ABCD of Safe Single Sitting Megasession Bariplastic Surgery: Our Experience and Protocol

Introduction

Massive weight loss patients often require multiple body contouring procedures usually performed in multiple sittings and very few series with megasession single stage bariplastic surgeries have been described in the past as most have suffered from high complications rate.^1,2 We have performed megasessions in select group of massive weight loss patients with a standardized ABCD protocol maximizing safety, efficiency and outcome.

A consecutive series of 50 cases of megasession body contouring post massive weight loss during a period of 4 years were retrospectively analysed for their outcomes. We define megasession as major body contouring involving 3 or more regions of the body done in a single sitting. Belt lipectomy was counted as two regions. All patients were operated by two teams of plastic surgeons lead by the senior author (SC). Techniques of body contouring were selected judiciously to allow simultaneous operating by two teams.(Figure 1 and 2)

METHODS

50 patients (45 females and 5 male) post massive weight loss were selected for mega session body contouring procedures. Only patients who were weight stable, BMI <30³, with no unstable or serious medical/psychological disorder and Haemoglobin³12g% were selected. All 50 patients had 3 or more regions operated for major contouring (35 Abdominoplasties, 40 Liposuctions, 20 Facelifts, 18 Blepharoplasties, 25 Breast Contouring and 5 Arm, 5 thigh lifts and 4 Belt lipectomies).

OBSERVATIONS

Average operating time was 7.5 hours. Average length of stay in the hospital was 3 days. All patients were given pre intra & post operative full DVT prophylaxis and operated under hypotensive anaesthesia. Only 5 patients required a blood transfusion postop and average drop in Hb was 3 gm%.

RESULTS

All patients were satisfied with their aesthetic result. 12% rated their result as fair, 28% as good and 60% as very good or excellent. No patient rated their result as poor. There were no major complications requiring readmission and no mortality. Eight patients had minor complications (two seroma and six wound dehiscence) requiring OPD/bedside procedures.

CONCLUSION

The ABCD of Safe Megasession Bariplastic Surgery according to our protocol is

A                     Aggressive approach to safety

B                     BMI pre-MBPS of <30

C                     Conservative Surgical techniques

D                     Delegation with multi-team approach

                          for efficient time management

We have shown that in select group of massive weight loss patients megasession body contouring can be performed safely in single sitting with advantages to the patient in terms of cost, recovery, positive body image with good outcome.

REFERENCES

1.    Hauben, D J., Benmeir, P M.D., Charuzi, I: One-stage Body Contouring Ann Plast Surg :21(5): 472-479, Nov 1988.

2. Shermak MA, Chang D, Magnuson TH, Schweitzer MA: An Outcomes Analysis of Patients Undergoing Body Contouring Surgery after Massive Weight Loss: Plast. Reconstr. Surg. 118: 1026, 2006

3. Greco JA et alThe Effect of Weight Loss Surgery and Body Mass Index on Wound Complications After Abdominal Contouring Operations: Ann Plast Surg 2008;61: 235–242)