Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience

Losco, Luigi; Roxo, Ana Cláudia Weck; Roxo, Carlos Weck; Torto, Federico Lo; Bolletta, Alberto; Sire, Alessandro de; Aksoyler, Dicle; Ribuffo, Diego; Cigna, Emanuele; Roxo, Carlos P

doi:10.1007/s00266-019-01543-x

Cited by 26 publications

(16 citation statements)

References 60 publications

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“…Our approach was recently evaluated in terms of long‐term outcomes and proved to determine a substantial reduction in circumference measurements and episodes of cellulitis (Ciudad, Manrique, Bustos, et al, 2020). In our experience, the combination of the VLNT with extensive therapeutic lipectomy helps reducing the lymphatic load on the newly transferred lymphatic tissue (Agko, Ciudad, & Chen, 2018; Bolletta et al, 2020; Inserra et al, 2016; Losco et al, 2020). The technique was investigated and found not causing further damage to the lymphatic system, but we avoided treating the areas where the LVAs were performed in order not to accidentally damage them.…”

Section: Discussionmentioning

confidence: 97%

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

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Background There is no consensus on the appropriate treatment of lymphedema. Proposed techniques include lymphaticovenous anastomosis (LVA), vascularized lymph nodes transfer (VLNT), and suction lipectomy (SL). The benefit of combined procedures has also been postulated. In this prospective study, a combined protocol is proposed as an alternative to single‐procedure strategies. Methods Between January 2016 and October 2018, we enrolled patients with secondary lymphedema of lower limbs, stage II‐III according to the International Society of Lymphology, progressive swelling and skin tonicity >60. Thirty‐seven consecutive patients were dichotomized into group I, undergoing VLNT, and group II undergoing VLNT and LVA. Gastroepiploic lymphnode flap was harvested through laparoscopy, and in the same operation, LVAs were performed in group II on the basis of indocyanine green lymphography and patent blue findings. Two weeks later, SL was performed in all the patients. Patients were prospectively evaluated through clinical examination, circumference measurement, and skin tonicity. Results The average follow‐up was 2 ± 0.8 years. The first consecutive 21 patients were treated with VLNT followed by SL. The next 16 patients underwent combined VLNT and LVA, followed by SL. A mean of 2.4 LVAs were performed. A significant difference in the postoperative circumference measurements was found overall (p < .05): 52.6 ± 18.9 above the knee, 42.9 ± 25 below the knee, 36.2 ± 37 at foot. The postoperative tonicity dropped by 12.7 ± 6.3% (p < .05). The episodes of cellulitis significantly decreased to 0.1 ± 0.3 (p < .05). Conclusions LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.

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Section: Discussionmentioning

confidence: 97%

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

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“…In addition, cross-sectional studies were also limited by insufficient follow-up time, and cohort and longitudinal studies were also limited by confounding factors such as the extent of weight loss, the degree of skin redundancy, and income level that had not been fully considered. Of note, to reduce the potential recall bias in our review, we excluded five single-arm studies 47,48,[51][52][53] that only enrolled post-BCS patients. These five studies were based on patients' recall of pre-BCS data regarding HRQoL, even though they came to the conclusion that supported BCS.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Summary Many post‐bariatric patients have impaired health‐related quality of life (HRQoL) due to excess skin following weight loss; however, it is inconclusive whether body contouring surgery (BCS) improves this impairment. We aimed to comprehensively summarize existing evidence of the effect of BCS on the HRQoL (primary outcome) and determine the prevalence of, the desire for, and barriers to BCS (secondary outcomes). Randomized controlled trials, cohort, cross‐sectional, case–control, and longitudinal studies were systematically searched in PubMed, Embase, the Cochrane Central, and Web of Science. After screening 1923 potential records, 24 studies (representing 6867 participants) were deemed eligible. Only 18.5% of respondents from cross‐sectional studies underwent BCS, with abdominal BCS as the most common procedure. Most participants desired BCS but listed “cost” and “lacking reimbursement” as the main barriers. Results suggest that most post‐bariatric patients who underwent BCS experienced improvements in their HRQoL, which could be seen in almost every dimension evaluated, including body image and physical and psychosocial functions. Therefore, both bariatric and plastic surgeons should regard BCS not only as an aesthetic supplement but also as a vital part of functional recovery in the surgery‐mediated weight loss journey and, thus, provide it to more post‐bariatric patients.

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“…The described mean difference of age in the described study, however, was only five years, which represents a limitation and likely points out a structural bias of the statistical analysis. Other studies (Nemerofsky et al [34], Losco et al [35], Arthrus et al [36]) on cosmetic thigh-and body-lift operations were able to demonstrate a significant increase in complications with increased BMI (>28-32 kg/m 2 ) but did do not observe any significant correlations of higher complications and age. However, these studies conclude that patients with a higher maximum body mass index before their massive weight loss had significant (p < 0.01) more complications.…”

Section: Discussionmentioning

confidence: 87%

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Schwaiger

Weitgasser

Mahrhofer

et al. 2021

JCM

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Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

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Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience

Cited by 26 publications

References 60 publications

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

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

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

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