Key points

Introduction

Abdominoplasty is one of the most common cosmetic procedures performed worldwide. According to the American Society for Aesthetic Plastic Surgery, approximately 160,000 cosmetic abdominoplasty procedures were performed in the United States in 2018, a 170% increase since 2000. ^, Abdominoplasty is not just growing in volume but also in diversity of types of abdominoplasty procedures. ^, This procedure is performed in a diverse patient population (ranging from postpartum women to weight loss patients), which has led to a wide range of different surgical techniques, each with specific indications. As more surgical techniques develop, a strong evidence-based guide in selecting the most appropriate procedure for each patient is necessary. ^, Surgeons need scientifically sound and clinically meaningful data to make informed medical decisions, and patients may benefit from these data by better understanding the expected outcomes and having a more active role in surgical decision making.

Cosmetic abdominoplasty procedure outcomes can be evaluated by using clinical end points such as complications and patient-reported outcomes (PROs) that measure health-related quality of life (HR-QOL). Traditionally, there has been a strong emphasis on clinical outcomes. However, because the main goal of abdominoplasty is to optimize appearance and HR-QOL, clinical data are insufficient on their own to evaluate the effectiveness of abdominoplasty procedures. Although clinical data remain important, they do not provide insight into patients’ perspectives regarding the outcomes of surgery. PRO data take into account the patient’s viewpoint, which adds an important perspective to the assessment of surgical procedures. PROs are best assessed by means of PRO measures (PROMs) and can be useful in clinical decision making and in comparative effectiveness research.

PROMs are used not only in academic and industry-funded research but can also be used by individual cosmetic surgeons in clinical practice. Advancements in technology have made it feasible to collect PROMs data electronically, which can provide immediate display of results. Surgeons can gain real-time insight into patients’ self-reported outcomes. Collected in advance of an appointment, such information can then be used to prepare clinic visits by identifying health needs or concerns. The use of PROMs can enhance the interactions between patients and surgeons, such as helping patients verbalize their feelings, and thereby supporting shared treatment decision making. Preoperatively, PROMs can help to screen patients who may have underlying psychological issues and require additional referral or support, or to identify patients who may require education to ensure realistic expectations about the outcomes that can be achieved. In previous studies, PRO data collection in clinical practice has been associated with increased frequency of patients discussing their outcomes, improved symptom control, and satisfaction with care.

Despite the interest in using PROMs in cosmetic abdominoplasty, PRO data have not been rigorously and comprehensively collected. In the absence of PROMs specific to the abdominoplasty population, generic PROMs (ie, the Short Form 36) have been the most frequently used measures. Generic PROMs are designed for general use not related to a specific disease or condition and can be used for comparison of HR-QOL across different patient populations or with healthy controls. However, generic PROMs lack domains relevant specifically to patients undergoing abdominoplasty procedures (eg, scarring related to body contouring procedures). Furthermore, generic PROMs may be limited by lack of sensitivity to measure changes (ie, responsiveness) as a result of not asking questions most relevant to cosmetic abdominoplasty patients. PROMs specific to the abdominoplasty population are able to detect differences that occur after surgery, and these measures should be used to evaluate the effectiveness of surgical procedures.

The BODY-Q

The BODY-Q is a comprehensive PROM designed to measure outcomes relevant to cosmetic body contouring patients, as well as bariatric and massive weight loss patients. ^{, ,} The BODY-Q conceptual framework consists of 3 domains (appearance, HR-QOL, and patient experience of health care) that can be measured using 25 independently functioning scales ( Table 1 ). ^, Each scale represents a stand-alone instrument. The modular approach enables researchers or clinicians to select the BODY-Q scale that is most relevant to their research or clinical purposes.

The BODY-Q scales were developed in a 3-phase mixed-methods approach following rigorous guidelines for instrument development (ie, reports from the Scientific Advisory Committee of the Medical Outcomes Trust, the US Food and Drug Administration [FDA], and Consensus-based Standards for the Selection of Health Measurement Instruments [COSMIN] checklist). The 3 phases were item generation, item reduction, and psychometric evaluation, and these phases have been published elsewhere. ^, In the first phase, the conceptual framework, preliminary scales, and items were generated from a literature review and were further augmented with 63 in-depth patient interviews. Patient quotations from the patient interviews were used to generate preliminary items for the BODY-Q. Patients and professionals were asked about the relevance, comprehensiveness, and/or comprehensibility of the items of the BODY-Q. Feedback from 3 rounds of cognitive interviews with 22 participants and expert input were used to revise the scales to ensure that all relevant items were included in each construct of the different BODY-Q scales. Each BODY-Q item includes 4 response options, and patients provided feedback on the appropriateness of these response options. In the second phase, an international and multicenter field-test study was performed with 734 patients recruited. The data were analyzed to reduce the number of items in each scale. The BODY-Q was analyzed using Rasch measurement theory (RMT), a modern psychometric approach. By using RMT analysis, items were selected that could be grouped together to form a valid BODY-Q scale. The questions in the BODY-Q scales were arranged in a meaningful, hierarchical order. As an example, the first item in the physical function scale is “Getting up from a bed,” which is considered an easy measure of physical function to endorse. Further along the scale, the last question in the scale asks about “Standing for a long period of time,” which is considered a difficult question of physical function to endorse. The BODY-Q scales scores are computed from the responses to the items, which are added together and converted to a scale from 0 (worst) to 100 (best). In the final phase, the BODY-Q was further examined for its responsiveness to measuring clinical change. ^,

The BODY-Q was field-tested in the United States, Canada, and the United Kingdom. Internationally, the BODY-Q is currently available in 13 languages. These translations followed recommended methodology for the translation, linguistic validation, and cultural adaption process, which ensured that items did not differ in their meaning across different language versions. In addition, the Danish team conducted a full psychometric validation study.

BODY-Q Data in Cosmetic Abdominoplasty

To show how the BODY-Q can be used in cosmetic abdominoplasty research or clinical practice, this article presents an example based on data from the field-test study of the BODY-Q. In this multicenter study performed in cosmetic surgery clinics in Hamilton, Vancouver, Mississauga (Canada), and Atlanta (United States), the sample included 234 patients who were before or after body contouring. In the survey, these participants were asked the following questions:

• 1.
  

  What body contouring procedures are you here about today?

  
  
• 2.
  

  Have you had the body contouring procedure you are here about today?

  
  
  
  
  • a.
    

    Yes, I am a postoperative patient

    
    
  • b.
    

    No, I am a preoperative patient

  
  

There were 157 participants who were seeking or had undergone an abdominoplasty. The sample included 111 from the United States and 46 from Canada. Most participants were female (n = 151) and white (n = 111), with the mean age 44 years (standard deviation [SD] = 9.5; range, 20–72 years). The sample was primarily cross-sectional: 140 participants who completed the BODY-Q once (37 preoperative and 103 postoperative) and 17 participants who completed the BODY-Q twice (preoperative and postoperative). The results for these 2 groups are presented separately later.

Table 2 shows the results of the cross-sectional data. The mean score for the scales measuring satisfaction with abdomen and body was lower for the preoperative sample compared with the sample who underwent abdominoplasty. For the HR-QOL scales, participants exploring or seeking abdominoplasty reported significantly lower levels of body image and sexual well-being compared with participants who underwent abdominoplasty. Psychological and social well-being scores were not significantly different between the 2 samples. Figs. 1 and 2 show the mean scores for the BODY-Q scales by clinical group (before or after body contouring).

Table 2

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