The area of redundant skin to be resected is marked in the upright and supine position in the preoperative holding room. The intervention consists of a suprapubic bi-iliac incision, followed by undermining of the adipocutaneous flap up to xiphoid-costal arch. The umbilicus is isolated and preserved with its stalk; after placing the patient in a 45° position on the operating table, the excessive cutaneous tissue is removed after confirming that the upper flap reached the lower incision without significant tension. Creation of the new site for umbilicus follows positioning of drains and sutures of various layers. If there were some incisional hernias, they must be repaired (Fig. 47.1).

Heparin is administered along with elastic stocking/mechanical calf compression during the day of surgery and on the first postoperative day. Infection prophylaxis consists of one dose of cefuroxime.

Overall complications in abdominoplasty surgery occur in a minority of cases but can be frustrating to manage nonetheless. The first paper in the literature to discuss the complications in depth was a survey of the opinions of 958 surgeons, rather than a clinical audit. Grazer and Goldwyn [10] presented these opinions on what problems could complicate abdominoplasty, and the rate was 14.6 %.

Controversy exists in the literature about the predictors of poor outcome [1, 4]. Pre-body contouring BMI [11–13], percentage excessive weight loss [4, 11], smoking [14–16], diabetes mellitus and/or hypertension [14, 17], nutritional deficiency [18], ASA classification [19], total amount of removed tissue [11–13], intraoperation time, multiple procedures, maximum BMI, and change in BMI from maximum to current BMI are mentioned variables as risk factors [4, 11].

From their experience, they have established risk factors, preoperative treatment, surgical staging, types of surgery, appropriate surgical time, and postoperative care, all with the goal of protecting the patient’s safety, preventing complications, and achieving maximum results [11].

The change in appearance after massive weight loss is expected to positively alter the patient’s body image and quality of life. Few people who have experienced a significant change in body image undergo body contouring surgeries. However, this might be because patients continue to have body image dissatisfaction due to residual feeling of being unattractive and self-conscious [23, 24]. There is a relation between perception and body satisfaction. Body contouring of a specific area increases the patient’s satisfaction with the area, but can shift his/her concerns toward other, unoperated areas. It is important to help patients accept the outcomes of massive weight loss and educate them about the next step in esthetic improvement [25].

A productive approach for clinical care and research is to ask how patients benefit from plastic surgery, which is an integral part of completing the treatment of post weight loss patients [26]. In modern medicine and health management, quality of life is increasingly accepted as a relevant endpoint. Especially in esthetic plastic surgery, the improvement of quality of life often represents the only surgical indication. Although some of the effects of body contouring may be esthetic, certainly there are positive outcomes related to better overall psychological well-being, quality of life, and functional ability, all of which may potentially contribute a significant portion to patient’s overall outcome [27].

Song et al. [28] investigated patients submitted to body contouring after 3 and 6 months and found out better quality of life and body image but not mood, which remained stable [28]. These results are similar to results of quantitative and qualitative research studies that describe improvement in body image, self-esteem, quality of life, and mental health [26, 29, 30]. A study by Van der Beek et al. [2] on the impact of reconstructive procedures after bariatric surgery indicated significant improvements in areas including physical appearance, physical functioning, mental well-being, social acceptance, intimacy, and sexuality. A recent report by Singh et al. [31

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