Body Contouring after Massive Weight Loss

10.1055/b-0034-97722

Simone W. Glaus & Marissa Tenenbaum

Breasts
- Grade III ptosis with significant deflation (see Table 26.1).
- Mild volume asymmetry (L > R).
- Striae superiorly.
Trunk, abdomen, buttocks
- Well-healed abdominal laparoscopic incisions (difficult to visualize).
- Redundancy of skin and fat in the lower abdomen extending onto the flanks and lower back.
- Ptotic gluteal region.
Medial thighs: Ptotic, redundant tissue with poor skin quality and elasticity.
Arms: Upper arm “bat wing” deformity.

Original and current body mass index (BMI)
- BMI: weight (kg)/[height (m)]².
Obesity classification (Table 32.1)

Obesity classification

Description

Body mass index

Overweight

25–30

Obesity

30–35

Severe obesity

35–40

Morbid obesity

40–50

Super obesity

> 50
Weight loss timeline
- How much over how long?
  - Should be within 10 to 15% of goal weight.
- Length of time weight has been stable
  - Weight must be stable over a 6-month period prior to body contouring procedures.
  - Exception is for panniculectomy or breast reduction if hindering exercise and further weight loss.
Method of weight loss, including bariatric procedures
- Should know example procedures and their physiologic consequences/nutritional deficiencies in case you are asked.
- Restrictive: Laparoscopic banding (Lap-Band), vertical banded gastroplasty.
- Malabsorptive: Biliopancreatic diversion ± duodenal switch.
- Combination restrictive–malabsorptive: Roux-en-Y gastric bypass.
Current diet and exercise habits, nutritional supplementation, symptoms of nutritional deficiency (e.g., fatigue, hair loss, poor wound healing, neuropathy).
Current and pre-weight-loss-medical and psychiatric comorbidities.
Risk factors for poor wound healing (e.g., smoking, steroids and immunosuppressive medications).

Comprehensive assessment of body contour, skin and tissue quality, degree of ptosis and/or deflation.
Presence of breast masses.
Presence of abdominal scars, hernias, Lap-Band port.
Signs of nutritional deficiency (e.g., pale mucous membranes, brittle nails and hair).