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Abdominoplasty improves quality of life despite risk of complications

The overwhelming majority of patients who responded to the survey stated that they were satisfied with the final outcome and would choose to have the procedure again

Abdominoplasty has a high patient satisfaction and improved the quality of life in patients who are overweight or have obesity despite a substantial risk of complications, according to a study published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

An ‘overwhelming majority’ of overweight/obese patients are happy with the results of abdominoplasty, according to the study by Dr Dennis C Hammond and colleagues of Partners in Plastic Surgery of West Michigan, Grand Rapids.

"A real quality of life improvement can be obtained by offering body contouring even in the face of obesity, with the caveat that the risk of minor postoperative complications is high," they noted.

In the paper, ‘Abdominoplasty in the Overweight and Obese Population: Outcomes and Patient Satisfaction’, the authors stated that abdominoplasty and other body contouring procedures have historically been discouraged in patients who are overweight or who have obesity, reflecting concerns that increased BMI may increase the risk of wound healing problems and other complications.

The purpose of the study was to determine the complication rate and to gauge the psychological impact of abdominoplasty in the overweight or obese patient. The researchers analysed the outcomes of abdominoplasty in 46 overweight/obese patients (41 women, average age 49 years, average BMI 32) over a 12-year period.

Eighty percent of patients underwent abdominoplasty, most often including a procedure to restore weakened or separated abdominal muscles. The remaining 20 percent had a procedure called panniculectomy to eliminate excess, ‘hanging’ abdominal fat and skin. The researchers analysed the outcomes of surgery, including complication rates and patient-rated outcomes.

The average abdominal resection weight was 4834.9g. Major complications were defined as complications requiring return to the operating room and occurred in four patients (8.7 percent), mainly due to wound healing problems and/or fluid collections. Minor complications, defined as complications that could be handled in an office setting or antibiotics, occurred in 18 patients (39.1 percent). Thirty-six patients (78.3 percent) responded to the survey.

The overwhelming majority of patients who responded to the survey (n=35 (97.2 percent)) stated that they were satisfied with the final outcome and would choose to have the procedure again. Nearly half of patients said they lost additional weight after surgery.

"Abdominoplasty and panniculectomy in the overweight patients and those with obesity presents as a surgical decision-making challenge for the treating surgeon," the authors write. Due to their increased risk of complications, patients are commonly advised to lose weight before undergoing body contouring surgery.

"Even with weight loss, the excess skin and fat...will not completely recede and can still present as an impediment to normal function and exercise." While acknowledging the increased risks, they offered abdominoplasty or panniculectomy to overweight patients and those with obesity "in an attempt to relieve the discomfort and physical effects of the excess skin and fat and offer the potential to jumpstart a weight loss process."

The authors believe their results support this strategy. Although complications were frequent, most were minor and readily manageable, and many patients lost more weight after surgery.

“However, even in the face of this elevated complication rate, patient satisfaction is overwhelmingly high, making body contouring procedures in this patient population an acceptable option in appropriately selected patients,” they concluded.

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