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Published in: Aesthetic Plastic Surgery 6/2021

01-12-2021 | Obesity | Review

Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis

Authors: Azmi Marouf, Hatan Mortada

Published in: Aesthetic Plastic Surgery | Issue 6/2021

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Abstract

Background

Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors.

Objectives

In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications.

Methods

We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types.

Results

In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7–13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m2 and low mean weight of resected tissue were associated with fewer complications.

Conclusion

Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/\(m^{2}\) before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Spivak H, Hewitt MF, Onn A, Half EE (2005) Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg 189(1):27–32PubMedCrossRef Spivak H, Hewitt MF, Onn A, Half EE (2005) Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg 189(1):27–32PubMedCrossRef
2.
go back to reference Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B (2012) Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg 23(1):24–30CrossRef Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B (2012) Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg 23(1):24–30CrossRef
3.
go back to reference Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724PubMedCrossRef
5.
go back to reference Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H (2018) Does body contouring after bariatric weight loss enhance quality of life? a systematic review of QOL studies. Obes Surg 28(10):3333–3341PubMedPubMedCentralCrossRef Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H (2018) Does body contouring after bariatric weight loss enhance quality of life? a systematic review of QOL studies. Obes Surg 28(10):3333–3341PubMedPubMedCentralCrossRef
6.
go back to reference Sandvik J, Hole T, Klöckner C, Kulseng B, Wibe (2020) The impact of post-bariatric abdominoplasty on secondary weight regain after Roux-en-Y gastric bypass. Front Endocrinol 11 Sandvik J, Hole T, Klöckner C, Kulseng B, Wibe (2020) The impact of post-bariatric abdominoplasty on secondary weight regain after Roux-en-Y gastric bypass. Front Endocrinol 11
7.
8.
go back to reference Botero AG, Wenninger MG, Loaiza DF (2017) Complications after body contouring surgery in postbariatric patients. Ann Plast Surg 79(3):293–297CrossRef Botero AG, Wenninger MG, Loaiza DF (2017) Complications after body contouring surgery in postbariatric patients. Ann Plast Surg 79(3):293–297CrossRef
9.
go back to reference Beidas OE, Gusenoff JA (2019) Common complications and management after massive weight loss patient safety in plastic surgery. Clin Plast Surg 46(1):115–122PubMedCrossRef Beidas OE, Gusenoff JA (2019) Common complications and management after massive weight loss patient safety in plastic surgery. Clin Plast Surg 46(1):115–122PubMedCrossRef
10.
go back to reference Guest RA, Amar D, Czerniak S, Dreifuss SE, Schusterman MA, Kenny EM, Chernoff EF, Barnett JM, Koesarie KR, Gusenoff JA (2017) Heterogeneity in body contouring outcomes based research: the pittsburgh body contouring complication reporting system. Aesthet Surg J 38(1):60–70PubMedCrossRef Guest RA, Amar D, Czerniak S, Dreifuss SE, Schusterman MA, Kenny EM, Chernoff EF, Barnett JM, Koesarie KR, Gusenoff JA (2017) Heterogeneity in body contouring outcomes based research: the pittsburgh body contouring complication reporting system. Aesthet Surg J 38(1):60–70PubMedCrossRef
11.
