We plastic surgeons do surgery often on people after major weight loss. There are tons of studies which show it helps people feel better mentally, keep the weight off, and see the results of their weight loss. But we know it can be tricky. There can be issues with anemia (low blood level), nutrition, residual obesity, and other comorbidities like blood pressure, diabetes, and other issues.
This study, in the January 2021 issue of the Aesthetic Surgery Journal, “Post Bariatric Abdominoplasty: Analysis of 406 Cases With Focus of Risk Factors and Complications.”
Study:
- Retrospective study of patients who had tummy tuck between January 2009 to December 2019
- Variables analyzed: sex, age, BMI, smoking, surgical technique, operative time, resection weight, drain output, complications
- 406 patients were in the study (320 women, 86 men), mean age 44, BMI 30.6
- Abdominoplasty techniques: Traditional (64%), fleur de lis (27%), and panniculectomy.
- Overall complications: 42%
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- The majority of these were wound healing issues 32%. This included wound separation, infection, and tissue loss.
- Major complications were 13%
- Frequency of complications was related to age, BMI (especially BMI over 30), and resection weight. (Operating room time did not affect complication rate).
- The role of technique will be evaluated further.
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These were overall big operations. The mean resected weight was 2679g, with a range up to 12500g. (Just for reference, that means the mean amount removed was about 6 pounds. That doesn’t sound like much to you, but as a plastic surgeon I can assure you that is a lot of tissue). They had 3 drains placed on average.
These patients still had medical issues despite their major weight loss. 20% were diabetic still, 31% had high blood pressure, and 38% were smokers.
The fleur de lis technique and panniculectomy had higher rates of issues, though not statistically significant. (Fleur de lis is where you have a horizontal and midline scar. Panniculectomy is where it is a large resection, so you wedge out the extra tissue without repositioning the belly button.)
Discussion:
They allude to why there are these higher complication rates. Diabetes is a clear factor. Malabsorption leads to nutritional issues: lack of B12, folic acid, iron, calcium, Vitamin D, and Vitamin K. BMI has been associated in many studies for having higher surgical risks period. BLOGS here.
My thoughts?
This is not new stuff. We know you have to look carefully at nutrition and anemia. Many of my patients must go on iron, B, and MVI prior to surgery to get their blood levels to be normal. Losing weight to get BMI down lowers risk factors for all sorts of issues: wound healing, infection, DVTs. And for cosmetics, you don’t want to lose a lot of weight after your tummy tuck- it just loosens up your skin tightening result.
So good reminders, and reaffirms doing the right surgery at the right time where everything is optimized is important.