preoperative BMI were the only independent risk factors for overall complications (OR 8.3; and OR 1.3; p < 0.001), minor complications (OR 7.4; and OR 1.3; p < 0.001) and seroma (OR 4.5; and OR 1.2; p = 0.002). Diabetes was an independent risk for major complications (OR 4.6; p = 0.047). CONCLUSION Obesity has negatively impacted the profile and risk of complications, whereas bariatric surgery independently did not. Our study provides an accurate understanding of abdominoplasty complications, allowing better risk stratification, candidate selection refinement, morbidity reduction, fair patient counseling and overall improvement in patient safety. EBM LEVEL III 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 .
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Affiliation(s)
- Íris M Brito
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal.
| | - Rita Meireles
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal
| | - João Baltazar
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal
| | - Carla Brandão
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal
| | - Fernanda Sanches
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal
| | - Mário J Freire-Santos
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Center, 3000-075, Coimbra, Portugal
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Lo Torto F, Marcasciano M, Frattaroli JM, Kaciulyte J, Mori FLR, Redi U, Casella D, Cigna E, Ribuffo D. Quality Assessment of Online Information on Body Contouring Surgery in Postbariatric Patient. Aesthetic Plast Surg 2020; 44:839-846. [PMID: 31712871 DOI: 10.1007/s00266-019-01535-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nowadays, we have to face the fact that the Web represents one of the most important sources of information for patients. Postbariatric patients in particular are usually very motivated, and they are enthusiastic users of the Web as a source of information on the different types of surgery they could undergo after their weight loss in order to reshape and remodel their body thus regaining physical and functional wellness and dignity. The aim of the study was to assess information on the four most commonly performed postbariatric procedures worldwide, tummy tuck, breast, arm and thigh lift, with the same scale. METHODS Google and Yahoo have been probed for the keywords "Post bariatric Mastopexy OR breast lift" and "Post bariatric abdominoplasty OR tummy tuck" and "Post bariatric brachioplasty OR arm lift" and "post bariatric thigh lift". The first 50 hits were included, and the quality of information was evaluated with the expanded EQIP scale. RESULTS There was a critical lack of information about qualitative risks and side-effect description, treatment of potential complications, alert signs for the patient and precautions that the patient may take. Moreover, there was poor information about the sequence of the medical procedure, quantitative benefits and risks and quality of life issues after the procedure, and often, there were no other sources of information. CONCLUSIONS Due to the poor and not reliable information offered by the Web, health professionals should seek for a good communication practice with their patients. LEVEL OF EVIDENCE V 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.
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Affiliation(s)
- Federico Lo Torto
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy.
| | - Marco Marcasciano
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Jacopo M Frattaroli
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Juste Kaciulyte
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Francesco L R Mori
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Ugo Redi
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Donato Casella
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
| | - Emanuele Cigna
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Diego Ribuffo
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, via Ettore Fieramosca 200, 00159, Rome, Italy
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18
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Wiser I, Plonski L, Shimon N, Friedman T, Heller L. Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery: A Nested Case-Control Study. Ann Plast Surg 2020; 82:493-498. [PMID: 30950874 DOI: 10.1097/sap.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients. OBJECTIVE The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery. METHODS This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs. RESULTS From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13-19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03-0.61). CONCLUSIONS Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.
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Affiliation(s)
| | - Lori Plonski
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Nitai Shimon
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Tali Friedman
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Lior Heller
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
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19
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Krauss S, Medesan R, Black J, Medved F, Schaefer R, Schaller HE, Daigeler A, Wahler T. Outcome of Body-Contouring Procedures After Massive Weight Loss. Obes Surg 2020; 29:1832-1840. [PMID: 30778847 DOI: 10.1007/s11695-019-03773-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the increased popularity of bariatric surgery, the demand for body-contouring procedures is growing. Associated with these procedures are a number of complications due to different risk factors and patients' characteristics. The aim of this study was to assess the outcome of body-contouring procedures and correlate it to possible risk factors. METHODS The study included a collective of 112 patients who underwent 157 body-contouring procedures. Patients' characteristics, risk factors, and complications have been recorded. Three groups were formed based on the type of surgical procedure to perform correlations of BMI, weight of resected tissue, and length of hospital stay using Spearman's rank test. Correlations between patients' risk factors and complication occurrence were analyzed with Fisher's exact test. RESULTS The most common procedure patients underwent was the classic abdominoplasty (n = 53). A significant correlation was found between preoperative BMI and weight of resected tissue in abdominoplasties (rho = 0.69), Fleur-de-Lis abdominoplasties (rho = 0.64), and body lifts (rho = 0.60). There was a significant correlation between weight of resected tissue and length of hospital stay (rho = 0.53) and preoperative BMI and length of hospital stay (rho = 0.4) as well. There was no significant correlation between patients' comorbidities or smoking status and the postoperative complication rate. The mean weight of resected tissue was higher in patients with than without complications requiring surgical revision. CONCLUSIONS The relevance of risk factors commonly believed to have an influence on postoperative complications should be revised. The weight of resected tissue has an influence on complication.
