Abstract
Body contouring surgery has experienced a true resurgence with the popularization of surgical treatment for morbid obesity. In recent years, a new and growing population of patients with extremely challenging deformities has been visiting plastic surgery clinics, demanding a new approach to techniques in search of better results. Some procedures that had been practically abandoned with the advent of liposuction are now returning because of the devastating nature of these deformities. The main concept to be incorporated by plastic surgeons in abdominal approaches to post-bariatric patients is to avoid isolated evaluation and intervention in the abdomen without considering associated deformities in the lower body. Each patient has a different reality and even specific genetic characteristics, but the general and circumferential character of the physiopathology and biodynamic deformities will always influence body contouring as a whole. Even when isolated intervention is chosen by the medical team, this decision must result from full knowledge of the overall contouring situation.
Preoperative planning is fundamental in this process and must be based on the complete physical exam, with vigorous palpation of tissues and simulation of probable correction vectors as well as the patient’s opinion. All of this careful surgical planning becomes evident in surgical site marking, which should be done carefully and calmly, preferably the night before surgery to avoid stress and mistakes resulting from marking in the operating room before anesthesia. Photographic and video records of both the physical examination and site marking provide essential support for retrospective assessments of the results obtained.
Some details of the surgical technique may also make the difference in caring for this type of patient. Although tissue resection can be extensive in the lower body, there is no need for larger detachments of remaining flaps. This means that the mobility of the covering resulting from the reorganization of the superficial fascia system permits large tissue advances, when correction vectors are found, safely and with circulatory viability. This abdominal approach without detachment was originally proposed by Avelar (Rev Bras Cir 88/89(1/6):3–20, 1999; Aesthet Surg J 22(1):16–25, 2002) and is naturally applicable in the post-bariatric patient since weight loss provokes the reduction of subcutaneous tissue and makes flap mobilization easier, with less risky maneuvers.
Technique
Anterior Transverse Approach – This technique is used for abdominoplasty in conventional patients, but is rarely recommended in the post-bariatric population. Although this approach is efficient in patients with deformities resulting from multiple pregnancies and is restricted to the anterior aspect of the abdomen, the anterior transverse approach tends to be insufficient for treating more general loose and circumferential tissue.
Circumferential Approach – The objective of this procedure is to expand the anterior transverse resection of the lower abdomen to the flanks and lower dorsum, removing an actual belt of loose tissue in order to remove remaining tissue and also lift the anterior and lateral base of the thighs, as well as the gluteal region.
Combined Anterior Approach – Also known as “anchor” or “fleur de lis” abdominoplasty, this technique combines longitudinal resection with the anterior transverse approach specifically to correct the horizontal excess abdominal tissue which is normally present in post-bariatric patients.
Combined Circumferential Approach – This technique also combines anterior longitudinal resection with the circumferential approach specifically to correct horizontal excess abdominal tissue which is typically present in the post-bariatric population.
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References
Agha Mohammadi S, Hurwitz DJ (2008) Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery. Plast Reconstr Surg 122:1901–1914
Albino FP, Koltz PF, Gusenoff JA (2009) A comparative analysis and systematic review of the wound-healing milieu: implications for body contouring after massive weight loss. Plast Reconstr Surg 124:1675
Arcelus JI, Candocia S, Traverso CI, Fabrega F, Caprini JA, Hasty JH (1991) Venous thromboembolism prophylaxis and risk assessment in medical patients. Semin Thromb Hemost 17(Suppl 3):313–318
Aly AS (2006) Belt lipectomy. In: Aly AS (ed) Body contouring after massive weight loss. Quality Medical, St Louis, pp 71–145
Andrades P, Prado A, Danilla S et al (2007) Progressive tension sutures in the prevention of postabdominoplasty seroma: a prospective randomized, double-blind clinical trial. Plast Reconstr Surg 120:935–946; discussion 947–951
