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Niu EF, Honig SE, Wang KE, Amro C, Davis HD, Habarth-Morales TE, Broach RB, Fischer JP. Obesity as a Risk Factor in Cosmetic Abdominal Body Contouring: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:2121-2131. [PMID: 37644187 DOI: 10.1007/s00266-023-03602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The incidence of obesity is on the rise around the globe. Outside of the massive weight loss (MWL) patient population, knowledge of risk factors associated with abdominal body contouring (BC) is limited. This systematic review and meta-analysis assesses the impact of obesity has on cosmetic abdominal BC outcomes. METHODS A systematic review conducted in accordance with PRISMA 2020 was done. PubMed, Embase, Scopus, and COCHRANE databases were reviewed under search syntax "obesity," "abdominoplasty," "panniculectomy," and "body contouring" for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of MWL. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving MWL patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. RESULTS Of 3088 initial studies, 16 met inclusion criteria, and nine were used for pooled and meta-analysis. Meta-analysis demonstrated that obesity was associated with more seromas (OR 1.45, 1.06-1.98, p = 0.02), hematomas (OR 2.21, 1.07-4.57, p = 0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p = 0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class showed no significant increase in odds in seromas or wound dehiscence. CONCLUSIONS This review demonstrates obesity increased odds of postoperative complications following cosmetic abdominal BC. However, risk of complications does not continue to increase with higher obesity class. A BMI ≥ 30 kg/m2 should not be a strict contraindication to cosmetic abdominal BC. Instead, plastic surgeons should evaluate patients on a case-by-case basis. LEVEL OF EVIDENCE 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)
- Ellen F Niu
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Stephanie E Honig
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Katherine E Wang
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Chris Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Harrison D Davis
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Theodore E Habarth-Morales
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Harrah PC, Deering AJ, Chung MT, Hughes K, Hosein RC. Endometriosis in Patients Undergoing Plastic Surgical Procedures: A Case Report and Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5904. [PMID: 38911574 PMCID: PMC11191020 DOI: 10.1097/gox.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/01/2024] [Indexed: 06/25/2024]
Abstract
Background Endometriosis is a common gynecological disorder described as the presence of functional endometrial tissue outside the uterus, which can also be found in extrapelvic locations. Although patients seeking treatment for endometriosis usually present to gynecologists, there are rare cases of endometriosis encountered by plastic surgeons in routine practice, either incidentally or as a concomitant finding. Methods We present a rare case of a 36-year-old woman with symptoms of panniculitis desiring panniculectomy. During surgery, an abdominal mass was excised and confirmed by pathological analysis to be endometriosis. A comprehensive literature review was conducted using the PubMed search engine of the National Institutes of Health to identify cases of endometriosis in plastic surgery. Following screening of the results, 14 articles were included in this analysis that fit the criteria of our search. Results Of the 14 articles reviewed, cutaneous endometriosis was the most common subtype found in plastic surgery. None of the studies described findings of endometriosis in routine panniculectomies. Several identified endometriosis discovered during cosmetic abdominoplasties. Conclusions Endometriosis encountered in plastic surgery is a rare but clinically important occurrence, with the cutaneous subtype representing the majority of cases. Endometriosis should always be on the differential diagnosis when an abdominal mass is found in a patient with a history of abdominal surgery. Abdominal masses found during routine aesthetic or reconstructive surgery should be submitted for tissue analysis to guide possible secondary treatments.
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Affiliation(s)
- Payden C. Harrah
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Augustine J. Deering
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Michael T. Chung
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Kenneth Hughes
- Department of Pathology, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Rayaad C. Hosein
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
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Breidung D, Delavari S, Megas IF, Reichert B, Billner M. Necrotizing Fasciitis after Panniculectomy Caused by Finegoldia magna. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5773. [PMID: 38689943 PMCID: PMC11057811 DOI: 10.1097/gox.0000000000005773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis.
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Affiliation(s)
- David Breidung
- From the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- Department of Health Management, Friedrich Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Sarina Delavari
- From the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- Department of General and Visceral Surgery, Hospital Martha-Maria, Nuremberg, Germany
| | - Ioannis-Fivos Megas
- From the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- Department of Orthopaedic and Trauma Surgery, Center of Plastic Surgery, Hand Surgery and Microsurgery, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - Bert Reichert
- From the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Moritz Billner
- From the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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Promny T, Ludolph I, Müller-Seubert W, Cai A, Promny D, Horch RE. [Postbariatric plastic surgery for body reconstruction]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:247-258. [PMID: 38372741 DOI: 10.1007/s00104-024-02050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery.
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Affiliation(s)
- Theresa Promny
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - Ingo Ludolph
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Wibke Müller-Seubert
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Aijia Cai
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Dominik Promny
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Raymund E Horch
- Plastisch- und Handchirurgische Klinik Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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