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Affiliation(s)
- Sabrina Krauss
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Raluca Medesan
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Jaantje Black
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Fabian Medved
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Ruth Schaefer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Hans-Eberhard Schaller
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Theodora Wahler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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20
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Losco L, Roxo AC, Roxo CW, Lo Torto F, Bolletta A, de Sire A, Aksoyler D, Ribuffo D, Cigna E, Roxo CP. Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience. Aesthetic Plast Surg 2020; 44:421-432. [PMID: 31748908 DOI: 10.1007/s00266-019-01543-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower body lift is a widespread procedure for massive weight loss patients aimed to improve the contour of the lower trunk, gluteal region and proximal lower extremity. The data about complications are confusing, and there is a lack of uniform studies for massive weight loss patients. A simple formula to carry out a reliable procedure in a short time with a low complication rate should be advocated. METHODS This retrospective study analyzed data of 323 patients undergoing lower body lift after bariatric surgery over a 10-year period. Selection criteria, careful preoperative marking, reliable intra- and postoperative care and a few surgical tips are discussed. All the complications (both major and minor) and the aesthetic satisfaction were evaluated. Risk factors assessed were patient age, tobacco consumption, current BMI, operative time and combined surgery. RESULTS The overall complication rate was 42%. We recorded a lower rate of major complications and skin dehiscence; no infection and no skin necrosis were observed. The most frequent complication was seroma (35%). A complication development was straight related to age (p = 0.0177) and tobacco use (p = 0.0336). Patients' satisfaction about overall aesthetic was high. CONCLUSIONS We present our case load and describe an easy recipe to perform a safe surgery without undermining and liposuction in short operative times. The reasonable overall complication rate and the surprisingly lower rate of dehiscence and skin necrosis combined with a pleasant aesthetic result make the lower body lift an easy and safe procedure, when applied to the appropriate patient population. LEVEL OF EVIDENCE IV 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.
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Affiliation(s)
- Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy.
| | - Ana Claudia Roxo
- Plastic Surgery Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Carlos W Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Alberto Bolletta
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro de Sire
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Dicle Aksoyler
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy
| | - Carlos P Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
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Lymphostasis and Hemostasis in Body-Contouring Surgery Using a Polysaccharide Based Hemostat (4DryField PH). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2128. [PMID: 31044110 PMCID: PMC6467625 DOI: 10.1097/gox.0000000000002128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
Background: Following liposuction, abdominoplasty is the most frequent body-contouring intervention in the world. The transection of small blood vessels in large areas and subsequent bleeding is a viable risk during this procedure. The resulting microvascular bleedings should be stopped thoroughly to reduce the probability of related complications. In this prospective, monocentric, randomized study, the efficacy of the polysaccharide-based hemostat 4DryField PH (4DF) (PlanTec Medical, Lueneburg, Germany) is examined in classic abdominoplasty and lower body lift after Lockwood. Methods: For this prospective, monocentric, randomized study, 40 patients underwent surgery for both interventions. Twenty patients received an abdominoplasty, and 20 patients underwent a body lift. In each group, 10 patients have been treated with 4DF, whereas 10 have been served as the untreated control group. Results: 4DF had neither a beneficial nor a negative effect on necessity of drainages, drainage volume and duration, length of hospital stay or frequency of postoperative seromas, wound healing disturbances, and infections, independent of surgical intervention. Patients in the 4DF group, however, had more individual risk factors, and required extended surgical interventions that might mask primary outcome results. Conclusions: This is the first prospective, monocentric, randomized study on 4DF in body-contouring surgery. The use of 4DF did not lead to a better postoperative outcome regarding hemostasis and lymphostasis. Potential benefits need further evaluation in high-volume studies.
