Quality of Life Long-Term after Body Contouring Surgery following Bariatric Surgery

Division of Clinical and Health Psychology, Utrecht University, Utrecht, Utrecht, Netherlands
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 07/2012; 130(5):1133-9. DOI: 10.1097/PRS.0b013e318267d51d
Source: PubMed


: Bariatric surgery for morbid obesity results in massive weight loss and improvement of health and quality of life. A downside of the major weight loss is the excess of overstretched skin, which may influence the patient's quality of life by causing functional and aesthetic problems. The purpose of the current study was to evaluate the patient's quality of life long-term after body contouring following bariatric surgery.
: Quality of life was measured with the Obesity Psychosocial State Questionnaire in 33 post-bariatric surgery patients 7.2 years (range, 3.2 to 13.3 years) after body contouring surgery. Data were compared with previous assessments 4.1 years (range, 0.7 to 9.2 years) after body contouring surgery of the quality of life at that time and before body contouring surgery.
: Compared with appraisals of quality of life before body contouring surgery, a significant, mostly moderate to large, sustained improvement of quality of life was observed in post-bariatric surgery patients 7.2 years after body contouring surgery in six of the seven psychosocial domains. A small deterioration occurred between 4.1- and 7.2-year follow-up on two of the seven domains except for the domain efficacy toward eating, which showed a significant improvement. At 7-year follow-up, 18 patients (55 percent) were satisfied with the result of body contouring surgery.
: This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery. This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity.
: Therapeutic, IV.

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Available from: Eva S J van der Beek, May 03, 2015
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    ABSTRACT: Background Massive weight loss after bariatric surgery can cause physical, functional, hygienic, and psychological problems and can also have impact on the quality of life. Reconstructive body contouring surgery can provide a solution for these problems. The number of patients seeking contouring surgery is far greater than the actual number of surgical reconstructions performed. The aim of this study was to register the demand for reconstructive surgery, take an inventory of the complaints, and index body satisfaction after massive weight loss. Methods This retrospective study is based on questionnaires filled out by 237 patients between 2007 and 2010 after undergoing a primary laparoscopic Roux-en-Y gastric bypass. Results This study showed a desire for reconstructive plastic surgery after massive weight loss in 28.3 % of the patients. These patients can in turn be divided into patients who received surgery (6.8 %), patients on the waiting list (5.5 %), and patients rejected by their insurance company (16 %). Ninety percent of these patients reported functional problems caused by excess skin, and 52 % experienced psychological distress after the massive weight loss. Patients were bothered most by their abdomen and breasts. Men were generally more satisfied than women (50 and 41 %, respectively). Conclusions Body contouring surgery reduces physical and psychological complaints after massive weight loss and positively influences quality of life. Prospective studies are needed to evaluate the approval and rejection criteria of health-care insurance companies. Level of evidence: III, risk/prognostic study
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    ABSTRACT: Massive weight loss after bariatric surgery leads to excess skin with functional and aesthetic impairments. The aim of this study was to evaluate the prevalence of excess skin after bariatric surgery and identify any relationship with pre- and postoperative characteristics. A total of 360 patients who had undergone bariatric surgery procedures were asked to complete a questionnaire designed by the surgical team at least 1 year after surgery. This questionnaire was planned to estimate any impairment due to redundant skin, which was graded according to a visual analogue scale (VAS, 0--0). Mean (standard deviation, SD) age of 110 males and 250 females was 51.2 (10.8) years. Mean preoperative body mass index (BMI) was 45.7 (6.4) kg m(-2) and mean postoperative BMI at follow-up was 33.6 (6.0) kg m(-2). After a mean follow-up of 56.1 (43.6) months, the mean weight loss was 35.2 (18.8) kg. Most patients (92.8%) reported problems with redundant skin, especially on the abdomen, upper arms and rear/buttocks, which impaired daily physical activity in half of them. Excess skin was associated with female gender (β=-13.56, 95% confidence interval (CI) -16.81 to -10.32, p<0.0001), weight loss (β=0.21, 95% CI 0.12-0.29, p<0.0001) and ΔBMI (β=0.21, 95% CI 0.12-0.29, p<0.0001) at multivariate analysis. Patients with a ΔBMI>20 kg m(-2) showed a significantly surplus skin discomfort compared to ΔBMI≤5 and 5<ΔBMI≤10 (p<0.001). Patients with a weight loss>50 kg showed a significantly redundant skin discomfort compared to weight loss<20 kg (p<0.001). Weight loss after bariatric surgery reduces the medical risks of obesity but psychosocial and functional problems often remain due to the surplus skin. Our data suggest that a ΔBMI≤10 kg m(-2) and weight loss>20 kg, not BMI alone, might be taken into consideration as cut-off values for developing score systems with the intention to apply evidence-based indications for the surgical management of post-bariatric impairments.
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