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Large amounts of weight are being lost in this country through the popular procedures of bariatric surgery, most notably gastric bypass and the lapband operations. Despite the popularity of bariatric surgery, I see in my practice just as many patients who come in for body contouring procedures who have lost weight through diet and exercise. Because these weight loss methods are so different, with theoretical higher risks of poor healing in gastric bypass patients due to malabsorption, it would be interesting to know if the complications from major body contouring surgery are different between these two groups.

This exact issue was looked at and published in the January 2009 issue of the journal Plastic and Reconstructive Surgery. In 220 massive weight loss patients (191 bariatric, 29 diet and exercise) patients that underwent body contouring surgery, the complication rates and outcomes were looked at and analyzed. The conclusion was that there was no evidence that either weight loss method increased the risk of complications from a number of common bariatric plastic surgery procedures such as panniculectomy, mastopexy, brachioplasty, body or thigh lifts. It should be pointed out that there was a large difference in the number of patients in each group (29 vs 191) but statistical analysis based on matched procedures did not show a significant difference.

Bariatric plastic surgery involves the most extensive removal and reshaping of body tissues that exists in all of plastic surgery…or for any form of surgery for that matter. These body contouring operations, while safe, are not complication free. Wound separation (dehiscences) and small areas of infection are common in most patients and I point this out to all patients in advance. Because the bariatric surgery patient is more likely to have nutritional deficiences than non-bariatric weight loss patients, one would assume they would have higher rates of complications. This does not appear to be so. However, I would point that the plastic surgeons that performed these procedures and did this study are experts in the field and undoubtably have a keen sense of patient selection and surgical execution. Their expertise has most likely prevented some potential complications. Preoperative nutritional assessment and the type and number of procedures performed in any weight loss patient (I rarely go over 5 hours of surgery at one time) are still extremely important issues for all weight loss patients, no matter how they lost it.

Dr. Barry Eppley

Indianapolis, Indiana

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