Abdominoplasty Following Massive Weight Loss

ABSTRACT

Bariatric surgery has become an effective treatment for severe obesity. Various techniques have evolved over the years, with the most common now being the Roux-en-Y gastric bypass. Patients who experience massive weight loss are left with disfiguring skin laxity that warrants surgical excision of the redundant tissue. Our experience comes from 400 abdominoplasties performed on patients with massive weight loss over the past 20 years. Special consideration must be given to this subset of patients when designing their abdominoplasties because of compromised vascularity from previous surgeries and persistent volumes of subcutaneous adipose tissue. In particular, the groin flap or cross-abdominal flap or both are presented as options for the postbypass patient in whom subcostal and midline scarring is present. The reverse abdominoplasty remains an option in special circumstances. In addition, we focus on complications these patients are more likely to develop, mainly related to associated incisional hernias and a disrupted vascular anatomy.

KEYWORDS

Massive weight loss - groin flap - cross-abdominal flap

^REFERENCES

• 1 Olshansky S J, Passaro D J, Hershow R C et al.. A potential decline in life expectancy in the United States in the 21st century.  N Engl J Med. 2005;  352 1138-1145
• 2 Must A, Spadano J, Coakley E H et al.. The disease burden associated with overweight and obesity.  JAMA. 1999;  282 1523-1529
• 3 Pi-Sunyer F X. Medical hazards of obesity.  Ann Intern Med. 1993;  119 655-660
• 4 Koplan JP, Liverman CT, Kraak VI Preventing Childhood Obesity: Health in the Balance. Washington, DC; National Academic Press 2005
• 5 Allison D B, Fontaine K R, Manson J R et al.. Annual deaths attributable to obesity in the United States.  JAMA. 1999;  282 1530-1538
• 6 NHLBI Obesity Education Initiative .The practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Rockville, MD; National Institutes of Health 2000 (NIH publication no. 00-4084)
• 7 Flegal K M, Carroll M D, Odgen C L, Johnson C L. Prevalence and trends in obesity among US adults, 1999-2000.  JAMA. 2002;  288 1723-1727
• 8 National Institutes of Health . Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Panel.  Ann Intern Med. 1991;  115 956-961
• 9 Buchwald H, Avidor Y, Braunwald E et al.. Bariatric surgery: a systematic review and meta-analysis.  JAMA. 2004;  292 1724-1737
• 10 Balsiger B M, Poggio J L, Mai J et al.. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity.  J Gastrointest Surg. 2000;  4 598-605
• 11 DeMaria E J, Sugerman H J, Meador J G et al.. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity.  Ann Surg. 2001;  233 809-818
• 12 Sugerman H J, Kellum J M, Engle K M. Gastric bypass for treating severe obesity.  Am J Clin Nutr. 1992;  55 560S-566S
• 13 Brolin R E, Gorman J H, Gorman R C et al.. Are vitamin B-12 and folate deficiency clinically important after Roux-en-Y gastric bypass?.  J Gastrointest Surg. 1998;  2 436-442
• 14 Savage R C. Abdominoplasty following gastrointestinal bypass surgery.  Plast Reconstr Surg. 1983;  71 500-507
• 15 Kelly H A. Report of gynecological cases (excessive growth of fat).  Johns Hopkins Med J. 1899;  10 196-197
• 16 Kelly H A. Excision of fat of the abdominal wall lipectomy.  Surg Gynecol Obstet. 1910;  10 229-231
• 17 Passot R. Chirurgie Esthetique Pure. Paris; Doin 1931: 261-267
• 18 Vernon S. Umbilical transplantation upward and abdominal contouring in lipectomy.  Am J Surg. 1957;  94 490-492
• 19 Pitanguy I. Abdominal lipectomy: an approach to it through an analysis of 300 consecutive cases.  Plast Reconstr Surg. 1967;  40 384-391
• 20 Gonzalez-Ulloa M. Abdominal wall disfigurement.  Ann Plast Surg. 1980;  4 357-369
• 21 Grazer F M. Abdominoplasty.  Plast Reconstr Surg. 1973;  51 617-623
• 22 Regnault P. Abdominoplasty by the W technique.  Plast Reconstr Surg. 1975;  55 265-274
• 23 Babcock W W. The correction of the obese and relaxed abdominal wall with special reference to the use of the buried silver chain.  Am J Obstet. 1916;  74 596
• 24 Elbaz J S, Flageul G. Plastic Surgery of the Abdomen. New York; Masson 1979
• 25 Castanares S, Goethel J A. Abdominal lipectomy: a modification in technique.  Plast Reconstr Surg. 1967;  40 378-383
• 26 Dufourmental C, Mouly R. Chirurgie Plastique. Paris; Flammarion 1959: 381-389
• 27 Brown R G, Vasconez L O, Jurkiewicz M J. Transverse abdominal flaps and the deep epigastric arcade.  Plast Reconstr Surg. 1975;  55 416-421
• 28 Regnault P, Daniel R K. Aesthetic Plastic Surgery. Boston, MA; Little, Brown 1984
• 29 Marques A, Brenda E, Pereira M D, de Castro M, Abramo A C. Abdominoplasty with two fusiform plications.  Aesthetic Plast Surg. 1996;  20 249-251
• 30 Psillakis J M. Plastic surgery of the abdomen with improvement in body contour.  Clin Plast Surg. 1984;  11 465-477
• 31 Appiani E. Muscular plastic for the aesthetic conformation of the abdominal girdle.  Ann Plast Surg. 1984;  13 97-106
• 32 Jackson I T, Downie P A. Abdominoplasty: the waistline stick and other refinements.  Plast Reconstr Surg. 1978;  61 180-183
• 33 Vastine V L, Morgan R F, Williams G S et al.. Wound complications of abdominoplasty in obese patients.  Ann Plast Surg. 1999;  42 34-39
• 34 Regnault P. Abdominal dermolipectomies.  Clin Plast Surg. 1975;  2 411-429
• 35 Juri J, Juri C, Raiden G. Reconstruction of the umbilicus in abdominoplasty.  Plast Reconstr Surg. 1979;  63 580-582
• 36 Hurwitz D J, Zewert T. Body contouring after bariatric surgery.  Operative Techniques in Plastic Reconstructive Surgery. 2002;  8 87-95
• 37 Nahai F, Brown R G, Vasconez L O. Blood supply to the abdominal wall as related to planning abdominal incisions.  Am Surg. 1976;  42 691-695
• 38 Hurwitz D J. Single stage total body lift after massive weight loss.  Ann Plast Surg. 2004;  52 435-441
• 39 Lockwood T E. Maximizing aesthetics in lateral-tension abdominoplasty and body lifts.  Clin Plast Surg. 2004;  31 523-537
• 40 Lockwood T E. Fascial anchoring technique in medial thigh lifts.  Plast Reconstr Surg. 1988;  82 299-304