[Current concepts and trends in post-bariatric plastic surgery]

Augmentation mammaplasty by superolateral thoracic flap: a case report

BACKGROUND

The lateral chest wall is intimately associated with the esthetics of the breast. Patients with massive weight loss often have excess skin and fat in the lateral thoracic region causing functional, esthetic, and psychological discomfort. In addition, the breasts exhibit extreme ptosis after weight loss due to a reduction in volume and projection that is exacerbated by qualitative changes in the skin, with loss of its natural elasticity. This article describes a reliable new technique for simultaneous autologous breast augmentation and lateral thoracic dermolipectomy to provide autologous tissue for breast augmentation and simultaneous rejuvenation of the chest wall.

CASE PRESENTATION

A 30-year-old Caucasian woman who had lost 58 kg after bariatric surgery had major skin excess sequelae combined with major breast ptosis. She wanted to correct her brachial and lateral thoracic skin and fat excess, as well as rejuvenate her breasts. The lateral thoracic panicle present was harvested and transposed in the retroglandular plane to perform autologous breast augmentation with lateral thoracic dermolipectomy.

RESULTS

The patient was totally healed and complication-free at day 15. Both esthetic results and patient satisfaction were good at 6 months post-surgery.

CONCLUSIONS

Superolateral thoracic flap augmentation mammaplasty during thoracic dermolipectomy is a simple and safe procedure for selected patients. Durable and natural autologous breast augmentation may be achieved in a single step without the need for a breast implant, while rejuvenating the thoracic region.

[Postbariatric plastic surgery]

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

Postoperative Body Mass Index Changes in Gastric Cancer Patients according to Reconstruction Type: Effectiveness of Long Jejunal Bypass on Weight Loss in Obese Patients after Distal Gastrectomy

The aim of this study was to investigate and compare the change of body mass index (BMI) in patients after gastrectomy for cancer according to the type of reconstruction. BMI was followed in 260 patients who had undergone curative surgery for gastric cancer from March 2003 to December 2009. The procedures were Billroth I in 63 patients, Billroth II in 52 patients, Roux-en-Y in 54 patients, long Roux-en-Y (bypassed proximal jejunum over 100 cm) in 47 patients, and total gastrectomy in 44 patients. BMI reduction was greatest in the total gastrectomy group at postoperative 6 months, 1 year, and 2 years. Postoperative 3-year BMI reduction was greatest in the long Roux-en-Y group. BMI reductions of the total gastrectomy and long Roux-en-Y groups were similar during the follow-up period. Among the subtotal gastrectomy groups, BMI reduction was greatest in the long Roux-en-Y group, and there was statistical significance in comparing with Billroth I and II groups, but no statistical difference with the Roux-en-Y group. Given the limitations of patient number and follow-up period, it can be concluded that obese patients with gastric cancer not requiring total gastrectomy may benefit from long Roux-en-Y reconstruction with adequate BMI reduction and accompanying health improvement.

[Postbariatric plastic surgery]

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

Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis

BACKGROUND

This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction.

METHODS

All patients presenting with a maximal BMI >/=35 kg/m(2) before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) >/= 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results.

RESULTS

A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data.

CONCLUSION

Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction.

The desire for body contouring surgery after bariatric surgery

BACKGROUND

Obesity has become far more prevalent over the last few decades. In parallel, bariatric surgery has been increasingly utilized as a method of treatment. This appears to be having an impact on the rate of body contouring surgery for hanging redundant skin after the massive weight loss that usually results from bariatric surgery. Little literature is available addressing how frequently patients who have undergone bariatric surgery receive or desire body contouring surgery or regarding how satisfied these patients are with the hanging skin in certain body areas.

METHODS

Seventy individuals (out of 250 who were mailed the questionnaire) who had undergone Roux-en-Y gastric bypass surgery 6-10 years previously completed a questionnaire, which obtained information regarding their experiences with as well as their desire for body contouring surgery and more general body area satisfaction.

RESULTS

Thirty three of the seventy patients reported having undergone a total of 38 body contouring procedures. The most common were abdominoplasties (24.3%), breast lifts (8.6%), and thigh lifts (7.1%). However, subjects were not uniformly satisfied with body areas that had undergone body contouring surgery; some found the areas unattractive. The majority of patients, at least to some extent, desired body contouring surgery, often in several areas, most notably the waist/abdomen, rear/buttock, upper arms, and chest/breast.

CONCLUSION

Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.