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







      Severe obesity


      Morbid obesity


      Super obesity


      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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