Patients with previous bariatric surgery who undergo body contouring (BC) regain more weight at long-term follow-up, compared to body contouring patients who did not have bariatric surgery, according to a study led by researchers from West Virginia University Division of Plastic, Reconstructive, and Hand Surgery, Morgantown, WV.
"While most patients regain some weight after BC surgery, those who have undergone bariatric surgery gain slightly more weight at long-term follow-up," commented lead author, Dr Joshua T Henderson of West Virginia University. "Our findings should not challenge the benefit of BC for patients with massive weight loss, but they do clarify the outcomes that patients and surgeons can expect in the years after surgery."
Body contouring refers to a range of surgical procedures to remove excess skin and soft tissue in patients with major weight loss, with the aim of "improving patients' quality of life, increasing function, and further motivating healthy lifestyles," according to the authors. However, there is limited data on how BC surgery affects weight control including potential differences between patients who underwent bariatric surgery, compared to other groups of patients with massive weight loss.
Henderson and colleagues analyzed weight regain after trunk-based BC surgery in 121 patients, 60 of whom had previously undergone bariatric surgery. Multiple measures of body weight were monitored at an average follow-up period of about 3.5 years. The two groups were similar in terms of initial body weight before undergoing BC. The study focused primarily on the effects of removing excess abdominal skin, hence surgery consisted of either panniculectomy or abdominoplasty.
Compared to immediately before BC surgery, the patients had an average increase of 2.30% of body weight during long-term follow-up. Weight gain was significantly greater in the bariatric surgery group: 4.39%, compared to 0.25% in non-bariatric patients (p=0.0273).
Average time to lowest body weight after BC surgery was about four months. From this point, weight regain through long-term follow-up was 11.81% in patients who had undergone bariatric surgery, compared to 7.56% in the non-bariatric group (p=0.0106).
Previous studies of long-term weight control after BC surgery have focused mainly on bariatric surgery patients, with little information on other groups of patients. Studies have also used varying measures of body weight for example, absolute versus percent total weight loss versus percent excess weight loss.
Percent change (loss) in total and excess weight "should become standard" in evaluating the long-term outcomes of BC surgery, Henderson and colleagues believe. They write, "Weight control at long-term follow-up should also be the focus, rather than maximum weight loss." While weight regain is somewhat greater for bariatric surgery patients, "All patients tend to regain weight after achieving their nadir following trunk-based BC surgeries, eventually surpassing their preoperative weight," the researchers add.
“The present study adds value to the pooled samples of previously published outcomes by reporting the highest quality weight metrics with multiple assessments at 6-month intervals, adjusting for tissue resection weight, and offering long-term outcomes over an average 3.5-year follow-up with a focus on BC procedures of one anatomical area”, the authors concluded. “All patients tend to regain weight after achieving their nadir following trunk-based BC operations, eventually surpassing their preoperative weight. This is not clinically surprising, nor does it conflict with the psychological benefits of removing tissue in this area. It primarily increases the confidence with which these patients can receive counsel of their expected postoperative course.”
The findings were featured in the paper, ‘Weight Control following Body Contouring Surgery: Long-Term Assessment of Postbariatric and Nonbariatric Patients’, published in Plastic & Reconstructive Surgery.
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