Case 42 Body Contouring after Massive Weight Loss



Jonathan P. Brower and Rachel R. Sullivan

Case 42 Body Contouring after Massive Weight Loss

Case 42 (a-d) A 51-year-old female requests body contouring after massive weight loss following gastric bypass.


42.1 Description




  • Loose, excess skin circumferentially noted across trunk




    • Notable abdominal skin laxity extending to posterior trunk



  • Significant sagging of skin across buttocks and medial thighs



42.2 Work-Up



42.2.1 History




  • 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




    • Ensure psychological comorbidities are stabilized



    • Establish patient’s priorities to determine most appropriate procedure(s)



    • 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.




42.2.2 Physical Examination




  • 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)

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 42 Body Contouring after Massive Weight Loss
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