Body contouring in adolescents after bariatric surgery

Abstract

Background: Bariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown. Objectives: Describe the incidence and effect of BCS following bariatric surgery among adolescents. Setting: University Hospitals. Methods: Teen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin-related symptoms between those who did and those who did not undergo BCS. Results: Among the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n 5 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P 5.04 and P 5.03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS. Conclusion: Few adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.

A systematic review of body contouring surgery in post‐bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers

“…First, we focused on patients in the non‐BCS group. In the study by Derderian et al, 33 at the 60‐month visit, 74.1% of adolescent responders expressed their desire for BCS in the abdomen, 66.3% desired the arm, 63.7% the thigh, and 51.7% the chest. Another study focusing on adolescents also found a strong desire for BCS (84%); when specifying the body parts, the abdomen came first (79%), followed by the thigh (66%), and the breasts or chest (60%) 26 .…”

“…Four 36–38,41 confirmed that self‐confidence significantly improved following BCS. However, Derderian et al 33 found that compared with non‐BCS patients, the self‐esteem of patients after BCS was higher at 2‐year follow‐up but showed no significant difference at 4 years. Differences in the self‐esteem domain between the BCS and non‐BCS groups were not found in the study by de Zwaan 27 …”

“…Azin et al 28 also reported cost as the most commonly reported barrier (87.8%), followed by a desire for more weight loss before considering BCS (9.8%), and fear of the operation (2.8%). Derderian et al 33 found that cost was the most common barrier and followed by the respondent's intention of “planning to” have BCS sometime in the future. In the Netherlands, all post‐bariatric BCSs are covered by healthcare insurance when patients meet certain conditions.…”

“…Of the post‐bariatric patients who did not undergo any BCS, the majority of participants desired BCS and when specifying the body site preferred for surgery, the abdomen also came first 18,24,26,28,30,32,33 . The desire for BCS was even stronger in patients who had undergone at least one BCS 24,30,37,38 .…”

Metabolic and Bariatric Surgery in Adolescents

“…Instead, adolescents and adults experienced similar problems and desired body-contouring surgery in similar numbers [ 60 ]. Relatively few adolescents who underwent bariatric surgery actually accessed subsequent body-contouring surgery (13%), and this was often for pannus-related skin conditions rather than psychological reasons [ 61 ].…”