Download PDF
Semin Plast Surg 2006; 20(1): 015-023
DOI: 10.1055/s-2006-932445
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Abdominoplasty Following Massive Weight Loss

Jordan M.S Jacobs1 , Steven Schechner2 , Jonathan S. Jacobs2
  • 1Department of Surgery, New York University School of Medicine, New York, New York
  • 2Associates in Plastic Surgery, Inc., Virginia Beach, Virginia
Further Information

Publication History

Publication Date:
26 January 2006 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Bariatric surgery has become an effective treatment for severe obesity. Various techniques have evolved over the years, with the most common now being the Roux-en-Y gastric bypass. Patients who experience massive weight loss are left with disfiguring skin laxity that warrants surgical excision of the redundant tissue. Our experience comes from 400 abdominoplasties performed on patients with massive weight loss over the past 20 years. Special consideration must be given to this subset of patients when designing their abdominoplasties because of compromised vascularity from previous surgeries and persistent volumes of subcutaneous adipose tissue. In particular, the groin flap or cross-abdominal flap or both are presented as options for the postbypass patient in whom subcostal and midline scarring is present. The reverse abdominoplasty remains an option in special circumstances. In addition, we focus on complications these patients are more likely to develop, mainly related to associated incisional hernias and a disrupted vascular anatomy.

