Case 42 Body Contouring after Massive Weight Loss

Jonathan P. Brower and Rachel R. Sullivan

Loose, excess skin circumferentially noted across trunk
- Notable abdominal skin laxity extending to posterior trunk
Significant sagging of skin across buttocks and medial thighs

Obesity classification (see Table 42.1)
Original and current body mass index (BMI) calculated by weight/height
- Should be within 10 to 15% of goal weight
Weight loss timeline (i.e., time from surgery or from start of weight loss)
Length of time weight has been stable
- Weight should be stable for at least a 3-month period prior to surgery
- May consider earlier intervention if there is a resulting functional issue (e.g., activities of daily living affected, unable to exercise)
Method of weight loss, including bariatric procedures
- Be aware of key procedures and their physiologic consequences/nutritional deficiencies
  - Restrictive: Lap-Band, vertical banded gastroplasty
  - Malabsorptive: Biliopancreatic diversion with or without duodenal switch
  - Combination of restrictive and malabsorptive: Roux-en-Y gastric bypass
Current diet and exercise habits
- Nutritional supplementation: Consider micronutrient deficiency (e.g., fatigue, hair loss, poor wound healing, neuropathy)
- Assess protein intake (goal 70–100g/day preoperatively)
- Refer back to bariatric surgeon if there is weight loss plateau at unacceptably high BMI
Medical comorbidities
- Ensure excellent glycemic control for diabetics (target HbA1c <6.5%)
- Personal or family history of thrombosis or bleeding diathesis
- Ensure cessation of nicotine exposure for 1 month prior to surgery

Psychological status/Expectations

Discuss patient’s willingness to trade improved contour for long/visible scars

Table 42.1 Obesity classification
Description	BMI
Overweight	25–30
Obesity	30–35
Severe obesity	35–40
Morbid obesity	40–50
Super obesity	>50
Abbreviation: BMI, body mass index.

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

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