Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring

Abstract

Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.

Keywords: American Society of Plastic Surgeons; abdominoplasty; body contouring; post-bariatric plastic surgery; weight loss.

Figure 1

Anteroposterior (AP) view: before (A,C,E,G) and after (B,D,F,H) the patients underwent abdominoplasty. (A,B): Female, 43 years old, underwent traditional abdominoplasty after sleeve gastrectomy and 18 kg of weight loss. (C,D): Female, 36 years old, abdominoplasty after gastric mini-bypass and 36 kg of weight loss. (E,F): Female, 32 years old, abdominoplasty after sleeve-gastrectomy and 28 kg of weight loss. (G,H): Female, 52 years old, abdominoplasty with vertical scar after sleeve-gastrectomy and 43 kg of weight loss.

Figure 2

Lateral view: before (A,C,E,G) and after (B,D,F,H) photos of the patients underwent high superior tension abdominoplasty. (A,B): Female, 52 years old, submitted to traditional abdominoplasty after gastric balloon and 19 kg of weight loss. (C,D): Female, 39 years old, abdominoplasty and abdominal wall reparation for umbilical hernia after gastric mini-bypass and 26 kg of weight loss. (E,F): Female, 40 years old, abdominoplasty after sleeve-gastrectomy and 32 kg of weight loss. (G,H): Female, 50 years old, lipo-abdominoplasty after sleeve-gastrectomy and 49 kg of weight loss.

Figure 3

AP-lateral view: (A,C,E,G) and after (B,D,F,H) photos of the patients underwent lipo-abdominoplasty and high superior tension using radiofrequencies energy for dissection. (A,B): Female, 44 years old, submitted to traditional abdominoplasty after gastric mini-bypass 41 kg of weight loss. (C,D): Female, 29 years old, abdominoplasty after diet and 18 kg of weight loss. (E,F): Female, 40 years old, abdominoplasty after sleeve-gastrectomy and 55 kg of weight loss. (G,H): Female, 59 years old, abdominoplasty after mini-bypass and 45 kg of weight loss.

Figure 4

Searching process flow chart displaying inclusion and exclusion criteria.

Figure 5

Timeline illustration showing the evolutionary history of abdominoplasty techniques.