Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery

Impact of Medial Thighplasty on Self-Perception and Body Image After Post-Bariatric Massive Weight Loss

BACKGROUND

The demand for body sculpting procedures after massive weight loss (MWL) has grown, with medial thighplasty (MT) emerging as an effective option. This study examines the impact of MT on quality of life (QoL), particularly focusing on body image and self-perception in individuals who have undergone MWL.

METHODS

This retrospective, single-center study included 21 patients who had post-bariatric MWL and subsequently underwent MT. QoL, with a focus on body image and self-perception, and was assessed through a custom-designed questionnaire administered before and after surgery. Inclusion criteria were a BMI < 35 and a history of bariatric surgery.

RESULTS

Twenty-one patients (20 female, 1 male) were included, with an average age of 50.3 years. The median weight loss was 58.4 kg. Post-operatively, the Physical Component Score (PCS-12) showed significant improvement, while the Mental Component Score (MCS-12) did not show a notable change. However, self-acceptance, body contact, sexuality, and self-esteem all significantly improved post-surgery, whereas vitality did not.

CONCLUSIONS

Consistent with previous studies, MT yields positive outcomes regarding physical well-being. This study further highlights the procedure's benefits for self-acceptance, body contact, sexuality, and self-esteem. Patients with expectations of improvements in vitality, or mental health concerns like depression or anxiety, should be carefully selected and may benefit from multidisciplinary care, including psychiatry or psychological support, to avoid dissatisfaction with post-surgical outcomes.

Abdominal Panniculectomy: Determining the Impact of Diabetes on Adverse Outcomes and Complications

Background: Despite its association with obesity, the relation between diabetes and the abdominal panniculectomy is less well-established. The purpose of this study was to evaluate the result of diabetes on post-panniculectomy complications in a large cohort and to establish the risk factors associated with unfavorable post-operative outcomes. Methods: Patients that underwent a panniculectomy between 2010 and 2018 were identified in PearlDiver, a national insurance claims database, and identified by Current Procedural Terminology code 15380. Patient demographics and comorbidities were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis were used to evaluate the association of risk factors and complications. Results: A total of 8282 panniculectomy patients were identified-4245 with diabetes, 4037 without. Obesity, tobacco use, and diabetes were all identified as significant risk factors in developing a surgical site infection, wound disruption, as well as needing to undergo reoperation. Diabetic panniculectomy patients had a higher rate of readmission as well as reoperation and sustained a higher rate of surgical complications, even when matched for. Conclusion: Diabetic panniculectomy patients are at a greater risk for developing complications. Identifying potential risk factors in this patient population could help reduce post-operative complications following a panniculectomy.

Desire for Body Contouring Surgery after Bariatric Surgery: A Nationwide Cross-sectional Study in Saudi Arabia

Background

The obesity pandemic in Saudi Arabia has led to a high demand for bariatric surgery (BS). Post-BS patients experience rapid and massive weight loss, with most patients experiencing redundant skin, leading to a desire for body contouring surgery (BCS).

Methods

A cross-sectional study was conducted from September 2022 to May 2023 among patients who underwent BS in Saudi Arabia, using an online self-administered questionnaire. The questionnaire comprised sociodemographic data, weight, and BS-related questions, and the post-BS appearance questionnaire assessed the desire for BCS, excess skin satisfaction, and overall appearance.

Results

A total of 410 of the patients electively enrolled. The mean perceived satisfaction of post-BS patients with the body's excess skin was rated as 4.28 ± 1.69 out of 7 points. The overall desire for BCS among the post-BS population was equal to a collective mean desire of 2.10 ± 0.92 out of 4 points. The desired body sites for BCS were focused on the abdomen/waist, followed by the lower back, then upper arms, buttocks, and thighs. Only 25.1% of the patients fulfilled their desires and recently underwent BCS.

Conclusions

The study highlights the importance of incorporating plastic and reconstructive surgery as an integral part of the multidisciplinary approach to morbidly obese patients after BS and the need for national guidelines on the referral pathway for post-BS BCS.

