Mirror, Mirror on the Wall: When the Postoperative Reflection Does Not Meet Patientsʼ Expectations

Abstract

In this study, the authors investigated the physiologic effects of the altered body composition that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-assisted liposuction. There were no significant intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of 6.5 kg (p < 0.00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/- 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p < 0.0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic blood pressure (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly altered after liposuction. In conclusion, over a 4-month period, large-volume liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles. Should these improvements be maintained over time, liposuction may prove to be a valuable tool for reducing the comorbid conditions associated with obesity.

Lifestyle Outcomes, Satisfaction, and Attitudes of Patients after Liposuction: A Dallas Experience

“…This reinforces the mantra that there needs to be proper preoperative patient selection and preoperative discussion of realistic postoperative results and expectations. 18 Complete analysis of the data demonstrated that among all the variables tested by this survey, weight gain was the most pivotal. In a separate publication, the relationship of weight gain, postoperative patient lifestyle choices, and satisfaction will be discussed.…”

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

“…Factors such as personal preference, aversion to medical intervention, and professional recommendations likely affect the decision to undergo treatment. Because patients' perspectives have become a major component of assessing outcome, patients' expectations also have become incorporated in the creation of quality reporting schemes [11,13,20,27,28,37]. Identification of expectations offers tangible participation in a shared decision-making process when an array of different treatment options is available.…”

“…Identification of expectations offers tangible participation in a shared decision-making process when an array of different treatment options is available. Understanding what generates or influences patients' expectations and identifying what patients expect may allow greater convergence of the priorities and goals held by patients and surgeons [13,20,27,28,37]. This may be fundamental to optimizing patient satisfaction.…”

Teaching Patient Selection in Aesthetic Surgery

“…Patients' expectations vary widely, are the product of the patient's personality and experiences, and can often be influenced by the surgeon during the consultation. 10,34 The importance of understanding and guiding patient expectations cannot be overstated. Mismanaged patient expectations are The importance of each factor in determining patient suitability for surgery is rated on a 7-point scale: 1 ϭ least important, 7 ϭ most important.…”