Background: An increasing number of patients are presenting for postbariatric reconstruction after massive weight loss.  Some of these patients present with residual obesity which may compromise outcomes.  We present a prospective registry analysis of the impact of body mass indices on the outcomes of body contouring surgery.

Methods: 449 body contouring patients were enrolled over 4 years.  Measures included medical comorbidities and complications.  Cases were analyzed in three groups: all cases, cases with one procedure (Group I), and those with multiple procedures (Group II).

Results: 449 patients (407 female, 42 male) with a mean age of 44.5 ± 10.3 underwent 511 separate operations.  Mean pre-weight loss BMI (MaxBMI) was 51.6 ± 9.5, post-weight loss BMI (CurrentBMI) was 29.3 ± 5.0 and the ΔBMI was 22.4 ± 7.6.  For all cases, the presence of a surgical complication was directly related to MaxBMI (p=0.003) and ΔBMI (p=0.002) but not CurrentBMI.  MaxBMI (p=0.001) and ΔBMI (p=0.002) were related to infections.  A MaxBMI > 50 led to an odds risk of 2.62 (95% CI 1.28-5.39) for infection.

Group I consisted of 194 single procedure cases.  Complications in Group I were related to MaxBMI (p=0.008) and CurrentBMI (p=0.02) but not ΔBMI (p=0.06).  MaxBMI impacted infections (p=0.001) while CurrentBMI impacted dehiscence (p=0.009) and infections (p=0.011).  Group II consisted of 317 cases with only ΔBMI directly related to overall complications (p=0.02), specifically seroma (p=0.039).

Conclusions: Body mass indices influence complications in the postbariatric reconstructive patient.  Current BMI impacts complications in single-procedure cases but may play less of a role in larger cases when multiple procedures are performed.  Careful patient selection and assessment of surgical complexity can help to optimize outcomes in this patient population.