Actualized lower body contouring surgery after bariatric surgery - a nationwide register-based study

Massive weight loss might lead to excess skin folds causing functional, physical, and psychosocial discomfort. Following bariatric procedures, an increasing number of patients are seeking lower body contouring surgery (LBCS). The proportion of bariatric patients who undergo LBCS is largely unknown. The aim of this current study was to analyse the incidence and realization of LBCS in bariatric patients in Finland.National retrospective register linkage study including all adult patients who received bariatric surgery in Finland during 1998-2016. The data were obtained from the Finnish national health registers maintained by the Finnish Institute for Health and Welfare. Altogether 1089 (14.1%) of 7703 bariatric patients underwent LBCS during the study period. The majority of the LBCS procedures were abdominoplasty (89%). Median latency between bariatric surgery and LBCS was 31 months. The patients with LBCS were younger (p < 0.001) and received sleeve gastrectomy (p < 0.001). We revealed an annual correlation between LBCS and bariatric procedures (r = 0.683). With a two-year latency between the bariatric and post-bariatric operations, the correlation co-efficiency was strong (r = 0.927). LBCS operations ranged from 5 to 215 per hospital district. Most LBCSs (97.3%) were performed in public hospitals, and some (41%) were performed in university hospitals. This study shows that only 14.1% of bariatric patients undergo LBCS. There is a correlation between bariatric procedures and succeeding plastic surgical reconstructive procedures.

Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study

PURPOSE

This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods.

METHODS

This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone.

RESULTS

A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05).

CONCLUSION

Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.

Comparing Bariatric Surgery Patients Who Desire, Have Undergone, or Have No Desire for Body Contouring Surgery: a 5-Year Prospective Study of Body Image and Mental Health

PURPOSE

After bariatric surgery, body contouring surgery (BCS) is thought to improve body image, weight loss, and mental health. Many patients desire but do not undergo BCS after bariatric surgery. This patient subset has rarely been studied. The present study compares bariatric surgery patients that, at 5 years after surgery, desires, have undergone or have no desire for BCS regarding pre- and post-surgery body image and mental health, including within-group changes over time.

MATERIALS AND METHODS

Data were collected from participants (N = 216) pre-bariatric surgery and at 1- and 5-year post-surgery. Health care providers measured body mass index (BMI). All other data were collected via self-report (questionnaires).

RESULTS

At 5-year post-surgery, 30.6% had undergone BCS, 17.1% did not desire it, and 52.3% desired BCS. Patients who subsequently desired BCS scored lower on body satisfaction pre-surgery than the other groups. They also reported less resilience pre-surgery and more depressive symptoms at all times compared to participants with BCS. For five-year post-surgery, patients who desired BCS had lower body satisfaction levels than patients with BCS and were more bothered with excess skin relative to the two other groups. Body satisfaction improved in all three groups from baseline to five years and in most patients with BCS. Mental health improved only in patients with BCS.

CONCLUSION

This study emphasizes the relevance of identifying participants who desire but have not undergone BCS. The study suggests that BCS is associated with improved body image and mental health.

Experience of Excess Skin and Attitude to Body Contouring Surgery of a Chinese Post-Bariatric Population

INTRODUCTION

Western studies have explored post-bariatric patients concerning their views on excess skin and body contouring surgery (BCS), but Asian data were lacking. This study aims to investigate the experience of excess skin and attitude to BCS of a Chinese post-bariatric population.

METHODS

A total of 210 Chinese patients who underwent bariatric surgery from March 2015 to September 2018 were cross-sectional studied using the Sahlgrenska Excess Skin Questionnaire and a study-specific questionnaire.

RESULTS

The survey response rate was 61.4%. Most responders (78.2%) reported they had excess skin, and the most common sites were the abdomen (70.2%) and the upper arms (61.3%). Most responders (66.1%) reported being bothered by impaired health-related quality of life (HRQoL), and the most common problem was "the feeling of having unattractive body appearance" (42.7%). Many patients (37.9%) desired for BCS, and "the impact of excess skin is not serious enough" was the reason why not undergoing BCS being chosen most (28.1%), then "the cost is too high" (20.2%) and "worrying about the risk or complications of BCS" (18.4%). Younger age, female gender, higher weight loss, having full-time job, and earning higher income were independent factors increasing their desires for BCS.

