Body Contouring after Massive Weight Loss
Description
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.
Work-up
History
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).
Physical examination
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).
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