Body Contouring after Massive Weight Loss


Body Contouring after Massive Weight Loss

Simone W. Glaus & Marissa Tenenbaum
A 57-year-old woman requests body contouring following massive weight loss.


  • 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


    Body mass index





    Severe obesity


    Morbid obesity


    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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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Body Contouring after Massive Weight Loss

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