CONCLUSIONS

Most Chinese post-bariatric patients have excess skin and are bothered by impaired HRQoL. The abdomen and upper arms are the sites where patients are most seriously affected and most eager for BCS. The conservative attitude toward BCS and the cost without reimbursement are the main barriers.

The PRS Rainbow Classification for Assessing Postbariatric Contour Deformities

Supplemental Digital Content is available in the text.

Background:

There is a need for a reliable classification system to grade contour deformities and to inform reimbursement of body contouring surgery after massive weight loss. We developed the PRS Rainbow Classification, which uses select photographs to provide standardized references for evaluating patient photographs, to classify contour deformities in postbariatric patients. To assess the reliability of the PRS Rainbow Classification to classify contour deformities in massive weight loss patients.

Methods:

Ten independent experienced plastic surgeons, 7 experienced medical advisors of the healthcare insurance company, and 10 laypersons evaluated 50 photographs per anatomical region (arms, breast, abdomen, and medial thighs). Each participant rated the patient photographs on a scale of 1–3 in an online survey. The inter-observer and the intra-observer reliabilities were determined using intra-class correlation coefficients (ICCs). The ICC analyses were performed for each anatomical region.

Results:

Inter-observer reliability was moderate to good in the body regions “arms,” “abdomen,” “medial thighs,” with mean ICC values of 0.678 [95% confidence interval (CI), 0.591–0.768], 0.685 (95% CI, 0.599–0.773), and 0.658 (95% CI, 0.569–0.751), respectively. Inter-observer reliability was comparable within the 3 different professional groups. Intra-observer reliability (test–retest reliability) was moderate to good, with a mean overall ICC value of 0.723 (95% CI, 0.572–0.874) for all groups and all 4 body regions.

Conclusions:

The moderate to good reliability found in this study validates the use of the PRS Rainbow Classification as a reproducible and reliable classification system to assess contour deformities after massive weight loss. It holds promise as a key part of instruments to classify body contour deformities and to assess reimbursement of body contouring surgery.

Excess skin problems among adolescents after bariatric surgery

BACKGROUND

Bariatric surgery results in significant and durable weight loss and improved health in severely obese adolescents. An important adverse consequence of the massive weight loss after bariatric surgery is excess skin and soft tissue. The prevalence and clinical characteristics of excess skin-related symptoms have been described in adults undergoing bariatric surgery but not in adolescents. Although the higher skin elasticity of adolescents may result in fewer excess skin problems compared with adults, this hypothesis remains untested.

OBJECTIVES

The purpose of the present study was to describe the natural history of excess skin and its associated complications among severely obese adolescents undergoing bariatric surgery.

SETTING

University Hospitals, United States.

METHODS

We evaluated data from the Teen-Longitudinal Assessment of Bariatric Surgery cohort, a prospective, multiinstitutional study of adolescents (13-19 yr) undergoing bariatric surgery. Abdominal pannus severity (graded 0-5) and excess skin symptoms were evaluated preoperatively and for the first 5 years after bariatric surgery.

RESULTS

Among the 217 study participants, 198 (90%) had an abdominal pannus and 16 (7%) reported pannus-related symptoms at the time of bariatric surgery. Preoperative symptoms included intertriginous infections (n = 12, 75%), recurrent cellulitis (n = 5, 31%), and superficial cutaneous ulcerations (n = 1, 6%). Participants with a higher pannus grade preoperatively experienced both a greater reduction in pannus severity (P < .0001) and a higher incidence of pannus-related symptoms (P = .002) postoperatively. Changes in pannus severity occurred during the first 24 months after bariatric surgery; mean pannus severity remained unchanged beyond 24 months.

CONCLUSIONS

Severely obese adolescents who undergo bariatric surgery often present with an abdominal pannus at the time of surgery with associated symptoms. Higher preoperative pannus grade is associated with more pannus related symptoms after surgery. Counseling about need for body contouring surgery should be considered in this group.