go back to reference Carloni R, Naudet F, Chaput B, de Runz A, Herlin C, Girard P, Watier E, Bertheuil N (2016) Are there factors predictive of postoperative complications in circumferential contouring of the lower trunk? A Meta-Analysis, Aesthet Surg J 36(10):1143–1154CrossRef Carloni R, Naudet F, Chaput B, de Runz A, Herlin C, Girard P, Watier E, Bertheuil N (2016) Are there factors predictive of postoperative complications in circumferential contouring of the lower trunk? A Meta-Analysis, Aesthet Surg J 36(10):1143–1154CrossRef
12.
go back to reference Benoit SC, Hunter TD, Francis DM, Cruz-Munoz NDL (2014) Use of Bariatric Outcomes Longitudinal Database (BOLD) to Study Variability in Patient Success After Bariatric Surgery. Obes Surg Benoit SC, Hunter TD, Francis DM, Cruz-Munoz NDL (2014) Use of Bariatric Outcomes Longitudinal Database (BOLD) to Study Variability in Patient Success After Bariatric Surgery. Obes Surg
13.
go back to reference Moher D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. ACP J Club 151(4):264 Moher D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. ACP J Club 151(4):264
14.
go back to reference Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for nonrandomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716PubMedCrossRef Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for nonrandomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716PubMedCrossRef
15.
go back to reference Espinosa-De-Los-Monteros A, Torre JIDL, Rosenberg LZ et al (2006) Abdominoplasty with total abdominal liposuction for patients with massive weight loss. Aesthet Surg J 30(1):42–46 Espinosa-De-Los-Monteros A, Torre JIDL, Rosenberg LZ et al (2006) Abdominoplasty with total abdominal liposuction for patients with massive weight loss. Aesthet Surg J 30(1):42–46
16.
go back to reference Rohrich RJ, Gosman AA, Conrad MH, Coleman J (2006) Simplifying circumferential body contouring: the central body lift evolution. Plast Reconstr Surg 118(2):525–535PubMedCrossRef Rohrich RJ, Gosman AA, Conrad MH, Coleman J (2006) Simplifying circumferential body contouring: the central body lift evolution. Plast Reconstr Surg 118(2):525–535PubMedCrossRef
17.
go back to reference Borud LJ, Warren AG (2007) Modified vertical abdominoplasty in the massive weight loss patient. Plast Reconstr Surg 119(6):1911–1921PubMedCrossRef Borud LJ, Warren AG (2007) Modified vertical abdominoplasty in the massive weight loss patient. Plast Reconstr Surg 119(6):1911–1921PubMedCrossRef
18.
go back to reference Cannistra C, Valero R, Benelli C, Marmuse JP (2007) Brachioplasty after massive weight loss: a simple algorithm for surgical plane. Aesthet Surg J 31(1):6–9 Cannistra C, Valero R, Benelli C, Marmuse JP (2007) Brachioplasty after massive weight loss: a simple algorithm for surgical plane. Aesthet Surg J 31(1):6–9
19.
go back to reference Gusenoff JA, Coon D, Rubin JP (2009) Implications of weight loss method in body contouring outcomes. Plast Reconstr Surg 123(1):373–376PubMedCrossRef Gusenoff JA, Coon D, Rubin JP (2009) Implications of weight loss method in body contouring outcomes. Plast Reconstr Surg 123(1):373–376PubMedCrossRef
20.
go back to reference Greco JA III, Castaldo ET, Nanney LB, Wendel JJ, Summitt JB, Kelly KJ et al (2008) The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations. Ann Plast Surg 61(3):235–242PubMedCrossRef Greco JA III, Castaldo ET, Nanney LB, Wendel JJ, Summitt JB, Kelly KJ et al (2008) The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations. Ann Plast Surg 61(3):235–242PubMedCrossRef
21.
go back to reference Coon D, Gusenoff JA, Kannan N, Khoudary SRE, Naghshineh N, Rubin JP (2009) Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases. Ann Plast Surg 249(3):397–401 Coon D, Gusenoff JA, Kannan N, Khoudary SRE, Naghshineh N, Rubin JP (2009) Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases. Ann Plast Surg 249(3):397–401