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Rosa SC, Macedo JLSD, Canedo LR, Casulari LA. Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: A retrospective cohort. Surg Obes Relat Dis 2019; 15:447-455. [PMID: 30718107 DOI: 10.1016/j.soard.2018.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/04/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is a major health risk factor associated with medical complications, such as cardiovascular disease, that may compromise outcomes. Furthermore, obesity may lead to difficulties in daily life, altering the quality of life and generating psychological disorders such as devalued self-image and depression. OBJECTIVES This study evaluated the quality of life and predictive factors of postoperative complications in patients who underwent abdominoplasty after Roux-en-Y gastric bypass. SETTING Bariatric and postbariatric center, North Wing Regional Hospital, Brasília, Brazil. METHODS Data were analyzed from a prospective registry of postbariatric patients who underwent abdominoplasty from January 2011 to December 2016. Variables examined included age, sex, body mass index (BMI), complications, and comorbidities. Multivariate analyses were performed to assess outcome measures. The quality-of-life assessment was measured with the Moorehead-Ardelt quality-of-life questionnaire. RESULTS One hundred and seven postbariatric patients were included. The mean age of the patients was 41 years. BMI at the time of abdominoplasty (current BMI) was 27.6 ± 3.7 kg/m2, and the average weight loss before abdominoplasty was 47.7 ± 17.3 kg. Pre-weight loss BMI (max BMI) was 45.5 ± 7.6 kg/m2, and ∆BMI was 18.6 ± 9.3 kg/m2. The overall rate of complications was 23.4%. Among the studied factors in the multivariate analysis, amount of removed tissue in the abdomen >2000 g, ∆BMI >20 kg/m2, and age >40 years significantly increased the rates of postoperative complications. In our study, abdominoplasty improved the quality of life of patients (mean quality-of-life scores, 2.1 ± 0.9). CONCLUSION The amount of removed tissue in the abdomen, ∆BMI >20 kg/m2, and age >40 years led to significantly more complications in patients undergoing abdominoplasty after gastroplasty. In addition, this study demonstrated that abdominoplasty should be proposed to patients with massive weight loss to improve quality of life.
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Affiliation(s)
- Simone Corrêa Rosa
- University of Brasília, Brasília, DF, Brazil; Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, Brasília, DF, Brazil
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Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method. J Plast Reconstr Aesthet Surg 2018; 72:649-655. [PMID: 30616907 DOI: 10.1016/j.bjps.2018.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/28/2018] [Accepted: 12/02/2018] [Indexed: 01/08/2023]
Abstract
Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method - bariatric surgery or lifestyle changes - affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien-Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0-24 hours post-operation) affected 8.3% of patients, with early complications (1-7 post-operative days) affecting 16.7% of them and late complications (8-30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p = 0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually.
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What Is the Impact of Comorbidities on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients? Obes Surg 2018; 29:552-559. [PMID: 30367325 DOI: 10.1007/s11695-018-3554-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is an increasing number of patients presenting after massive weight loss for plastic surgery, and many of these patients have residual diseases that may compromise outcomes. This study aims to evaluate the impact of comorbidities on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS Descriptive, analytical, and prospective study was performed on patients who underwent plastic surgery following RYGB from January 2011 to December 2016. Measures included BMI (body mass index) before RYGB and before plastic surgery, medical complications and comorbidities. RESULTS One hundred thirty-nine patients (130 female, 9 male) with a mean age of 41 years underwent 233 separate operations. The average BMI at the time of plastic surgery was 27.44 kg/m2. The average weight loss was 47.02 kg, and the mean pre-weight-loss BMI (max BMI) was 45.17 kg/m2. The most important pre-plastic comorbidities were arterial hypertension (11.5%), degenerative arthropathy (5.4%), diabetes mellitus (5.0%), and metabolic syndrome (4.3%). Of the 139 patients operated upon, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%). The overall rate of complications was 26.65%. Initially, on univariate regression analyses, comorbidities influenced the development of postoperative complications. However, after multiple logistic regression, the most important comorbidities failed to predict an increased risk of complications. CONCLUSION In this group of patients, with these anthropometric and clinical profiles, the most important comorbidities (diabetes, arterial hypertension, and metabolic syndrome) failed to influence the incidence of postoperative complications in postbariatric patients after plastic surgery.