Digital Support for Patients Undergoing Bariatric Surgery: Narrative Review of the Roles and Challenges of Online Forums

Background

The internet has become an important medium within health care, giving patients the opportunity to search for information, guidance, and support to manage their health and well-being needs. Online forums and internet-based platforms appear to have changed the way many patients undergoing bariatric surgery view and engage with their health, before and after weight loss surgery. Given that significant health improvements result from sustained weight loss, ensuring patient adherence to recommended preoperative and postoperative guidance is critical for bariatric surgery success. In a patient cohort with high information needs preoperatively, and notoriously high attrition rates postoperatively, online forums may present an underutilized method of support.

Objective

The aim of this study was to conduct a narrative review focusing on the developing roles that online forums can play for patients with bariatric conditions preoperatively and postoperatively.

Methods

A literature search was conducted in October-November 2019 across 5 electronic databases: Scopus, EMBASE, PsycINFO, CINAHL, and MEDLINE. Qualitative or mixed methods studies were included if they evaluated patients undergoing bariatric surgery (or bariatric surgery health care professionals) engaging with, using, or analyzing online discussion forums or social media platforms. Using thematic analysis, themes were developed from coding patterns within the data to identify the roles and challenges of online forums for patients undergoing bariatric surgery.

Results

A total of 8 studies were included in this review, with 5 themes emerging around (1) managing expectations of a new life; (2) decision making and signposting; (3) supporting information seeking; (4) facilitating connectedness: peer-to-peer social and emotional support; and (5) enabling accessibility and connectivity with health care professionals.

Conclusions

Online forums could offer one solution to improving postoperative success by supporting and motivating patients. Future research should consider how best to design and moderate online forums for maximal effectiveness and the sharing of accurate information. The surgical multidisciplinary team may consider recommendations of online peer-support networks to complement care for patients throughout their surgical journey.

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery

OBJECTIVE

This study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery.

METHOD

Five female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA).

RESULTS

Three super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences-including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours.

DISCUSSION

This study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake.

Impact of Lipo-Body Lift Compared to Classical Lower Body Lift on Postoperative Outcome and Patient's Satisfaction: A Retrospective Study

INTRODUCTION

Lately, the growing number of bariatric procedures performed each year led to an increasing demand for lower trunk reconstruction. Our team previously described the lipo-body lift (LBL) technique into lower duration of drainage and therefore seromas and other complications. In this study, we compared the classical body lift (CBL) technique to the LBL procedure.

MATERIALS AND METHODS

All patients who underwent a LBL or CBL after massive weight loss between November 2012 and October 2017 were included. Surgery outcome parameters were collected as well as patient satisfaction through a satisfaction score realized at least after 1 year postoperative. Comparisons between CBL and LBL were conducted to assess the surgery's safety and the patient's satisfaction.

RESULTS

A total of 130 patients were included, 61 patients who had a LBL were compared to 69 patients who had a CBL. The mean patient age was 39.64 ± 9.97 (21-66) years old, the mean body mass index before plastic surgery was 26.83 ± 3.08 kg/m² (19.83-32.69), and the average weight loss was 53.40 ± 17.37 kg. The two groups had comparable preoperative data. Duration of drainage and hospital stay was significantly lower in the LBL group than in the CBL (p < 0.0001 and p < 0.0001, respectively). Surgical outcomes were comparable between groups as well as patient satisfaction scores.

CONCLUSION

Lipo-body lift allows early discharge of the patient by reducing the duration of drainage without increasing the risk for complications. In our opinion, this technique should be used for type 1 and 2 patients with no contraindication for abdominal liposuction.

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.

Review of Insurance Coverage for Abdominal Contouring Procedures in the Postbariatric Population

BACKGROUND

Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population.

METHODS

The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage.

RESULTS

Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415).

CONCLUSIONS

For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.

The Impact of Massive Weight Loss on Psychological Comorbidities: A Large, Retrospective Database Review

BACKGROUND

The obese population has a higher incidence of mood disorders compared to individuals with normal body mass index (BMI). A better understanding of the unique psychosocial challenges faced by this patient population will allow physicians to better optimize patient psychosocial support systems perioperatively, as well as help the patient to maintain appropriate expectations.

