Utilization of Body Contouring Procedures Following Weight Loss Surgery: A Study of 37,806 Patients.

BACKGROUND: Bariatric surgery has substantial health benefits; however, some patients desire body contouring (BC) procedures following rapid weight loss. There is a paucity of data regarding the true rate of BC following bariatric procedures. The purpose of our study is to examine the utilization of two common procedures, abdominoplasty, and panniculectomy, following bariatric surgery in New York State. METHODS: The SPARCS longitudinal administrative database was used to identify bariatric procedures by using ICD-9 and CPT codes between 2004 and 2010. Procedures included sleeve gastrectomy, Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. Using a unique patient identifier, we tracked those patients who subsequently underwent either abdominoplasty or panniculectomy with at least a 4-year follow-up (until 2014). Multivariable Cox proportional hazard model was used to evaluate predictors of follow-up BC surgery. RESULTS: 37,806 patients underwent bariatric surgery between 2004 and 2010. Only 5.58% (n = 2112) of these patients subsequently had a BC procedure, with 143 of them (6.8%) having ≥1 plastic surgery. The average time to plastic surgery after band, bypass, or sleeve was 1134.83 ± 671.09, 984.70 ± 570.53, and 903.02 ± 497.31 days, respectively (P < 0.0001). Following the multivariable Cox proportional hazard model, a female, SG patients, patients with Medicare or Medicaid, and patients in either <20 or >80%ile in yearly income were more likely to have plastic surgery after adjusting for age, race/ethnicity, comorbidities and complications (P values < 0.0001). CONCLUSIONS: This study shows that plastic surgery is completed by only 6% of patients following bariatric procedures. As insurance and income are associated with pursuing surgery, improved access may increase the number of patients who are able to undergo these reconstructive procedures.

Liposuction induces a compensatory increase of visceral fat which is effectively counteracted by physical activity: a randomized trial.

CONTEXT: Liposuction is suggested to result in long-term body fat regain that could lead to increased cardiometabolic risk. We hypothesized that physical activity could prevent this effect. OBJECTIVE: Our objective was to investigate the effects of liposuction on body fat distribution and cardiometabolic risk factors in women who were either exercise trained or not after surgery. DESIGN, SETTING, AND PARTICIPANTS: Thirty-six healthy normal-weight women participated in this 6-month randomized controlled trial at the University of Sao Paulo, Sao Paulo, Brazil. INTERVENTIONS: Patients underwent a small-volume abdominal liposuction. Two months after surgery, the subjects were randomly allocated into two groups: trained (TR, n = 18, 4-month exercise program) and nontrained (NT, n = 18). MAIN OUTCOME MEASURES: Body fat distribution (assessed by computed tomography) was assessed before the intervention (PRE) and 2 months (POST2), and 6 months (POST6) after surgery. Secondary outcome measures included body composition, metabolic parameters and dietary intake, assessed at PRE, POST2, and POST6, and total energy expenditure, physical capacity, and sc adipocyte size and lipid metabolism-related gene expression, assessed at PRE and POST6. RESULTS: Liposuction was effective in reducing sc abdominal fat (PRE vs. POST2, P = 0.0001). Despite the sustained sc abdominal fat decrement at POST6 (P = 0.0001), the NT group showed a significant 10% increase in visceral fat from PRE to POST6 (P = 0.04; effect size = -0.72) and decreased energy expenditure (P = 0.01; effect size = 0.95) when compared with TR. Dietary intake, adipocyte size, and gene expression were unchanged over time. CONCLUSION: Abdominal liposuction does not induce regrowth of fat, but it does trigger a compensatory increase of visceral fat, which is effectively counteracted by physical activity.

