Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring

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.

Status of Body Contouring Following Metabolic Bariatric Surgery in a Tertiary Hospital of Greece—Still a Long Way to Go

“…Overall, the participants from both sub-cohorts declared a satisfactory appearance and quality of life, as represented in our questionnaire, in accordance with international literature [15][16][17]. As has been stressed in a recent seminal comprehensive review by Sadeghi et al, abdominoplasty (and BCS in general) significantly improves health-related quality of life (HRQoL) after bariatric surgery [34]. Most importantly, BCS may contribute either directly (through molecular and metabolic effects on adipose tissue) or indirectly (via HRQoL amelioration and improvements in bodily satisfaction) to decreased weight regain after MBS.…”

Body Contouring Surgery After Bariatric Surgery Improves Long-Term Health-Related Quality of Life and Satisfaction With Appearance

“…While some studies attest to BCS as a safe and effective reconstruction solution to remove excess skin following MWL, 35 others have reported high complication rates. 36 In the included countries, BS and BCS are either available through public health systems within specified criteria (Denmark and Finland), 25,37 via health insurance companies (the Netherlands, Germany, and Italy), 11,38 and National Healthcare Insurer (Poland). 39 Currently, only a few American studies have investigated the impact of socioeconomic factors on the reimbursement of BCS following BS.…”

“…10 Therefore, MWL after BS has led to a new population of patients seeking body contouring surgery (BCS) in the United States and Europe. 11,12 Figure 1 shows the change in appearance after BCS. In the short term (< 5 years of follow-up), BCS has been shown to positively impact HRQL.…”

“…Excess skin is associated with infections, ulcerations, pain, impairments in physical activities, social isolation, and concerns regarding the patient’s body image 10 . Therefore, MWL after BS has led to a new population of patients seeking body contouring surgery (BCS) in the United States and Europe 11,12 Figure 1. shows the change in appearance after BCS.…”

Advances on Capsular Contracture—Prevention and Management Strategies: A Narrative Review of the Literature

“…Most authors agree that the gold standard of CC treatment is represented by capsulectomy, site change, and implant exchange. 15,99,100 Success rate is estimated at 79%, but the procedure carries morbidity, and it is not free from complications. 101 It is also technically more complicated than capsulotomy, which involves incision and release of the pathological capsule, or partial capsulectomy in which the fibrotic capsule is only partially dissected and removed.…”