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ROSA SIMONECORRÊA, MACEDO JEFFERSONLESSASOARESDE, CASULARI LUIZAUGUSTO, CANEDO LUCASRIBEIRO, MARQUES JOÃOVITORALMEIDA. Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery. Rev Col Bras Cir 2018; 45:e1613. [DOI: 10.1590/0100-6991e-20181613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. Methods: 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. Results: 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%. Conclusion: 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.
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Guest RA, Amar D, Czerniak S, Dreifuss SE, Schusterman MA, Kenny EM, Chernoff EF, Barnett JM, Koesarie KR, Gusenoff JA. Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System. Aesthet Surg J 2017; 38:60-70. [PMID: 29040346 DOI: 10.1093/asj/sjx081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. OBJECTIVES We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications. METHODS The authors reviewed the literature for the terms "body contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring. RESULTS Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. CONCLUSIONS Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
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Affiliation(s)
- Rachel A Guest
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Dalit Amar
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Sharona Czerniak
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Stephanie E Dreifuss
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Mark A Schusterman
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Elizabeth M Kenny
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Eva F Chernoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Joshua M Barnett
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Kathleen R Koesarie
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
- Body Contouring Section, Aesthetic Surgery Journal
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Carloni R, Naudet F, Chaput B, de Runz A, Herlin C, Girard P, Watier E, Bertheuil N. Are There Factors Predictive of Postoperative Complications in Circumferential Contouring of the Lower Trunk? A Meta-Analysis. Aesthet Surg J 2016; 36:1143-1154. [PMID: 27402788 DOI: 10.1093/asj/sjw117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The massive weight loss patient may require a circumferential contouring of the lower trunk. OBJECTIVES To summarize the complication rates and explore the possibility of predictive risk factors for complications. METHODS We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. RESULTS The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques (P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. CONCLUSIONS The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Raphael Carloni
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Florian Naudet
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Benoit Chaput
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Antoine de Runz
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Christian Herlin
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Paul Girard
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Eric Watier
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Nicolas Bertheuil
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
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Ellart J, Grolleau JL, Gangloff D, Meresse T, Garrido I, Bertheuil N, Carloni R, Chaput B. [Morbidity of bodylift. Evaluation of 111 patients over 5 years]. ANN CHIR PLAST ESTH 2016; 61:820-826. [PMID: 27666182 DOI: 10.1016/j.anplas.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The management of patients with weight loss sequelae, sometimes major, is increasingly well standardized. However, this surgery is not without risk. Complications of bodylift are more frequent than those of conventional abdominoplasties. The objective of this study was to evaluate the morbidity associated with this surgery through a retrospective, single-center study. MATERIALS AND METHODS One hundred and eleven circular abdominaloplasties were conducted between June 2011 and September 2015 in the plastic surgery department of the university hospital of Toulouse. Minor and major complications were identified and analyzed. RESULTS Frequency of postoperative complications was 44.1% in our series. Major complications have involved 15.3% of patients. Blood transfusions (9%) and hematoma requiring reoperation (7.2%) were the most frequent major complications. We found significantly more major complications in patients with important fat resection with a cut off at 3200 g (P=0.02). Men experienced significantly more major complications than women (P=0.005). The average delta-BMI (before and after weight loss) was significantly higher in the group of patients with the highest percentage of minor complications (P=0.045). Indeed, a high delta-BMI (greater than 19.5) was associated with an excess risk of minor complications in our population. CONCLUSION Democratization and progress in the field of bodylift should not obscure the fact that it is, in reality, a procedure at risk. While we manage increasingly better cosmetic results and thromboembolic complications, it still persists many complications.
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Affiliation(s)
- J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Lille, rue Émile-Laine, 59037 Lille, France
| | - J-L Grolleau
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - D Gangloff
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - T Meresse
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Sud, université de Rennes 1, 2, rue Henri-Le-Guillax, 35000 Rennes, France
| | - R Carloni
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
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Chetta MD, Aliu O, Patrick BA, Abdulghani M, Kidwell KM, Momoh AO. Complications in body contouring stratified according to weight loss method. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Body contouring procedures following massive weight loss have become increasingly common and, unfortunately, continue to be associated with a high complication rate. Objective To evaluate how weight loss method affects complications following abdominally based body contouring procedures. Methods Patients undergoing abdominally based contouring procedures were retrospectively evaluated over an 11-year period and stratified into two groups based on method of weight loss: diet and exercise; or bariatric surgery. Complications, including seroma, wound dehiscence, skin necrosis, infection, hematoma and venous thromboembolism, were included if they required intervention. An adjusted logistic model was used to examine the effect of weight loss method on aggregate complication rates. Results A total of 307 patients were included: 77 (25%) lost weight through diet and exercise; and 230 (75%) through bariatric surgery. Results from the logistic model showed no difference in complication rates between weight loss methods (OR 1.01 [95% CI 0.51 to 2.02]). However, there was a strong correlation between body mass index at the time of surgery and complication rates (OR 1.05 [95% CI 1.02 to 1.08]; P<0.01). Conclusions The findings reveal no difference in complication rates following abdominal body contouring procedures attributable to method of weight loss. Rather, there was a proportional rise in complication rates in patients with a higher body mass index at the time of surgery. Surgeons and patients should be aware of this trend, and it should be part of any discussion of abdominal body contouring procedures and informing patients of their risk profile.
