Classifying Severity of Abdominal Contour Deformities after Weight Loss to Aid in Patient Counseling

Abstract

Background Prior to massive weight loss (MWL), many patients wonder about their future abdominal contour. Abdominal contour deformities after MWL are highly variable, ranging from a mild upper protuberance to multiple rolls. Correction of these deformities is challenging and may require advanced surgical techniques. The incidence of patients presenting with various abdominal deformities and the factors influencing these deformities are not well defined, but could aid patients undergoing weight loss. Methods All MWL patients presenting for abdominal contouring from 2002–2012 were reviewed, and abdomens were graded using a modified Pittsburgh Rating Scale. Data collected for each patient included BMI indices, history of bariatric surgery, and type of abdominal contouring surgery. Results 1006 patients were evaluated with a mean age of 44.2 years ± 10.5 years. The mean MaximumBMI was 51.7 kg/m2±9.6 kg/m2, mean CurrentBMI was 30.0 kg/m2±6.4 kg/m2, and mean DeltaBMI was 21.7 kg/m2±7.0 kg/m2. 64% had a high-grade deformity. Patients with larger DeltaBMIs had higher deformity grades (p < 0.001). Patients with higher deformity grades were more likely to undergo a fleur-de-lis abdominoplasty (p < 0.001). Conclusions Most patients presenting for body contouring after MWL have high-grade abdominal deformities with multiple rolls. DeltaBMI is positively correlated with deformity grade and more aggressive abdominal contouring procedures. Patients interested in MWL should be counseled that, depending on desire for eventual outcomes, more complex procedures may be required to correct the resultant abdominal deformity. Level of Evidence Therapeutic, III.

Body Contouring After Bariatric Surgery

“…The desire for further BCS appears to increase following each additional surgery (Staalesen, Olsén, and Elander, 2013). Additionally, increased desire for BCS is seen among those with more severe skin deformities (Zammerilla et al, ). Overall, it appears that desire for BCS and the selected operative sites are significantly correlated with the areas of self‐reported and expert‐rated skin redundancy issues.…”

“…In one study using this scale, higher deformity grades of excess skin were associated with bariatric surgery of any type, with lesser deformity grades among those who experienced large weight losses with lifestyle modification (diet and exercise) rather than bariatric surgery. Additionally, greater changes in BMI from prebariatric to post‐bariatric surgery were also associated with higher deformity grades (Zammerilla et al, ). As expected, a strong correlation has been found between the self‐reported magnitude of excess skin, objective measures of excess skin and the self‐reported discomfort related to the excess skin (Staalesen et al, ).…”

“…In order to reduce the number of surgeries, surgery cost and time spent under anaesthesia, concomitant BCS procedures are commonly performed (Zammerilla et al, ). In a large sample of post‐bariatric patients receiving abdominal BCS, it was found that 47% underwent two or more procedures concurrently, with the most common procedures being lower body lifts (19%), mammoplasty (17%) and brachioplasty (13%; Zammerilla et al, ). Chong et al () found that among post‐bariatric BCS patients, 60% of patients reported undergoing a single BCS procedure that addressed multiple body areas, with abdominoplasty and breast contouring as the most common combination.…”

“…The desire for further BCS appears to increase following each additional surgery (Staalesen, Olsén, and Elander, 2013). Additionally, increased desire for BCS is seen among those with more severe skin deformities (Zammerilla et al, 2014).…”

Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

“…With the recent developments in bariatric surgery, there is a large emphasis on the surgical treatment of abdominal contour deformities after weight loss, most notably in the form of an ABP [12]. As an individual procedure, the complication rates of ABP are very low [13], and in general, patients who experienced these adverse outcomes still report a positive experience and would recommend the procedure to a friend [14].…”