22.
go back to reference Migliori FC, Gabrielli A, Rizzo R, Cervetti GGS (2010) Breast contouring in postbariatric patients: a technique selection algorithm. Obes Surg 20(5):651–656PubMedCrossRef Migliori FC, Gabrielli A, Rizzo R, Cervetti GGS (2010) Breast contouring in postbariatric patients: a technique selection algorithm. Obes Surg 20(5):651–656PubMedCrossRef
23.
go back to reference Beek ESVD, Molen AMVD, Ramshorst BV (2011) Complications after body contouring surgery in postbariatric patients: the importance of a stable weight close to normal. Obes Facts 4(1):61–66PubMedPubMedCentralCrossRef Beek ESVD, Molen AMVD, Ramshorst BV (2011) Complications after body contouring surgery in postbariatric patients: the importance of a stable weight close to normal. Obes Facts 4(1):61–66PubMedPubMedCentralCrossRef
24.
go back to reference Chong T, Coon D, Toy J, Purnell C, Michaels J, Rubin JP (2012) Body contouring in the male weight loss population. Plast Reconstr Surg 130(2) Chong T, Coon D, Toy J, Purnell C, Michaels J, Rubin JP (2012) Body contouring in the male weight loss population. Plast Reconstr Surg 130(2)
25.
go back to reference Iglesias M, Ortega-Rojo A, Garcia-Alvarez MN, Vargas-Vorackova F, Gonzalez-Chavez AM, Gonzalez-Chavez MA et al (2012) Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country. Ann Plast Surg 69(1):54–58PubMedCrossRef Iglesias M, Ortega-Rojo A, Garcia-Alvarez MN, Vargas-Vorackova F, Gonzalez-Chavez AM, Gonzalez-Chavez MA et al (2012) Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country. Ann Plast Surg 69(1):54–58PubMedCrossRef
26.
go back to reference Staalesen T, Olsén MF, Elander A (2012) Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy. J Plast Surg Hand Surg 46(6):416–420PubMedCrossRef Staalesen T, Olsén MF, Elander A (2012) Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy. J Plast Surg Hand Surg 46(6):416–420PubMedCrossRef
27.
go back to reference Austin RE, Lista F, Khan A, Ahmad J (2015) The impact of protein nutritional supplementation for massive weight loss patients undergoing abdominoplasty. Aesthet Surg J 36(2):204–210PubMedCrossRef Austin RE, Lista F, Khan A, Ahmad J (2015) The impact of protein nutritional supplementation for massive weight loss patients undergoing abdominoplasty. Aesthet Surg J 36(2):204–210PubMedCrossRef
28.
go back to reference Capella JF, Matarasso A (2016) Management of the postbariatric medial thigh deformity. Plast Reconstr Surg 137(5):1434–1446PubMedCrossRef Capella JF, Matarasso A (2016) Management of the postbariatric medial thigh deformity. Plast Reconstr Surg 137(5):1434–1446PubMedCrossRef
29.
go back to reference Correia-Gonçalves I, Valença-Filipe R, Carvalho J, Rebelo M, Peres H, Amarante J et al (2017) Abdominoplasty with Scarpa fascia preservation – comparative study in a bariatric population. Surg Obes Relat Dis 13(3):423–428PubMedCrossRef Correia-Gonçalves I, Valença-Filipe R, Carvalho J, Rebelo M, Peres H, Amarante J et al (2017) Abdominoplasty with Scarpa fascia preservation – comparative study in a bariatric population. Surg Obes Relat Dis 13(3):423–428PubMedCrossRef
30.
go back to reference D’Aniello C, Cuomo R, Grimaldi L, Brandi C, Sisti A, Tassinari J et al (2016) Superior pedicle mammaplasty without parenchymal incisions after massive weight loss. J Invest Surg 30(6):410–420PubMedCrossRef D’Aniello C, Cuomo R, Grimaldi L, Brandi C, Sisti A, Tassinari J et al (2016) Superior pedicle mammaplasty without parenchymal incisions after massive weight loss. J Invest Surg 30(6):410–420PubMedCrossRef
31.
