Impact of Body Contouring Procedures on Maintenance of Post-Bariatric Weight Loss

Obese patients often suffer from low quality of life, psychosocial distress and co-morbidities, such as hypertension and diabetes mellitus. Bariatric surgery has evolved as an effective tool to manage weight and associated co-morbidities. Post-bariatric patients often experience concerns with excess skin resulting in difficulty with maintaining hygiene, recurrent infections, or functional impairment leading to physical inactivity. It has been reported in the literature that up to 50% of bariatric patients regain some of the weight loss. Several papers have shown the association of improved psychosocial functioning of bariatric patients after interventions, such as body contouring. However, there is currently no literature presenting the associated weight loss connection with minimally invasive sleeve gastrectomy patients undergoing body contouring procedures. Our purpose was to examine whether body contouring is associated with improved % Excess Weight Loss (%EWL) in post-bariatric patients. 

Methods: Retrospective study of patients who underwent minimally invasive sleeve gastrectomy at the University of Illinois at Chicago Medical Center from March 2008 to March 2013. We identified patients who underwent panniculectomy or abdominal lipectomy after bariatric surgery. Groups were compared in relation to demographics and co-morbidities. We compared the %EWL between patients undergoing panniculectomy or abdominal lipectomy after minimally invasive sleeve gastrectomy with patients undergoing bariatric surgery alone.

Results: 262 patients underwent minimally invasive sleeve gastrectomy between March 2008 and March 2013. Eighteen consecutive patients underwent a panniculectomy or abdominal lipectomy after bariatric surgery. Patient’s demographics and pre-surgical co-morbidities showed no significant differences (p>0.05) with and without body contouring. With the bariatric procedure as the reference time, statistically significant differences were found when comparing %EWL at 24 (p<0.0001), 36 (p<0.0001) and more than 36 months (p<0.005) follow-up between the groups. There was a greater %EWL in patients undergoing body contouring procedures after minimally invasive sleeve gastrectomy.

Conclusion: Based on our experience and preliminary information given the small sample size, we believe patients who underwent post-bariatric body contouring have improved %EWL than bariatric only patients. Although larger studies will be necessary to confirm, we purpose plastic surgery be used as an extension in the overall treatment of a bariatric patient to maintain long-term weight loss.