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Body-contouring

Body-contouring should be as standard post-bariatric surgery

36 (83.7%) participants felt that their self-image after body-contouring surgery had positively affected their social life, while only seven (16.3%) patients complained of it negatively affecting their social life
After body-contouring surgery, 41 (95.3%) participants reported a positive effect on their daily activities, two (4.7%) participants claiming no positive effect on their daily activities

Bariatric surgery followed by body-contouring surgery should be considered as the standard management in patients who are morbidly obese who have significant a layer of fibrovascular tissue or granulation tissue (pannus), following weight loss greater than 20kg. These are the conclusions by researchers from the College of Medicine and the  Plastic Surgery Department, King Khalid University Hospital, Riyadh, Saudi Arabia, who assessed the psychosocial impact of body-contouring surgery on patients after weight loss.

In the paper, ‘A Psychosocial Analysis of the Effect of Body-Contouring Surgery on Patients After Weight Loss’, published online in ePlasty, the investigators used a self-report questionnaire to assess the psychosocial aspect of patients who have undergone body-contouring surgery after weight loss in a single visit to their plastic surgery clinic.

The authors explained that excess and lax skin after massive weight loss can lead to functional problems and profound dissatisfaction with appearance, resulting in patients to consider body-countering surgeries. Body-countering not only improves body image but also the quality of life. Therefore, they evaluated the psychosocial impact of body-contouring surgery on the Saudi population and believe the outcomes will help the Saudi population in deciding whether body-contouring surgery is a viable option.

They conducted a cross-sectional observational study on patients who lost at least 20kg and then underwent body-contouring surgery to remove the sagging skin that resulted from their weight loss. The study included cross-sectional concurrent and cross-sectional retrospective recall of baseline data. The researchers used a 20-question interviewer-administrated questionnaire to collect the data from their patient sample during a single visit to the plastic surgery clinic between December 2013 and March 2014. The questionnaire was divided into four sections: (1) demography, (2) depression and other psychiatric illnesses, (3) the effect of body image, and (4) and rate of satisfaction regarding surgery.

A total of 43 patients were interviewed, the majority were female (n=24, 55.8%), the mean age was 34 (±10 years; range: 20-56 years) and mean BMI was 28 (±3.3 kg; range: 21.60-37.75kg). Participants lost weight using three different methods; the majority of the patients (30, 69.8%) lost weight by using a nonsurgical method such as diet and exercise. Furthermore, 12 (27.9%) participants lost weight through bariatric surgery, and only 1 (2.3%) participant lost weight by using medications. Of the 12 participants had undergone bariatric surgery as a method of weight lossthese six (13.9%) underwent sleeve gastrectomy, three patients (7.0%) underwent gastric banding, and three (7.0%) underwent gastric bypass.

When asked about their opinions on the surgery, 37 participants were pleased with the results of their surgery, one participant was not sure, and only five were displeased or dissatisfied. Moreover, 27 participants reported that the surgery had met their expectations, seven participants were not sure, and seven others reported that the surgery did not meet their expectations. Regarding self-image after the surgery, 24 were satisfied, nine were unsure and ten were not satisfied. Although, no statistical significance was found when comparing different body-contouring surgeries to patient's opinion (p=0.613), patient's expectations (p=0.747) and self-satisfaction (p=0.405).

When patients were asked about the public's view on their body appearance, 24 participants reported an improvement, 11 reported no change, eight were not sure, and no participants reported worsening of their appearance after surgery.

When asked whether or not they would repeat their surgery if they had the chance, 35 participants would repeat it, five were not sure and three would not repeat their surgery. In addition, complete satisfaction with the surgery was reported by 27 (62.8%) participants, partial satisfaction was reported by 13 (30.2%) participants and three participants (6.98%) were dissatisfied.

A total of 17 (39.5%) participants had reported symptoms of depression before undergoing the body-contouring surgery, but only two (4.7%) participants consulted a psychiatrist. One (2.3%) participant felt depressed after surgery, a statistically significant difference (p<0.001) when comparing the number of reported depression cases before and after surgery (Table 1).

A total of 37 (86%) participants felt that their self-image prior to the body-contouring surgery negatively affected their social life, while only 6 (14%) participants reported not being negatively affected. However, 36 (83.7%) participants felt that their self-image after body-contouring surgery had positively affected their social life, while only seven (16.3%) patients complained of it negatively affecting their social life. The results evidence a statistically significant difference (p<0.001) between the variables corresponding to the effect on social life before and after surgery (Table 1).

Before body-contouring surgery, 21 (48.8%) participants complained their self-image hindering their daily activities and 22 (51.2%) participants stated that their daily activities had not been negatively affected by their self-image. After body-contouring surgery, 41 (95.3%) participants reported a positive effect on their daily activities, two (4.7%) participants claiming no positive effect on their daily activities.

After undergoing body-contouring surgery, 23 (95.8%) participants reported an improvement in their sex life, and only one (4.2%) participant reported no effect (Table 1). After comparing the paired variables, the results were shown to be statistically significant (p<0.001).

Table 1: The effect of body-contouring surgery on patient's (1) social life, (2) marital life (sex), (3) daily activities, (4) job performance, and (5) depression (dichotomous variable)

The authors state that their results have shown an improvement in the psychological and social aspects in the lives of patients who have undergone body-contouring surgery after weight loss. In addition, body-contouring surgery has improved patients’ quality of life in their social life, sexual activity and work domains. A high percentage of patients were also satisfied with the results of their operation.

“To achieve better results, we recommend conducting a prospective cohort study on a large sample of patients who have not yet undergone body-contouring surgery and comparing psychosocial aspects of these patients before and after surgery,” the authors state. “We also believe that recall bias has the potential to affect the validity of our results, particularly because data were collected in a single visit.”

To access this paper, please click here

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