Lipoabdominoplastia con desinserción umbilical y despegamiento abdominal reducido / Lipoabdominoplasty with umbilical detachment and reduced abdominal undermining

Presentamos una combinación de procedimientos quirúrgicos para el tratamiento del exceso de volumen abdominal con flacidez moderada, utilizando una miniabdominoplastia con despegamiento y desinserción umbilical, asociada a liposucción. La indicación de la técnica se restringe a aquellos casos en los que la liposucción aislada provocaría un agravamiento de la flacidez, mientras que una abdominoplastia clásica implicaría una resección exagerada de piel o la necesidad de dejar una pequeña cicatriz vertical. Una miniabdominplastia trataría solamente la flacidez del abdomen inferior, dejando un exceso de piel en la región supraumbilical. La combinación de liposucción amplia y despegamiento controlado del área central del abdomen, asociada a una desinserción umbilical y su posterior reinserción unos 2 a 4 cm más abajo, nos permite lograr una completa plicatura de los rectos abdominales, con una buena resección del exceso cutáneo del abdomen inferior, además de un tratamiento adecuado de la flacidez moderada del abdomen superior (AU)

We present a combination of procedures for thetreatment of the abdominal volume excess withmoderate skin excess, using lipoabdominoplasty withdetachment of the navel. Indications are restricted tothose cases where the isolated suction-assisted lipoctomy(SAL) would take to the worsening of the skinflaccidity, while the full abdominoplasty would implyin exaggerated excision of the skin or presence ofsmall vertical scar. The miniabdominoplasty morefrequently used would only treat the flaccidity aboutthe inferior abdomen, leaving skin excess in the upperabdomen area. The combination of wide suctionassistedlipectomy with undermining in the centralarea of the abdomen, with umbilical detachment andits posterior new implantation about 2 to 5 cm lower,allows a complete plication of the abdominal rectums,with good excision of the skin excess of theinferior abdomen, besides the treatment of the moderateflaccidity of the superior abdomen

Outcome study in liposuction breast reduction.

Liposuction as a primary modality of treating breast hypertrophy has been reported in the literature; however, many of these reports are small series and personal experiences. This report is the first outcome study to attempt to validate the effectiveness of liposuction as a primary method of breast reduction surgery. Questionnaires were sent to 117 patients who had undergone liposuction breast reduction surgery in our office during a 4-year period. Seventy-eight questionnaires were returned (67 percent response rate). The patients were asked about their complaints, their surgical results, and their satisfaction with the operation. Complaints such as neck and back pain, shoulder ruts, and intertrigo were improved or eliminated in the vast majority of patients. Women returned to work in 5 days on average and resumed full exercise in 2 weeks. Eighty percent of patients were either very or completely satisfied with their outcomes, 87 percent would choose the liposuction method again, and 92 percent would recommend the liposuction method to a friend. This study demonstrates that liposuction breast reduction is an effective method of breast reduction surgery.

Mamaplastia vertical com lipoaspiração / Vertical mammaplasty with liposuction

Os autores apresentam os resultados obtidos em mamaplastia redutora, utilizando a técnica de Lejour.

The authors report the results of mammaplasty reduction using Lejour procedure.

[Complications in plastic surgery breast reconstruction with TRAM flap. Preventive methods and treatment modalities]. / Uslozhneniia pri rekonstruktsiia na biusta s TRAM-lambo. Sposobi za tiakhnata profilaktika i nachini za tretiraneto im.

The breast reconstruction with the TRAM-flap is sophisticated and demanding procedure, requiring careful planning and technical proficiency. Despite these efforts, the outcome of the breast reconstruction can be compromised by factors such as vascular insufficiency, scar contraction, errors in planning of the flap, or in the technique of building the new breast. Preventing the problems and complications in breast reconstruction require careful preoperative study, proper patient selection, accurate analysis of the results and immaculate technical performance.

Elefantíase congênita (doença de Milroy-Meige) / Congenital elephaniasis (Milroy-Meige's disease)

Os autores apresentam um caso de linfoedema congênito dos membros inferiores comprometendo pernas e coxas (doença de Milroy-Meige). Discorrem sobre o linfoedema e elefantíase de um modo geral. Estudam a etiofisiopatogenia dos respectivos quadros, bem como os sintomas e sinais que os acompanham. Fazem referência a trabalhos experimentais de diversos autores visando esclarecer a fisiopatogenia do linfoedema. Concluem que o terreno é importante, mas que as infecçöes repetidas säo necessárias para o estabelecimento definitivo da elefantíase. Säo favoráveis ao tratamento cirúrgico do linfoedema e efefantíase (dermofibrolipectomia), uma vez que o tratamento clínico é inoperante