Body Contouring Following Massive Weight Loss

Body-Contouring Surgery

Body-contouring surgery has become increasingly popular over recent years, owing to increasing number of weight loss surgery procedures being performed as a definitive treatment for morbid obesity. It is now recognized as a subspecialty of plastic surgery. These procedures are rewarding, with very good patient satisfaction.

Detailed preoperative counseling, selection of safe procedure, meticulous planning, attention to minute aesthetic details, adequate investment of time, and personalized postoperative care are essential for the best outcome to be attained. A liposuction-assisted pseudoundermining technique is preferred for surgical undermining for all skin reduction procedures. This technique preserves perforators and lymphatics, minimizing the incidence of flap necrosis and seroma. Adjunctive liposuction debulks the skin flaps, improves flap mobility, and facilitates sculpturing.

Conventional procedures carry a higher risk to skin flap vascularity and of wound dehiscence. Pseudoundermining using a power-assisted liposuction device mostly preserves the integrity of Scarpa's fascia.

This chapter focuses on truncal body contouring procedures following massive weight loss, emphasizing key technical features and perioperative care.

Patient Selection

Patients with a stable weight for at least 12 months following massive weight loss, absence of major comorbidities, and abstinence from smoking are the main criteria for selection. It is advisable to defer patients who are younger than 16 years, are active smokers, and have psychosocial conditions until they are no longer smoking and are clearly motivated. Patients who are young and fit can be considered for longer duration combined procedures.

A multidisciplinary approach for an individualized management plan is essential.

Preoperative Planning

There should be at least two preoperative consultations with time to reflect on the benefits and risks, with preoperative patient photographs and detailed documentation, including measurements. A thorough clinical examination is necessary, particularly examining the divarication of recti, hernial sites, and muscle tone. There should be an assessment of redundant excessive skin and residual fat to determine the type of procedure required.

Counseling of the patient about the procedure includes providing the patient with an information leaflet. The patient should sign a consent form and given the opportunity to speak to a patient who has previously undergone a similar procedure.

There should be a preoperative anesthetic assessment. The standard preoperative investigation should include the use of methicillin-resistant Staphylococcus aureus swabs.

This is a summary of the suggested preoperative routine:

• Completion of consent form

• Preoperative photography

• Marking for procedure in standing position

• Pinch test and use of multicolor permanent marker

• Marking the proposed site of skin excision and extended zone of liposuction

• Application of compressive stocking

• General anesthesia

• Intravenous broad spectrum antibiotic on induction, continued orally for 5 days postoperatively

• Aqueous povidone-iodine (10%) for skin preparation