Aspects of excess skin in obesity, after weight loss, after body contouring surgery and in a reference population

Elander, Anna; Biörserud, Christina; Staalesen, Trude; Ockell, Jonas; Olsén, Monika Fagevik

doi:10.1016/j.soard.2018.10.032

Cited by 18 publications

(20 citation statements)

References 15 publications

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“…If so, discomfort related to excess skin on the arms does not seem to be an exception. The effect of a high BMI before bariatric surgery on the development of discomforting excess skin has also been reported in previous studies [9,13,21]. It is possible that a higher pre-operative BMI causes the skin to become more stretched and subsequently results in more floppy and discomforting skin when the patient loses weight.…”

Section: Discussionsupporting

confidence: 65%

“…As the number of surgeries increases, however, so does the incidence of adverse effects associated with massive weight loss post-operatively, i.e., excess skin [5][6][7][8][9][10][11][12][13][14]; studies have shown that up to 90% of post-bariatric patients experience excess skin [6,8,10,15,16]. Although most patients are satisfied with their bariatric surgery, some describe the resulting excess skin as "a suit of skin, several sizes too big"; it has been shown to cause significant discomfort, symptoms such as back pain, itching, and rashes, as well as difficulty in finding well-fitting clothes and intimacy issues [6,10,13,[15][16][17][18]. This may result in a low quality of life (QoL) and/or negative body image, and some patients even regret having undergone the operation [7,[19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…This may result in a low quality of life (QoL) and/or negative body image, and some patients even regret having undergone the operation [7,[19][20][21][22][23][24]. Several studies have shown that body-contouring surgery (BCS) is efficient in improving several aspects of QoL for post-bariatric surgery patients with uncomfortable excess skin, including physical functioning, psychological well-being, and social functioning [11,13,23,[25][26][27][28][29][30][31]. The most common locations for this excess skin are the abdomen, arms, thighs, buttocks, and chest/ breasts [5,6,8,10,11,16,17,[31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery

et al. 2022

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Background Bariatric surgery is an effective weight loss method for patients with obesity. One side effect of bariatric surgery is uncomfortable excess skin. Much remains to be learned about physical measurements and patients’ subjective perceptions of it. Here, we investigated the pre- to post-bariatric changes in patients’ perception and physical measurements of the skin on the arms and thighs, in order to find possible subgroups especially affected by post-operative excess skin and to identify predicting factors. Methods One hundred forty-seven patients eligible for bariatric surgery completed the Sahlgrenska Excess Skin Questionnaire (SESQ) and underwent measurements of their skin before and 18 months after the procedure. Results Although most physical measurements decreased post-operatively, many patients reported increased discomfort. We identified one subgroup particularly prone to report excess skin on the arms post-operatively: women with high discomfort from excess skin on the arms and high body mass index (BMI), pre-operatively. Ptosis of the excess skin seems to be a feasible measurement for predicting post-operative discomfort. For every centimetre of ptosis pre-operatively, patients had 1.37- and 1.31-fold higher odds of achieving a score for post-operative discomfort from excess skin on the upper arms and thighs, respectively, of ≥ 6 (on a 0–10 scale). Conclusions We identified a subgroup especially affected by discomforting excess skin on arms and thighs after weight loss. Furthermore, we suggest a pre-operative pro-operative ptosis measuring to predict post-operative discomfort level. The result of this study further increases the knowledge of excess skin and should be useful in further improving patient education. Level of Evidence: Level III, risk / prognostic study.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery

et al. 2022

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“…For some patients, considerable weight loss after bariatric surgery implies burdensome excess skin mainly on abdomen, but also on thighs, arms, breast, back, and face. The excess skin might result in intertrigo, skin infections, and mobility problems, as well as a negative body image, depression, and social dysfunction (8,9).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Post-bariatric Abdominoplasty on Secondary Weight Regain After Roux-en-Y Gastric Bypass