Avelar J (1989) Regional distribution and behaviour of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg 13:155
Avelar J (1999) A new technique for abdominoplasty – closed vascular system of subdermal flap folded over itself combined with liposuction. Rev Bras Cir 88/89(1/6):3–20
Avelar J (2002) Abdominoplasty without panniculus undermining and resection: analysis and 3-year follow-up of 97 consecutive cases. Aesthet Surg J 22(1):16–25
Au K et al (2008) Correlation of complications of body contouring surgery with increasing body mass index. Aesthet Surg J 28:425–429
Baroudi R et al (1974) Abdominoplasty. Plast Reconstr Surg 54(2):161–168
Baroudi R (1978) Thigh lift and buttocks-lift. In: Courtiss EH (ed) Aesthetic surgery. Mosby, St Louis, p 233
Baroudi R (1984) Body sculpting. Clin Plast Surg 11(3):119–143
Baroudi R, Ferreira C (1998) Seroma: how to avoid it and how to treat it. Aesthet Surg J 18:439–441
Blinder MA, Young VL (2009) Approach to venous thromboembolism and bleeding. In: Young VL, Botney R (eds) Patient safety in plastic surgery. QMP, St. Louis, pp 279–310
Coon D et al (2009) Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases. Ann Surg 249(3):397–401
Colwell AS, Borud JL (2008) Optimization of patient safety in postbariatric body contouring: a current review. Aesthet Surg J 28:437–442
Consensus Panel (2006) Safety considerations and avoiding complications in the massive weight loss patient. Plast Reconstr Surg 117(1):74S–81S
Davinson SP, Clemens MW (2008) Safety first: precautions for the massive weight loss patient. Clin Plast Surg 35:173–183
Forstot RM (1995) The etiology and management of inadvertent perioperative hypothermia. J Clin Anesth 7:657–674
Gonzalez-Ulloa M (1960) Belt lipectomy. Br J Plast Surg 13:179
Guyatt GH, Aki EA, Crowther M et al (2012) Antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines (9th Edition). Chest 141(Suppl 2):7S–47S
Lockwood TE (1991) Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 87:1009–1018
Lockwood TE (1993) Lower body lift with superficial fascial suspension. Plast Reconstr Surg 92:1112–1122
Markman B, Barton F Jr (1980) Anatomy of the subcutaneous tissue of the trunk and lower extremities. Plast Reconstr Surg 80:248
Modolin M et al (2003) Circumferential abdominoplasty for sequential treatment after morbid obesity. Obes Surg 13:95–100
Pannucci CJ, Barta RJ, Portschy PR et al (2012) Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk Score. Plast Reconstr Surg 130:343–351
Pannucci CJ, Watchman CF, Dreszer M et al (2012) The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg 129:160–168
Pinho PR et al (2011) Psychological approach for post-bariatric plastic surgery. Rev Bras Cir Plast 26(4):685–690
Pitanguy I (1967) Abdominal lipectomy: an approach to it through an analysis of 300 consecutive cases. Plast Reconstr Surg 40(4):384–391
Pitanguy I (1972) Thigh lift and abdominal lipectomy. In: Goldwyn RM (ed) Unfavorable results in plastic surgery. Little Brown, Boston, p 387
Pitanguy I (1975) Abdominal lipectomy. Clin Plast Surg 2:401–410
Pitanguy I (1977) Dermolipectomy of the abdominal wall, thighs, buttocks and upper extremity. In: Converse JM (ed) Reconstructive plastic surgery, vol 7, 2nd edn. Saunders, Philadelphia, pp 3800–3823
Pitanguy I et al (2000) Contour surgery in the patient with great weight loss. Aesthetic Plast Surg 24(6):406–411
Reason JT (1990) Human error. Cambridge University Press, New York
Shermak MA (2012) Pearls and perils of caring for post bariatric body contouring patient. Plast Reconstr Surg 130:585–596
Shermak MA, Rotellini-Coltvet LA, Chang D (2008) Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg 122:280
Shermak M, Shoo B, Deune EG (2006) Prone positioning precautions in plastic surgery. Plast Reconstr Surg 117:1584–1588; discussion 1589
Somalo M (1940) Dermolipectomia circular del tronco. Sem Med 47:1435–1443
Song AY et al (2005) A classification of weight loss deformities: the Pittsburgh rating scale. Plast Reconstr Surg 116:1535–1554
Song AY et al (2006) Biomechanical properties of the superficial fascial system. Aesthet Surg J 26(4):395–403
Wolf AM, Beisiegel U (2007) The effect of loss of excess weight on the metabolic risk factors after bariatric surgery in morbidly and super-obese patients. Obes Surg 17:910–919
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Mendes, F., Viterbo, F. (2016). Abdominoplasty After Massive Weight Loss. In: Avelar, J. (eds) New Concepts on Abdominoplasty and Further Applications. Springer, Cham. https://doi.org/10.1007/978-3-319-27851-3_23
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DOI: https://doi.org/10.1007/978-3-319-27851-3_23
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