KEYWORDS

Massive weight loss - groin flap - cross-abdominal flap

REFERENCES

  • 1 Olshansky S J, Passaro D J, Hershow R C et al.. A potential decline in life expectancy in the United States in the 21st century.  N Engl J Med. 2005;  352 1138-1145
    CrossrefPubMedGoogle Scholar
  • 2 Must A, Spadano J, Coakley E H et al.. The disease burden associated with overweight and obesity.  JAMA. 1999;  282 1523-1529
    CrossrefPubMedGoogle Scholar
  • 3 Pi-Sunyer F X. Medical hazards of obesity.  Ann Intern Med. 1993;  119 655-660
    PubMedGoogle Scholar
  • 4 Koplan JP, Liverman CT, Kraak VI Preventing Childhood Obesity: Health in the Balance. Washington, DC; National Academic Press 2005
    Google Scholar
  • 5 Allison D B, Fontaine K R, Manson J R et al.. Annual deaths attributable to obesity in the United States.  JAMA. 1999;  282 1530-1538
    CrossrefPubMedGoogle Scholar
  • 6 NHLBI Obesity Education Initiative .The practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Rockville, MD; National Institutes of Health 2000 (NIH publication no. 00-4084)
    Google Scholar
  • 7 Flegal K M, Carroll M D, Odgen C L, Johnson C L. Prevalence and trends in obesity among US adults, 1999-2000.  JAMA. 2002;  288 1723-1727
    CrossrefPubMedGoogle Scholar
  • 8 National Institutes of Health . Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Panel.  Ann Intern Med. 1991;  115 956-961
    PubMedGoogle Scholar
  • 9 Buchwald H, Avidor Y, Braunwald E et al.. Bariatric surgery: a systematic review and meta-analysis.  JAMA. 2004;  292 1724-1737
    CrossrefPubMedGoogle Scholar
  • 10 Balsiger B M, Poggio J L, Mai J et al.. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity.  J Gastrointest Surg. 2000;  4 598-605
    CrossrefPubMedGoogle Scholar
  • 11 DeMaria E J, Sugerman H J, Meador J G et al.. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity.  Ann Surg. 2001;  233 809-818
    CrossrefPubMedGoogle Scholar
  • 12 Sugerman H J, Kellum J M, Engle K M. Gastric bypass for treating severe obesity.  Am J Clin Nutr. 1992;  55 560S-566S
    PubMedGoogle Scholar
  • 13 Brolin R E, Gorman J H, Gorman R C et al.. Are vitamin B-12 and folate deficiency clinically important after Roux-en-Y gastric bypass?.  J Gastrointest Surg. 1998;  2 436-442
    CrossrefPubMedGoogle Scholar
  • 14 Savage R C. Abdominoplasty following gastrointestinal bypass surgery.  Plast Reconstr Surg. 1983;  71 500-507
    PubMedGoogle Scholar
  • 15 Kelly H A. Report of gynecological cases (excessive growth of fat).  Johns Hopkins Med J. 1899;  10 196-197
    PubMedGoogle Scholar
  • 16 Kelly H A. Excision of fat of the abdominal wall lipectomy.  Surg Gynecol Obstet. 1910;  10 229-231
    PubMedGoogle Scholar
  • 17 Passot R. Chirurgie Esthetique Pure. Paris; Doin 1931: 261-267
    Google Scholar
  • 18 Vernon S. Umbilical transplantation upward and abdominal contouring in lipectomy.  Am J Surg. 1957;  94 490-492
    CrossrefPubMedGoogle Scholar
  • 19 Pitanguy I. Abdominal lipectomy: an approach to it through an analysis of 300 consecutive cases.  Plast Reconstr Surg. 1967;  40 384-391
    PubMedGoogle Scholar
  • 20 Gonzalez-Ulloa M. Abdominal wall disfigurement.  Ann Plast Surg. 1980;  4 357-369
    PubMedGoogle Scholar
  • 21 Grazer F M. Abdominoplasty.  Plast Reconstr Surg. 1973;  51 617-623
    PubMedGoogle Scholar
  • 22 Regnault P. Abdominoplasty by the W technique.  Plast Reconstr Surg. 1975;  55 265-274
    CrossrefPubMedGoogle Scholar
  • 23 Babcock W W. The correction of the obese and relaxed abdominal wall with special reference to the use of the buried silver chain.  Am J Obstet. 1916;  74 596
    PubMedGoogle Scholar
  • 24 Elbaz J S, Flageul G. Plastic Surgery of the Abdomen. New York; Masson 1979
    Google Scholar
  • 25 Castanares S, Goethel J A. Abdominal lipectomy: a modification in technique.  Plast Reconstr Surg. 1967;  40 378-383
    PubMedGoogle Scholar
  • 26 Dufourmental C, Mouly R. Chirurgie Plastique. Paris; Flammarion 1959: 381-389
    Google Scholar
  • 27 Brown R G, Vasconez L O, Jurkiewicz M J. Transverse abdominal flaps and the deep epigastric arcade.  Plast Reconstr Surg. 1975;  55 416-421
    CrossrefPubMedGoogle Scholar
  • 28 Regnault P, Daniel R K. Aesthetic Plastic Surgery. Boston, MA; Little, Brown 1984
    Google Scholar
  • 29 Marques A, Brenda E, Pereira M D, de Castro M, Abramo A C. Abdominoplasty with two fusiform plications.  Aesthetic Plast Surg. 1996;  20 249-251
    CrossrefPubMedGoogle Scholar
  • 30 Psillakis J M. Plastic surgery of the abdomen with improvement in body contour.  Clin Plast Surg. 1984;  11 465-477
    PubMedGoogle Scholar
  • 31 Appiani E. Muscular plastic for the aesthetic conformation of the abdominal girdle.  Ann Plast Surg. 1984;  13 97-106
    PubMedGoogle Scholar
  • 32 Jackson I T, Downie P A. Abdominoplasty: the waistline stick and other refinements.  Plast Reconstr Surg. 1978;  61 180-183
    PubMedGoogle Scholar
  • 33 Vastine V L, Morgan R F, Williams G S et al.. Wound complications of abdominoplasty in obese patients.  Ann Plast Surg. 1999;  42 34-39
    CrossrefPubMedGoogle Scholar
  • 34 Regnault P. Abdominal dermolipectomies.  Clin Plast Surg. 1975;  2 411-429
    PubMedGoogle Scholar
  • 35 Juri J, Juri C, Raiden G. Reconstruction of the umbilicus in abdominoplasty.  Plast Reconstr Surg. 1979;  63 580-582
    PubMedGoogle Scholar
  • 36 Hurwitz D J, Zewert T. Body contouring after bariatric surgery.  Operative Techniques in Plastic Reconstructive Surgery. 2002;  8 87-95
    PubMedGoogle Scholar
  • 37 Nahai F, Brown R G, Vasconez L O. Blood supply to the abdominal wall as related to planning abdominal incisions.  Am Surg. 1976;  42 691-695
    PubMedGoogle Scholar
  • 38 Hurwitz D J. Single stage total body lift after massive weight loss.  Ann Plast Surg. 2004;  52 435-441
    PubMedGoogle Scholar
  • 39 Lockwood T E. Maximizing aesthetics in lateral-tension abdominoplasty and body lifts.  Clin Plast Surg. 2004;  31 523-537
    CrossrefPubMedGoogle Scholar
  • 40 Lockwood T E. Fascial anchoring technique in medial thigh lifts.  Plast Reconstr Surg. 1988;  82 299-304
    CrossrefPubMedGoogle Scholar

Jonathan S JacobsD.M.D. M.D. 

935 First Colonial Road

Virginia Beach, VA 23454