et al. 2020

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Roux-en-Y gastric bypass (RYGB), implies a considerable weight loss during the first two years after surgery. Excess skin due to rapid weight loss might affect self-esteem, decrease quality of life and be a hindrance to physical activity. Removing excess skin might reduce secondary weight regain. Among plastic surgeons, a BMI < 30 kg/m 2 is usually required to have abdominoplasty (AP). Many RYGB patients never reach this threshold even if they have a considerable weight loss and experience practical as well as emotional problems due to excess skin. The aim of this study was to investigate the role of abominoplasty on weight development until five years, among patients who did and did not achieve a nadir BMI < 30 kg/m 2 during the first two years after RYGB. Data on 645 patients from a single center RYGB-quality register from 2004 to 2013 with baseline and follow-up data were analyzed. Post-bariatric AP was publicly funded if medically needed. Weight regain (WR) from nadir weight to five years was analyzed as percentage WR of maximal weight loss. Nadir BMI was available in 633 (98.1%) patients, and BMI after five years in 553 (85.7%) patients. The 233 patients with nadir BMI < 30 kg/m 2 who underwent AP regained 17.8 (±16.1) % of their maximal weight loss at five years compared to 24.2 (±19.7) % in 185 patients not having AP (p < 0.001). The 27 patients with nadir BMI > 30 kg/m 2 within two years after RYGB who underwent AP regained 12.9 (±19.3) % compared to 31.4 (±24.7) % in 188 patients without AP (p < 0.001). This procedure was more common among women than men, as 224 (46.4%) women, and 36 (22.2%) men underwent AP. Abdominoplasty was associated with reduced secondary weight regain after RYGB in this study. Whether this is caused by increased bodily satisfaction and better physical function, or a biological response to reduction of adipose tissue remains unclear. If removing abdominal subcutaneous adipose tissue prevent secondary weight regain and increase the robustness of bariatric surgery, this should be offered as part of the standard treatment after bariatric surgery.

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“… 5 , 6 , 9 – 18 Body contouring surgery (BCS) can be used to address these problems of redundant excess skin. 19 – 21 BCS holds promise for significant improvement of health-related quality of life and better weight control after bariatric surgery. 20 – 31 Studies reported that 62%–90% of the postbariatric patients desired additional reconstructive surgery.…”

Section: Introductionmentioning

confidence: 99%

The PRS Rainbow Classification for Assessing Postbariatric Contour Deformities

Vries

Berg

Monpellier

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: There is a need for a reliable classification system to grade contour deformities and to inform reimbursement of body contouring surgery after massive weight loss. We developed the PRS Rainbow Classification, which uses select photographs to provide standardized references for evaluating patient photographs, to classify contour deformities in postbariatric patients. To assess the reliability of the PRS Rainbow Classification to classify contour deformities in massive weight loss patients. Methods: Ten independent experienced plastic surgeons, 7 experienced medical advisors of the healthcare insurance company, and 10 laypersons evaluated 50 photographs per anatomical region (arms, breast, abdomen, and medial thighs). Each participant rated the patient photographs on a scale of 1–3 in an online survey. The inter-observer and the intra-observer reliabilities were determined using intra-class correlation coefficients (ICCs). The ICC analyses were performed for each anatomical region. Results: Inter-observer reliability was moderate to good in the body regions “arms,” “abdomen,” “medial thighs,” with mean ICC values of 0.678 [95% confidence interval (CI), 0.591–0.768], 0.685 (95% CI, 0.599–0.773), and 0.658 (95% CI, 0.569–0.751), respectively. Inter-observer reliability was comparable within the 3 different professional groups. Intra-observer reliability (test–retest reliability) was moderate to good, with a mean overall ICC value of 0.723 (95% CI, 0.572–0.874) for all groups and all 4 body regions. Conclusions: The moderate to good reliability found in this study validates the use of the PRS Rainbow Classification as a reproducible and reliable classification system to assess contour deformities after massive weight loss. It holds promise as a key part of instruments to classify body contour deformities and to assess reimbursement of body contouring surgery.

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Aspects of excess skin in obesity, after weight loss, after body contouring surgery and in a reference population

Cited by 18 publications

References 15 publications

Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery

Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery

The Impact of Post-bariatric Abdominoplasty on Secondary Weight Regain After Roux-en-Y Gastric Bypass

The PRS Rainbow Classification for Assessing Postbariatric Contour Deformities

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