METHODS

A large, retrospective database of 1135 patients with greater than 50 pounds of weight loss was reviewed. Data were analyzed using a multinomial regression model to determine the influence of psychosocial factors on the incidence of depression and anxiety.

RESULTS

Prior to massive weight loss, patients reported an overall incidence of depression and anxiety of 42.5% and 26.3%, respectively. Following massive weight loss, the incidence of depression decreased to 32.3% and the incidence of anxiety decreased to 22.0%. Patients with spousal support and with positive self-image were more likely to experience resolution of depression. Patients with positive self-image were likely to experience resolution of anxiety. Resolution of medical comorbidities correlated with a decrease in the rate of depression.

CONCLUSION

Depression and anxiety are prevalent in the massive weight loss patient population undergoing body contouring surgery. Support systems are a vital resource for patients with psychological comorbidities undergoing massive weight loss. Patients who have a positive self-image of themselves are more likely to experience resolution of psychological comorbidities. Physicians should consider recommending support groups and/or counseling in patients who have poor support and negative self-image.

LEVEL OF EVIDENCE IV

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.

Knowledge is power: Providing previsit insurance coverage information of body contouring procedures to improve understanding and satisfaction in the massive weight loss patient

INTRODUCTION

Because of the prevalence of obesity worldwide, the rates of bariatric surgery are increasing. Bariatric surgery is covered by insurance; however, often, a surgery to correct massive weight loss surgeries is not covered despite patient perception.

METHODS

One hundred patients were identified by their initial visit to the institutional Life After Weight Loss center. Fifty of them were randomized into receiving previsit educational materials about their individual insurance plans. All the patients were surveyed to assess whether this education improved their understanding and overall consultation experience.

RESULTS

Although a majority of patients believed "panniculectomy" would be covered by insurance, most subjects overestimated insurance coverage for other procedures. Nearly all respondents (93.8%) agreed that previsit educational material improved their understanding and the satisfaction of the visit.

CONCLUSION

Many patients believe body contouring procedures to be covered by insurance, although most are not. By providing patients with their individualized insurance plans, patients report improved understanding and overall satisfaction with the consultation.

The Danish Scale for visual rating of massive weight loss body contours. Conceptualization and construct

The 'Danish Scale' (DS) is a visual rating scale of massive weight loss body contour deformities and excessive skin in female MWL-patients with current BMI < 30 kg/m² and massive weight loss defined as BMI loss (delta-BMI) > 15 kg/m², regardless of weight loss method. The scope of the scale is to simplify the reporting of objective findings by a three-step grading of minor, moderate and severe body contour changes in six different body regions: breasts, abdomen, upper back, buttocks, arms and legs. The DS is presented with descriptions of the conceptualization and construct of the scale. It provides a new visual reference tool for indications and preoperative planning in MWL body contouring, that is specific for the post-MWL BMI-range between 21 and 30 kg/m² and, at the same time, simpler than previous scales. The scale combines evaluations of different and adjacent body regions in a simple manner and presents modern cut-off points for health insurance reimbursement for MWL body contouring as offered in the Danish public health care system. The DS was developed by repeat expert discussions until final nationwide consensus was reached and can act as an adjunct to the written guidelines by the National Board of Health in Denmark.

Risk Factors for Undergoing Elective Abdominal Contouring Surgery Shortly After Hospitalization

BACKGROUND

Having posthospital syndrome (PHS) at the time of an elective surgery increases the risk of postoperative adverse outcomes. The purpose of this article was to identify incidence and risk factors for having PHS at the time of abdominal contouring surgeries.

METHODS

Insurance claims from the Truven MarketScan Databases were used to identify patients who underwent outpatient abdominoplasty, liposuction, or panniculectomy between April 2010 and August 2015. Patients were presumed to have PHS if they were hospitalized within 90 d before surgery. Incidence rates of having PHS were calculated for patient groups defined by demographic data and comorbidities. Statistical inference based on adjusted odds ratios was used to evaluate the association of potential risk factors with PHS. A nonparametric regression method was used to demonstrate nonlinear effects of patient covariates on the risk of PHS.