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Affiliation(s)
- Matthew D Chetta
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Oluseyi Aliu
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Bao Anh Patrick
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mariam Abdulghani
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System
| | | | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Chetta MD, Aliu O, Tran BAP, Abdulghani M, Kidwell KM, Momoh AO. Complications in body contouring stratified according to weight loss method. Plast Surg (Oakv) 2016; 24:103-6. [PMID: 27441194 DOI: 10.4172/plastic-surgery.1000961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Body contouring procedures following massive weight loss have become increasingly common and, unfortunately, continue to be associated with a high complication rate. OBJECTIVE To evaluate how weight loss method affects complications following abdominally based body contouring procedures. METHODS Patients undergoing abdominally based contouring procedures were retrospectively evaluated over an 11-year period and stratified into two groups based on method of weight loss: diet and exercise; or bariatric surgery. Complications, including seroma, wound dehiscence, skin necrosis, infection, hematoma and venous thromboembolism, were included if they required intervention. An adjusted logistic model was used to examine the effect of weight loss method on aggregate complication rates. RESULTS A total of 307 patients were included: 77 (25%) lost weight through diet and exercise; and 230 (75%) through bariatric surgery. Results from the logistic model showed no difference in complication rates between weight loss methods (OR 1.01 [95% CI 0.51 to 2.02]). However, there was a strong correlation between body mass index at the time of surgery and complication rates (OR 1.05 [95% CI 1.02 to 1.08]; P<0.01). CONCLUSIONS The findings reveal no difference in complication rates following abdominal body contouring procedures attributable to method of weight loss. Rather, there was a proportional rise in complication rates in patients with a higher body mass index at the time of surgery. Surgeons and patients should be aware of this trend, and it should be part of any discussion of abdominal body contouring procedures and informing patients of their risk profile.
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Affiliation(s)
- Matthew D Chetta
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Oluseyi Aliu
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Bao Anh Patrick Tran
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mariam Abdulghani
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Michigan, USA
| | - Kelly M Kidwell
- Department of Biostatistics, University of Michigan, Michigan, USA
| | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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A Multiple Regression Analysis of Postoperative Complications After Body-Contouring Surgery: a Retrospective Analysis of 205 Patients. Obes Surg 2015; 25:1482-90. [DOI: 10.1007/s11695-014-1559-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Genser L, Tabbara M, Barat M, Carandina S, Bossi M, Rizk N, Polliand C, Quilichini J, Barrat C. Outcomes of Panniculectomy after Bariatric Surgery: A Comparative Study and Review of the Literature. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Laurent Genser
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Malek Tabbara
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Maxime Barat
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Sergio Carandina
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Manuela Bossi
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Nabil Rizk
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Claude Polliand
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Julien Quilichini
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Christophe Barrat
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
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Risk Factors for Pannus Formation in the Post–Bariatric Surgery Population. Plast Reconstr Surg 2014; 133:623e-627e. [DOI: 10.1097/prs.0000000000000101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Constantine RS, Davis KE, Kenkel JM. The effect of massive weight loss status, amount of weight loss, and method of weight loss on body contouring outcomes. Aesthet Surg J 2014; 34:578-83. [PMID: 24676143 DOI: 10.1177/1090820x14528208] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The impact of massive weight loss (MWL) on body contouring procedures and outcomes has not been firmly established in the literature. OBJECTIVE The authors investigate the correlations between MWL status, the method of achieving MWL, and the amount of weight lost with wound-healing complications after body contouring procedures. METHODS The charts of 450 patients (124 of whom had undergone MWL) who underwent body contouring procedures including abdominoplasty, brachioplasty, thighplasty, breast mastopexy/reduction, lower bodylift, bodylift, buttock lift, and liposuction were reviewed. MWL patients were classified as having achieved weight loss through diet and exercise, gastric banding or sleeving, or gastric bypass. Postoperative complication data were collected, including cases of infection, delayed wound healing, seroma, hematoma, dehiscence, and overall wound problems. Odds ratios (OR) were estimated using 4 multivariate logistic regression models. RESULTS MWL status was a significant predictor of wound problems (OR, 2.69; P < .001). Patients with 50 to 100 lbs of weight loss did not have a significantly increased risk of wound problems (OR, 1.93; P = .085), while patients with over 100 lbs of weight loss did (OR, 3.98; P < .001). Gastric bypass (OR, 3.01; P = <.001) had a higher risk correlation than did diet and exercise (OR, 2.72, P = .023) or restrictive bariatric surgery (OR, 2.31; P = .038) as a weight loss method. Patients who lost over 100 lbs demonstrated increased risk of complications if they had gastric bypass or restrictive procedures. CONCLUSIONS MWL was a significant risk factor for wound complications in the body contouring population. Method and amount of weight loss were also significant factors in predicting complications.
