Abdominoplasty in the Massive Weight Loss Patient: Are Aesthetic Goals and Safety Mutually Exclusive?

Abstract

Background: The goals of abdominoplasty in massive weight loss (MWL) patients are often functional, with a greater emphasis on safety than on aesthetic rejuvenation. As important as functional improvements and safety are, however, there may be room for increasing the aesthetic potential of abdominoplasties in these patients.

Objectives: To determine the safety of the pursuit of aesthetic goals for abdominoplasty in MWL patients.

Methods: This is a retrospective study examining 910 consecutive female patients consisting of 3 groups: postpartum (n = 718), dietary MWL (n = 65), and bariatric MWL (n = 127). All patients were approached with a well-defined set of aesthetic goals which were pursued as needed and as feasible.

Results: The utilization of aesthetic abdominoplasty components was similar in all groups, supporting the assertion that the groups were subjected to a similar aesthetic emphasis. Logistic regression showed that a history of bariatric MWL was an independent risk factor for multiple complications (odds ratio 2.738, P = 0.014) and that elevated body mass index (BMI), smoking, diabetes, and age were likewise independent risk factors for complications. Propensity score-matched case-control pairs showed that bariatric MWL patients were more likely than dietary MWL patients to experience multiple complications (9.52% vs 0%, P = 0.031).

Conclusions: Bariatric MWL patients but not dietary weight loss patients seem to have a higher risk than postpartum patients. Other comorbidities (elevated BMI, smoking, diabetes, and age) seem to be more important predictors of complications than MWL status. Select MWL patients can likely be approached with an emphasis on aesthetic goals, without increasing risks as compared with the postpartum population.

Figure 1.

Principles of abdominoplasty flap contouring in the massive weight loss population. 1. Flap itself may need improvement (thinning, release, and possible tightening), which can be achieved by sub-Scarpa’s resection with electrocautery. 2. Higher upper incision results in strong downwards/lateral tension vector. 3. Extended, upwards curving lower incision provides lateral tension vector. 4. Mons rejuvenation through a lower incision placement (approximately 6-7 cm from introitus) with upwards/lateral tension vector as well as mons thinning and fascial suspension.

Figure 2.

A 31-year-old nonsmoking, nondiabetic woman with body mass index of 30.84 and a deformity rating of 3(b) had lost 140 pounds following gastric bypass and then underwent abdominoplasty with “belt” lipectomy and breast reduction. The anterior abdominal specimen weighed 4038 g. Photographs taken at 3 years postoperative follow-up. (A) Frontal preoperative view. (B) Frontal postoperative view. (C) Lateral preoperative view. (D) Lateral postoperative view. (E) Oblique preoperative view. (F) Oblique postoperative view.

Figure 3.

A 43-year-old nonsmoking, nondiabetic woman with a body mass index of 32.89 and a deformity rating of 3(c) had lost 120 pounds by a program of diet and exercise and then underwent abdominoplasty and brachioplasty. Photographs taken at 1 year postoperative follow-up. (A) Frontal preoperative view. (B) Frontal postoperative view. (C) Lateral preoperative view. (D) Lateral postoperative view. (E) Oblique preoperative view. (F) Oblique postoperative view.