RESULTS

This study included 18,947 patients who underwent abdominal contouring; 77% were female, and the mean age was 48.7 y (SD = 14.7). Six percent (n = 1045) of patients had PHS at the time of surgery. A significantly stronger association with PHS (P < 0.001) was observed in patients with deep venous thrombosis (adjusted odds ratio = 3.56), Elixhauser score > 8 (3.28), and smokers (2.16). Age was found to have a piecewise linear effect on PHS, with odds increasing by 2.1% per year over the age of 45 y.

CONCLUSIONS

Older patients have an increased risk of undergoing abdominal contouring surgery in a deconditioned state. Screening at-risk populations for PHS would help identify patients who need rehabilitation before operative intervention.

Health and appearance: Factors motivating the decision to seek bariatric surgery

BACKGROUND

Few studies have examined the motivating factors and people that lead patients to seek bariatric surgery. Bariatric surgery helps to improve body image, but little is known about patients' desired changes in the appearance of specific body parts.

OBJECTIVES

To identify key factors and people motivating patients' decision to seek bariatric surgery, and to assess body dissatisfaction and desire for surgery to change the appearance of specific body parts.

SETTING

U.S. university-based hospital clinic.

METHODS

Patients seeking bariatric surgery (N = 208, 78.4% women, 52.4% black, mean age = 42.0 ± 12.3 yr, mean body mass index = 46.7 ± 8.5 kg/m²) completed the Reasons for Bariatric Surgery questionnaire before their preoperative Psychosocial-behavioral evaluation. Participants rated (1-10) the importance of 15 potential reasons and 7 potential people motivating their decision to seek bariatric surgery. Participants also rated their dissatisfaction and desire for surgery to change the appearance of 11 body parts.

RESULTS

Mean scores of motivating factors were highest for Physical Health (9.9 ± .4), followed by Longevity (9.7 ± .9). Patients reported high body dissatisfaction and desire for surgery to change the appearance of several body parts, including stomach and thighs. "Myself" was the highest-rated motivating person, followed by healthcare providers, family, and someone who had undergone bariatric surgery.

CONCLUSIONS

Health is the primary reason reported by patients for seeking bariatric surgery. Patients also report a strong desire for surgery to change the appearance of their body. Patients are self-driven to pursue surgery but are also influenced by healthcare providers, family, and people who have undergone surgery. (Surg Obes Relat Dis 2019;X:XXX-XXX.) © 2019 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Abdominal Contouring and Combining Procedures

The abdomen is the most common area of concern among patients with massive weight loss (MWL). Abdominal contouring techniques in the MWL population include panniculectomy, standard abdominoplasty, fleur-de-lis abdominoplasty, reverse abdominoplasty and various combinations of these techniques as part of circumferential procedures such as, circumferential abdominoplasty, and lower body lift. The authors believe that the optimal surgical approach to the abdomen is an integration of the patient aesthetic preferences and the surgeon assessment and experience. The authors recommend to limit total body reconstruction of MWL patients to 2 stages, and include the abdominal area in the first stage.

Arm Contouring in the Massive-Weight-Loss Patient

Brachioplasty is an increasingly popular procedure performed for improved arm contour in the massive-weight-loss population. There are challenging deformities presented in this population, such as redundant skin, posterior arm lipodystrophy, and loosening of fascial layers of the upper arm and chest wall that must be addressed to achieve successful contour of the arms. Common complications can be minimized with meticulous technique and knowledge of surgical anatomy. Additionally, brachioplasty can be combined with liposuction of the posterior arm as a safe and effective method for arm contouring without a higher risk of complications.

Aspects of excess skin in obesity, after weight loss, after body contouring surgery and in a reference population

BACKGROUND

Excess skin is well known after massive weight loss but, there is missing knowledge from various groups.

OBJECTIVES

To describe and compare excess skin in a reference population during obesity, after obesity surgery, and after reconstructive abdominoplasty.

SETTING

University hospital, Sweden.