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Achieving Patient Satisfaction in Abdominally Based Free Flap Breast Reconstruction. Plast Reconstr Surg 2014; 133:763-773. [DOI: 10.1097/prs.0000000000000027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Breast Reconstruction With Abdominal-Based Free Flaps in High Body Mass Index Population. Ann Plast Surg 2014; 72:13-22. [DOI: 10.1097/sap.0b013e31825c07f3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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García-García ML, Martín-Lorenzo JG, Campillo-Soto A, Torralba-Martínez JA, Lirón-Ruiz R, Miguel-Perelló J, Mengual-Ballester M, Aguayo-Albasini JL. [Complications and level of satisfaction after dermolipectomy and abdominoplasty post-bariatric surgery]. Cir Esp 2013; 92:254-60. [PMID: 24360407 DOI: 10.1016/j.ciresp.2013.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/02/2013] [Accepted: 04/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. MATERIAL AND METHODS Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003-2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. RESULTS a) COMPLICATIONS The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%). b) Satisfaction rating: 1) very satisfied: 51.4%, 2) satisfied: 31.9%, 3) dissatisfied: 8.3%, 4) very dissatisfied: 8.3%. c) The presence of complications was significantly associated with patients' satisfaction, reoperation rate and longer hospital stays (P<.001). CONCLUSIONS Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients' satisfaction was negatively influenced by complication occurrence and not by the aesthetic results.
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Affiliation(s)
- María Luisa García-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España.
| | | | - Alvaro Campillo-Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España
| | | | - Ramón Lirón-Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España
| | - Joana Miguel-Perelló
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España
| | - Mónica Mengual-Ballester
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España
| | - José Luis Aguayo-Albasini
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia, España
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Fredheim JM, Rollheim J, Sandbu R, Hofsø D, Omland T, Røislien J, Hjelmesæth J. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med 2013; 9:427-32. [PMID: 23674932 DOI: 10.5664/jcsm.2656] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Few studies have compared the effect of surgical and conservative weight loss strategies on obstructive sleep apnea (OSA). We hypothesized that Roux-en-Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA (apnea-hypopnea-index [AHI] ≥ 5 events/hour). METHODS A total of 133 morbidly obese subjects (93 females) were treated with either a 1-year ILI-program (n = 59) or RYGB (n = 74) and underwent repeated sleep recordings with a portable somnograph (Embletta). RESULTS Participants had a mean (SD) age of 44.7(10.8) years, BMI 45.1(5.7) kg/m(2), and AHI 17.1(21.4) events/hour. Eighty-four patients (63%) had OSA. The average weight loss was 8% in the ILI-group and 30% in the RYGB-group (p < 0.001). The mean (95%CI) AHI reduced in both treatment groups, although significantly more in the RYGB-group (AHI change -6.0 [ILI] vs -13.1 [RYGB]), between group difference 7.2 (1.3, 13.0), p = 0.017. Twenty-nine RYGB-patients (66%) had remission of OSA, compared to 16 ILI-patients (40%), p = 0.028. At follow-up, after adjusting for age, gender, and baseline AHI, the RYGB-patients had significantly lower adjusted odds for OSA than the ILI-patients-OR (95% CI) 0.33 (0.14, 0.81), p = 0.015. After further adjustment for BMI change, treatment group difference was no longer statistically significant-OR (95% CI) 1.31 (0.32, 5.35), p = 0.709. CONCLUSION Our study demonstrates that RYGB was more effective than ILI at reducing the prevalence and severity of OSA. However, our analysis also suggests that weight loss, rather than the surgical procedure per se, explains the beneficial effects.
