Selecting appropriate massive weight loss patients for body contouring critical

Goal BMI, weight loss through diet & exercise, gender may affect complication rates

October 8, 2008
American Society of Plastic Surgeons (ASPS)

The importance of pre-operative screening for patients seeking body contouring after massive weight loss will be assessed in three studies presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 ? Nov. 5, in Chicago. These studies examine demographic factors that could affect complication rates; specifically, those who have not yet attained their goal body mass index (BMI); those who lost weight through diet and exercise and those who are male.

"With the rapid increase in obesity rates in the U.S. and, subsequently, more people losing large amounts of weight, we are seeing more patients who want body contouring following massive weight loss," said J. Peter Rubin, M.D., Chair of the ASPS Post-Bariatric Task Force and co-author of the studies. "Because of this, the need to examine various demographics for differences in how these patients tolerate surgery is ever important to guarantee appropriate patient selection, safety and optimal results."

The first study looked at 449 patients to see if having body contouring surgery while still obese and prior to reaching goal BMI would affect complication rates. The study found being obese did increase surgery complication rates for single body contouring procedures.

"As patient safety advocates, plastic surgeons should counsel their patients to wait for body contouring surgery until they reach their goal BMI," said Dr. Rubin. "Body contouring yields excellent results in the appropriate patient. If waiting a little longer means ensuring safe surgery, then it's worth it."

A second study examined 435 women and 48 men to assess whether gender impacted complication rates following body contouring. According to the study, men were at an increased risk for bleeding after surgery (hematoma) 12.5% and fluid collection (seroma) 25%, as opposed to 4.1% and 14.3%, respectively, of all patients.

"Hematoma and seroma are complications that can range in severity. Patients should know that plastic surgery is real surgery," said Dr. Rubin. "We don't know why men have slightly higher complication rates, so more research is necessary. However, this information is important to keep in mind when examining prospective patients."

Finally, the authors examined whether there were complication differences in patients who lost weight (more than 50 pounds) via gastric bypass surgery (449 patients) as opposed to those who exclusively lost weight through diet and exercise (29 patients). The study found the differences in overall complication rates in these two groups were not statistically significant.

"The findings were not what I expected," said Dr. Rubin. "Most plastic surgeons, including myself, would assume since nutritional status might be better in diet and exercise patients, they would have fewer complications than those who lost weight through gastric bypass. It shows how important it is to ask all massive weight loss patients, pre-operatively, about their nutritional status, lifestyle, participation in exercise programs and medical health."

Nearly 67,000 body contouring procedures after massive weight loss were performed in 2007, according to the ASPS. More than 8,000 thigh lifts; 9,300 upper arm lifts; 19,500 lower body lifts and 30,000 breast lift/reductions were performed in 2007. 76% of all thigh and upper arm lifts were performed following massive weight loss in 2007.