Treating the Abdominotorso Region of the Massive Weight Loss Patient: An Algorithmic Approach

Abstract

There has been tremendous growth in the number of patients seeking body contouring procedures after massive weight loss. Most patients desire improvement of the abdominotorso region first. After massive weight loss, there is enormous variability of body proportions, and therefore there have been many surgical options proposed based on the quality of the skin, subcutaneous fat component, and location of the lax tissue. Each area needs to be assessed to see whether there is a significant lower abdominal component, an upper midline abdominal component, or contributions from the buttocks and flanks. An algorithm for treatment is presented to simplify the decision-making process. Patient examples are also shown to demonstrate the usefulness of the algorithm.

Multiple Procedures and Staging in the Massive Weight Loss Population

“…Numerous authors have advocated strategies for approaching this problem; however, there is relatively little evidence assessing how staging and different combination strategies affect clinical outcomes. [1][2][3] We sought to quantify our experience with combined procedures to provide evidence-based analysis of staging and outcomes in post-bariatric surgery body contouring.…”

Skin Sensory Function in Post-Bariatric Patients—Implications for Selection of Post-Bariatric Abdominal Body-Contouring Techniques

“…This finding has major implications for the post-bariatric or plastic surgeon since a large armamentarium of different abdominal body-contouring techniques has been described [2], all of which, depending on the specific technique used may further impair abdominal sensory function [3]. In case that pre-existing abdominal scars further compromise abdominal sensitivity, as is the case among others after open gastric bypass, the selection of a contouring technique that preserves abdominal sensory function by considering the existing scar's position and orientation (vertical or horizontal) is of major clinical importance and may reduce later patient complaints.…”

Anatomical Basis of Biomechanical Properties of Superficial Tissues of the Anterior Abdominal Wall

“…When an adult's growth hormone production decreases, skin nutrition is disrupted and it becomes atrophic: it becomes pale, cold, dry, sweat and fat secretion decreases, small wrinkles appear, its elasticity is lost. At the raised level of somatotropic hormone, the skin thickens, roughens, the expressiveness of skin folds amplifies, the number of sweat glands increases and a real thickening of all layers of the skin occurs [35][36][37]. In Cushing's syndrome or after treatment with glucocorticoids in appropriate pharmacological doses, there is often the appearance of stasis, overflow of skin vessels with blood, thinning of the skin, a tendency to bruising [39].…”