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Affiliation(s)
- Jan Magnus Fredheim
- Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
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Staalesen T, Fagevik Olsén M, Elander A. Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients. Obes Surg 2013; 23:1632-44. [DOI: 10.1007/s11695-013-0978-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Staalesen T, Olsén MF, Elander A. Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy. J Plast Surg Hand Surg 2012; 46:416-20. [DOI: 10.3109/2000656x.2012.717898] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Staalesen T, Elander A, Strandell A, Bergh C. A systematic review of outcomes of abdominoplasty. J Plast Surg Hand Surg 2012; 46:139-44. [DOI: 10.3109/2000656x.2012.683794] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Demographic Factors, Outcomes, and Complications in Abdominal Contouring Surgery After Massive Weight Loss in a Developing Country. Ann Plast Surg 2012; 69:54-8. [DOI: 10.1097/sap.0b013e3182223d0f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gravante G, Elmussareh M. Enhanced recovery for non-colorectal surgery. World J Gastroenterol 2012; 18:205-11. [PMID: 22294823 PMCID: PMC3261537 DOI: 10.3748/wjg.v18.i3.205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient’s clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS’ acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?
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Impaired Abdominal Skin Sensory Function in Morbid Obesity and After Bariatric Surgery. Obes Surg 2011; 22:353-9. [DOI: 10.1007/s11695-011-0485-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Glycosaminoglycans of Abdominal Skin After Massive Weight Loss in Post-bariatric Female Patients. Obes Surg 2011; 21:774-82. [DOI: 10.1007/s11695-011-0405-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Millions of individuals in the United States and around the world are overweight or obese. Bariatric surgery is now considered an evidenced-based choice for sustainable long-term weight loss and may reduce obesity-related comorbidities such as diabetes and obstructive sleep apnea. As bariatric surgical procedures increase, it can be expected that intensive care unit (ICU) admissions will increase as well. An emerging ICU population includes postbariatric patients either immediately after undergoing bariatric surgery or returning for subsequent surgical procedures. Massive weight loss following surgery leads to an excess of lax, overstretched skin, causing physical discomfort and psychosocial problems. It is important to understand the complex pathophysiological changes that occur in order to care for this growing population of patients. This review addresses the growing and evolving issues related to the complex nature of the postbariatric ICU patients.
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van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts 2011; 4:61-6. [PMID: 21372612 PMCID: PMC6444757 DOI: 10.1159/000324567] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Body contouring surgery is in high demand following the increase in bariatric surgery. Massive weight loss leads to an excess of lax, overstretched skin causing physical and psychosocial discomfort. Plastic surgical procedures can give rise to an improvement in quality of life, but the relative high complication rate could negatively affect these potential gains. The purpose of this study is to identify predictors of complications in order to optimize outcomes in this patient population. METHODS Out of a group of 465 post-bariatric patients, 61 patients underwent body contouring surgery following massive weight loss. A total of 43 respondents were reviewed retrospectively for demographic data, pre- and post-operative weight status and co-morbidities. Medical complications were categorized according to the modified Clavien classification. All cases were analyzed for risk factors. RESULTS A stable weight over a period of at least 3 months prior to body contouring surgery is associated with a significant lower complication rate (odds ratio 0.24; CI 0.07-0.79) and the percentage excess weight loss (odds ratio 0.96; 95% CI 0.92-1.00) was an independent predictor for the occurrence of complications. The overall complication rate was 27.9% with a major complication rate of 8.8%. Most frequent procedures were abdominoplasty (61%) and breast reduction/ mammapexy (25%). CONCLUSION This study emphasizes the importance to strive for a stable weight close to normal before surgery to minimize the risk of complications. The positive effects of the long-term results of bariatric surgery tolerate the relative high complications rate. Careful pre-operative planning and patient selection are essential to optimize the results of body contouring surgery of post-bariatric patients.
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Affiliation(s)
| | - Aebele Mink van der Molen
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Nieuwegein
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- *Bert van Ramshorst MD, PhD, Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands, Tel +31 30 60-99111, Fax +-36578,
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