Body Contouring after Massive Weight Loss



10.1055/b-0034-97722

Body Contouring after Massive Weight Loss

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

Only gold members can continue reading. Log In or Register to continue

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