go back to reference Anlatıcı R, Özerdem G, Demiralay S, Özerdem ÖR (2018) One-stage combined postbariatric surgery: a series of 248 procedures in 55 cases. Aesthet Surg J 42(6):1591–1599 Anlatıcı R, Özerdem G, Demiralay S, Özerdem ÖR (2018) One-stage combined postbariatric surgery: a series of 248 procedures in 55 cases. Aesthet Surg J 42(6):1591–1599
32.
go back to reference Mendes FH, Viterbo F, Luna ALAP (2018) Inner Scar Umbilicus. Plast Reconstr Surg 141(4). Mendes FH, Viterbo F, Luna ALAP (2018) Inner Scar Umbilicus. Plast Reconstr Surg 141(4).
33.
go back to reference Rosa SC, Macedo JLSD, Casulari LA, Canedo LR, Marques JVA (2018) Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery. Rev Col Bras Cir 45(2) Rosa SC, Macedo JLSD, Casulari LA, Canedo LR, Marques JVA (2018) Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery. Rev Col Bras Cir 45(2)
34.
go back to reference Rosa SC, de Macedo JL, Canedo LR, Casulari LA (2019) Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: a retrospective cohort. Surg Obes Relat Dis 15(3):447–455PubMedCrossRef Rosa SC, de Macedo JL, Canedo LR, Casulari LA (2019) Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: a retrospective cohort. Surg Obes Relat Dis 15(3):447–455PubMedCrossRef
35.
go back to reference Giudice G, Maruccia M, Vestita M, Nacchiero E, Annoscia P, Bucaria V et al (2019) The medial -central septum based mammaplasty: a reliable technique to preserve nipple -areola complex sensitivity in post bariatric patients. Breast J 25(4):590–596PubMedCrossRef Giudice G, Maruccia M, Vestita M, Nacchiero E, Annoscia P, Bucaria V et al (2019) The medial -central septum based mammaplasty: a reliable technique to preserve nipple -areola complex sensitivity in post bariatric patients. Breast J 25(4):590–596PubMedCrossRef
36.
go back to reference Losco L, Roxo AC, Roxo CW, Torto FL, Bolletta A, de Sire A et al (2019) Lower body lift after bariatric surgery: 323 consecutive cases over 10-year experience. Aesth Plast Surg 44(2):421–432CrossRef Losco L, Roxo AC, Roxo CW, Torto FL, Bolletta A, de Sire A et al (2019) Lower body lift after bariatric surgery: 323 consecutive cases over 10-year experience. Aesth Plast Surg 44(2):421–432CrossRef
37.
go back to reference Morandi EM, Ploner C, Wolfram D, Tasch C, Dostal L, Ortner F et al (2019) Risk factors and complications after body -contouring surgery and the amount of stromal vascular fraction cells found in subcutaneous tissue. Int Wound J 16(6):1545–1552PubMedPubMedCentralCrossRef Morandi EM, Ploner C, Wolfram D, Tasch C, Dostal L, Ortner F et al (2019) Risk factors and complications after body -contouring surgery and the amount of stromal vascular fraction cells found in subcutaneous tissue. Int Wound J 16(6):1545–1552PubMedPubMedCentralCrossRef
38.
go back to reference Pajula S, Jyränki J, Tukiainen E, Koljonen V (2019) Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method. JPRAS Ope 72(4):649–655 Pajula S, Jyränki J, Tukiainen E, Koljonen V (2019) Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method. JPRAS Ope 72(4):649–655
39.
go back to reference de Macedo JL, Rosa SC, Canedo LR, Casulari LA (2020) What is the impact of residual obesity on the risk for postoperative body-contouring surgery complications in postbariatric patients? Obes Surg 30(10):4149–4154PubMedCrossRef de Macedo JL, Rosa SC, Canedo LR, Casulari LA (2020) What is the impact of residual obesity on the risk for postoperative body-contouring surgery complications in postbariatric patients? Obes Surg 30(10):4149–4154PubMedCrossRef
40.
go back to reference Michaels J, Coon D, Rubin JP (2011) Complications in postbariatric body contouring: strategies for assessment and prevention. Plast Reconstr Surg 127(3):1352–1357PubMedCrossRef Michaels J, Coon D, Rubin JP (2011) Complications in postbariatric body contouring: strategies for assessment and prevention. Plast Reconstr Surg 127(3):1352–1357PubMedCrossRef
