Research Article| Volume 72, ISSUE 4, P649-655, April 2019

Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method

Published:December 15, 2018DOI:


      Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method — bariatric surgery or lifestyle changes — affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien–Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0–24 hours post-operation) affected 8.3% of patients, with early complications (1–7 post-operative days) affecting 16.7% of them and late complications (8–30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p = 0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually.

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        • Kitzinger H.B.
        • Abayev S.
        • Pittermann A.
        • et al.
        After massive weight loss: patients' expectations of body contouring surgery.
        Obes Surg. 2012; 22: 544-548
        • Biorserud C.
        • Olbers T.
        • Fagevik Olsen M.
        Patients' experience of surplus skin after laparoscopic gastric bypass.
        Obes Surg. 2011; 21: 273-277
        • Bossert R.P.
        • Rubin JP
        Evaluation of the weight loss patient presenting for plastic surgery consultation.
        Plast Reconstr Surg. 2012; 130: 1361-1369
        • Gilmartin J.
        Body image concerns amongst massive weight loss patients.
        J Clin Nurs. 2013; 22: 1299-1309
        • Staalesen T.
        • Fagevik Olsen M.
        • Elander A.
        Experience of excess skin and desire for body contouring surgery in post-bariatric patients.
        Obes Surg. 2013; 23: 1632-1644
        • Biorserud C.
        • Fagevik Olsen M.
        • Elander A.
        • Wiklund M.
        Objective measurements of excess skin in post bariatric patients–inter-rater reliability.
        J Plast Surg Hand Surg. 2016; 50: 68-73
        • Klassen A.F.
        • Cano S.J.
        • Scott A.
        • Johnson J.
        • Pusic A.L.
        Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study.
        Obes Surg. 2012; 22: 1527-1534
        • Colwell A.S.
        Current concepts in post-bariatric body contouring.
        Obes Surg. 2010; 20: 1178-1182
        • Song A.Y.
        • Jean R.D.
        • Hurwitz D.J.
        • et al.
        A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale.
        Plast Reconstr Surg. 2005; 116 (discussion 45-6): 1535-1544
        • Tremp M.
        • Delko T.
        • Kraljevic M.
        • et al.
        Outcome in body-contouring surgery after massive weight loss: A prospective matched single-blind study.
        J Plast Reconstr Aesthet Surg. 2015; 68: 1410-1416
        • Garcia Botero A.
        • Garcia Wenninger M.
        • Fernandez Loaiza D.
        Complications After Body Contouring Surgery in Postbariatric Patients.
        Ann Plast Surg. 2017; 79: 293-297
        • van der Beek E.S.
        • van der Molen A.M.
        • van Ramshorst B.
        Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal.
        Obes Facts. 2011; 4: 61-66
        • Parvizi D.
        • Friedl H.
        • Wurzer P.
        • et al.
        A Multiple Regression Analysis of Postoperative Complications After Body-Contouring Surgery: a Retrospective Analysis of 205 Patients: Regression Analysis of Complications.
        Obes Surg. 2015; 25: 1482-1490
        • Modarressi A.
        • Meia Ruegg E.
        • Bezzola T.
        • Pittet-Cuenod B.
        Circular abdominoplasty after massive weight loss: Is it a risky procedure?.
        J Plast Reconstr Aesthet Surg. 2016; 69: 1497-1505
        • Mejia J.A.
        • Cardenas Castellanos Y.A.
        Extended abdominoplasty: applications and a new classification system for abdominoplasty.
        Aesthetic Plast Surg. 2012; 36: 278-284
        • Friedman T.
        • O'Brien Coon D.
        • Michaels J.
        • et al.
        Fleur-de-Lis abdominoplasty: a safe alternative to traditional abdominoplasty for the massive weight loss patient.
        Plast Reconstr Surg. 2010; 125: 1525-1535
        • Reiffel A.J.
        • Jimenez N.
        • Burrell W.A.
        • et al.
        Body contouring after bariatric surgery: how much is really being done?.
        Ann Plast Surg. 2013; 70: 350-353
        • Wong M.S.
        Post-Bariatric Body Contouring Surgery After Weight Loss: Lessons Learned From an Obesity Epidemic in the United States.
