Lower Body Weight Before Plastic Surgery Means Fewer Complications

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


December 16 2008

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People who lose a massive amount of weight (100 pounds or more) often find that as they reach their goal weight they face new issues like sagging skin and excess fat deposits that just don't melt away like pounds. Many opt for body contouring surgery to finish the job that bariatric surgery or diet and exercise started. But two new studies suggest that cosmetic surgery should be postponed until patients have lowered their body mass index (BMI) as close to normal as possible.

The studies examined the relationship between the complications of body contouring surgery and BMI and concluded that surgical risks rise as BMI increases.

"With the rapid increase in obesity rates in the U.S. and, subsequently, more people losing large amounts of weight, we are seeing more patients who want body contouring following massive weight loss," notes board-certified plastic surgeon J. Peter Rubin, MD, chairman of the American Society of Plastic Surgeon's Post-Bariatric Task Force and co-author of a University of Pittsburgh Medical Center study presented at the ASPS annual conference in November. He adds that a number of factors – including BMI – should be considered by surgeons to guarantee "appropriate patient selection, safety, and optimal results."

"Obesity is a significant risk factor when considering operative procedures, particularly due to secondary conditions such as hypertension, diabetes, sleep apnea, cardiovascular disease, and poor healing that generally accompany it," concurs Donald Mackay, MD, a board-certified plastic surgeon at Penn State's College of Medicine in Pennsylvania. He is also the senior author of a study reported in the July-August 2008 issue of the Aesthetic Surgery Journal, a publication of the American Society for Aesthetic Plastic Surgery (ASAPS).

After any major weight loss, skin and tissues may not be elastic enough to conform to the reduced body size. The result is unattractive folds of skin that can only be removed by body contouring surgery. The goal of this cosmetic surgery is twofold: to improve the shape and tone of the underlying tissue that supports fat and skin, and to remove excess sagging fat and skin.

Just as a person loses weight over time, body contouring is usually performed in stages. The surgical plan for body contouring may include a circumferential lower body lift (which often includes abdominoplasty) to correct the sagging abdomen, buttocks, outer thigh, and groin; a breast lift and augmentation to raise sagging, flattened breasts; a thigh lift to address the sagging inner and mid-thigh; liposuction to remove body fat deposits, including abdominal liposuction; and an upper arm lift. According to ASAPS statistics, more than 368,000 body contouring procedures were performed in the United States in 2007.

Dr. Mackay's study involved 129 patients who underwent a single body contouring procedure. They were categorized based on their BMI, a measure of body fat based on height and weight that applies to both adult men and women. Complications were sorted into minor (postoperative wound infection, seroma, hematoma) and major (hospital readmission, reoperation, death).

Researchers found that the percentage of complications increased as the weight category increased. Minor complications ranged from 3.3% in the ideal weight group (BMI less than 25) to 46.9% in the severely morbidly obese group (BMI greater than 41). Major complications ranged from 6.6% to 43.7% within the same range.

In Dr. Rubin's study, 449 patients were reviewed to see if having body contouring surgery prior to reaching their goal BMI affected complication rates. Like Dr. Mackay's study, Dr. Rubin's study concluded that having a high BMI before surgery increased complication rates for single body contouring procedures.

For body contouring patients, the results of both studies would indicate that it's best to postpone cosmetic surgery until their BMI is close to or within the normal range. Individual plastic surgeons often establish their own BMI parameters for body contouring surgery, so it's best to discuss those requirements during a preliminary consultation.

"As patient safety advocates, plastic surgeons should counsel their patients to wait for body contouring surgery until they reach their goal BMI," says Dr. Rubin. "If waiting a little longer means ensuring safe surgery, then it's worth it."