41.
go back to reference Agha-Mohammadi S, Hurwitz DJ (2008) Nutritional deficiency of post-bariatric surgery body contouring patients: what every plastic surgeon should know. Plast Reconstr Surg 122(2):604–613PubMedCrossRef Agha-Mohammadi S, Hurwitz DJ (2008) Nutritional deficiency of post-bariatric surgery body contouring patients: what every plastic surgeon should know. Plast Reconstr Surg 122(2):604–613PubMedCrossRef
42.
go back to reference Hasanbegovic E, Sørensen JA (2014) Complications following body contouring surgery after massive weight loss: a meta-analysis. J Plast Reconstr Aesthet Surg 67(3):295–301PubMedCrossRef Hasanbegovic E, Sørensen JA (2014) Complications following body contouring surgery after massive weight loss: a meta-analysis. J Plast Reconstr Aesthet Surg 67(3):295–301PubMedCrossRef
43.
go back to reference Shermak MA, Chang DC, Heller J (2007) Factors impacting thromboembolism after bariatric body contouring surgery. Plast Reconstr Surg 119(5):1590–1596PubMedCrossRef Shermak MA, Chang DC, Heller J (2007) Factors impacting thromboembolism after bariatric body contouring surgery. Plast Reconstr Surg 119(5):1590–1596PubMedCrossRef
44.
go back to reference Ortiz VE, Kwo J (2015) Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol 15(1) Ortiz VE, Kwo J (2015) Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol 15(1)
45.
go back to reference Anaya DA, Dellinger EP (2006) The obese surgical patient: a susceptible host for infection. Surg Infect 7(5):473–480CrossRef Anaya DA, Dellinger EP (2006) The obese surgical patient: a susceptible host for infection. Surg Infect 7(5):473–480CrossRef
46.
go back to reference Toma O, Suntrup P, Stefanescu A, London A, Mutch M, Kharasch E (2011) Pharmacokinetics and tissue penetration of cefoxitin in obesity. Anesth Analg 113(4):730–737PubMedCrossRef Toma O, Suntrup P, Stefanescu A, London A, Mutch M, Kharasch E (2011) Pharmacokinetics and tissue penetration of cefoxitin in obesity. Anesth Analg 113(4):730–737PubMedCrossRef
47.
go back to reference Pierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC et al (2014) Obesity and surgical wound healing: a current review. Int Sch Res Notices 2014:1–13 Pierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC et al (2014) Obesity and surgical wound healing: a current review. Int Sch Res Notices 2014:1–13
48.
go back to reference Parvizi D, Friedl H, Wurzer P, Kamolz LP, Lebo P, Tuca A et al (2015) A multiple regression analysis of postoperative complications after body-contouring surgery: a retrospective analysis of 205 patients. Obes Surg 25(8):1482–1490PubMedCrossRef Parvizi D, Friedl H, Wurzer P, Kamolz LP, Lebo P, Tuca A et al (2015) A multiple regression analysis of postoperative complications after body-contouring surgery: a retrospective analysis of 205 patients. Obes Surg 25(8):1482–1490PubMedCrossRef
49.
go back to reference Souto LRM, Chaim EA, Barbosa RC, Bizzacchi JMA (2012) Increased intraoperative bleeding in patients undergoing abdominoplasty after gastroplasty is not due to coagulopathy. Aesthet Surg J 36(6):1283–1312 Souto LRM, Chaim EA, Barbosa RC, Bizzacchi JMA (2012) Increased intraoperative bleeding in patients undergoing abdominoplasty after gastroplasty is not due to coagulopathy. Aesthet Surg J 36(6):1283–1312
Metadata
Title
Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis
Authors
Azmi Marouf
Hatan Mortada
Publication date
01-12-2021
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 6/2021
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-021-02315-2

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