        Ann Plast Surg. 2016; 77: S53-S59
        • Coriddi M.R.
        • Koltz P.F.
        • Chen R.
        • Gusenoff J.A.
        Changes in quality of life and functional status following abdominal contouring in the massive weight loss population.
        Plast Reconstr Surg. 2011; 128: 520-526
        • Poodt I.G.
        • van Dijk M.M.
        • Klein S.
        • Hoogbergen M.M.
        Complications of Lower Body Lift Surgery in Postbariatric Patients.
        Plast Reconstr Surg Glob Open. 2016; 4: e1030
        • Winocour J.
        • Gupta V.
        • Ramirez J.R.
        • et al.
        Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures.
        Plast Reconstr Surg. 2015; 136: 597e-606e
        • Greco 3rd, J.A.
        • Castaldo E.T.
        • Nanney L.B.
        • et al.
        The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations.
        Ann Plast Surg. 2008; 61: 235-242
        • Neaman K.C.
        • Hansen J.E.
        Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital.
        Ann Plast Surg. 2007; 58: 292-298
        • Rogliani M.
        • Gentile P.
        • Silvi E.
        • Labardi L.
        • Cervelli V.
        Abdominal dermolipectomy: risks and complications in smokers treated from 2004 to october of 2006.
        Plast Reconstr Surg. 2008; 122: 85e-86e
        • Gravante G.
        • Araco A.
        • Sorge R.
        • et al.
        Wound infections in post-bariatric patients undergoing body contouring abdominoplasty: the role of smoking.
        Obes Surg. 2007; 17: 1325-1331
        • Coon D.
        • Michaels Jt.
        • Gusenoff J.A.
        • et al.
        Hypothermia and complications in postbariatric body contouring.
        Plast Reconstr Surg. 2012; 130: 443-448
        • Hasanbegovic E.
        • Sorensen J.A.
        Complications following body contouring surgery after massive weight loss: a meta-analysis.
        J Plast Reconstr Aesthet Surg. 2014; 67: 295-301
        • Bray G.A.
        • Fruhbeck G.
        • Ryan D.H.
        • Wilding J.P.
        Management of obesity.
        Lancet. 2016; 387: 1947-1956
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Montano-Pedroso J.C.
        • Garcia E.B.
        • Omonte I.R.
        • Rocha M.G.
        • Ferreira L.M.
        Hematological variables and iron status in abdominoplasty after bariatric surgery.
        Obes Surg. 2013; 23: 7-16
        • Kitzinger H.B.
        • Cakl T.
        • Wenger R.
        • et al.
        Prospective study on complications following a lower body lift after massive weight loss.
        J Plast Reconstr Aesthet Surg. 2013; 66: 231-238
        • Nemerofsky R.B.
        • Oliak D.A.
        • Capella J.F.
        Body lift: an account of 200 consecutive cases in the massive weight loss patient.
        Plast Reconstr Surg. 2006; 117: 414-430
        • de Kerviler S.
        • Husler R.
        • Banic A.
        • Constantinescu M.A.
        Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis.
        Obes Surg. 2009; 19: 553-559
        • Shermak M.A.
        • Rotellini-Coltvet L.A.
        • Chang D.
        Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies.
        Plast Reconstr Surg. 2008; 122: 280-288
        • Hng K.N.
        • Ang Y.S.
        Overview of bariatric surgery for the physician.
        Clin Med (Lond). 2012; 12: 435-440

      Linked Article

      • Abdominoplasty in massive weight loss patient: Modifying the technique to improve the safety
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 72Issue 6
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          We read with great interest the recent article by Pajula et al.1 regarding complications after lower body contouring in massive weight loss patients. This retrospective review analyzed 158 patients undergoing abdominoplasty or belt lipectomy after massive weight loss. Patients were divided into two groups using the weight loss method employed: those who lost weight through bariatric surgery (90 patients, 57%) and those who lost weight through diet or physical activity (68 patients, 43%). The most common bariatric procedure was gastric bypass (75 patients, 83.3%) followed by sleeve gastrectomy (14 patients, 15.5%), and gastric balloon (1 patient, 1.1%).
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