METHODS

The following 6 groups were included: the reference population, obese adults before obesity surgery, obese adults after obesity surgery, adolescents after obesity surgery, super-obese adults after obesity surgery, and adults after abdominoplasty. All groups filled in the Sahlgrenska Excess Skin Questionnaire (SESQ). Some groups also underwent measurements of ptosis/excess skin on 4 body parts.

RESULTS

All groups scored significantly higher experience of and discomfort from excess skin compared with the reference population. SESQ scores were significantly higher for obese adults (10.5 ± 8.5) and even higher for adults and adolescents (12.3 ± 8.1 versus 14.4 ± 7.7) after obesity surgery compared with the reference population (1.5 ± 3.5). Abdominoplasty resulted in significantly reduced scores (2.9 ± 5.2). Those undergoing obesity surgery and weight loss had significantly less excess skin measured on arms, breasts, and abdomen compared with before surgery, except for the upper arms on the adolescents. Excess skin increased on inner thighs in both age groups after weight loss. Correlations between objectively measured ptosis/excess skin and the patients' experience of and discomfort were .16 to .71, and the highest correlations were found among adolescents.

CONCLUSION

Excess skin is not a problem for the vast majority of the normal population but is linked to obesity and massive weight loss. The SESQ score illustrates major problems related to excess skin both for obese adults and after obesity surgery for adults and for adolescents, who have problems similar to or worse than adults. Abdominoplasty markedly decreases symptoms.

Patient-Reported Satisfaction Following Post-bariatric Surgery: A Systematic Review

INTRODUCTION

The aims of our study were to identify studies that evaluated patient satisfaction following post-bariatric surgery, analyse existing questionnaires, and summarise their development, psychometric properties, and content.

PATIENTS AND METHODS

A multistep search was undertaken on the web-based PubMed database from the National Library of Medicine to identify studies on patient satisfaction and quality of life following post-bariatric surgery. The authors summarised all the questionnaires used in every study and categorised them as generic, surgery specific, or ad hoc, and whether they contained either validated or unvalidated measures.

RESULTS

Our search generated a total of 1754 articles. We performed a systematic review of the 12 remaining studies, because these had sufficient data and met the inclusion criteria. All the studies identified from the literature review were assessed to determine the type of surgery used, and whether or not the questionnaire used to analyse patient satisfaction had been validated. The questionnaires were analysed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 20 individual questionnaires that included 10 generic instruments that assessed quality of life, six instruments specific for post-bariatric surgery, three instruments specific for breast surgery.

CONCLUSIONS

In post-bariatric patients, the BODY-Q was shown to be a more objective and confident measure for evaluating the quality of life of patients following post-bariatric surgery.

LEVEL OF EVIDENCE III

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 .

Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery

BACKGROUND

Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events.

METHODS

We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts.

RESULTS

Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P < 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P < 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS (P < 0.001).

CONCLUSIONS

Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.

Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq

BACKGROUND

The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives.

OBJECTIVES

Is there a gender difference in seeking body countering after bariatric surgery for weight loss?

PATIENTS AND METHODS

A longitudinal observational study includes 209 obese patients with mean age of 31 ± 8.6 years; (31 ± 9, 31 ± 7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ± 9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ± 7 cm in female and 118 ± 4 cm in males.

RESULTS

Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ± 2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50-70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor.

CONCLUSION

The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.

Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors

INTRODUCTION

Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.

METHODS

A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.

RESULTS

Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p < 0.01), fleur-de-lis panniculectomy (p < 0.01), concomitant hernia repair (p < 0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p < 0.05) and incision type (OR 1.64, p < 0.05) to be independent predictors of morbidity.

CONCLUSION

High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision.

What Is Known About the Correlates and Impact of Excess Skin After Bariatric Surgery: a Scoping Review

Although bariatric surgery (BS) improves health among adults with severe obesity, it results in excess skin in more than 70% of adults. The purpose of this study was to synthesize current knowledge on (1) the impact of excess skin experienced by adults after BS and (2) the correlates of excess skin quantity and inconveniences. PubMed, PsyArticles, and CINAHL databases were searched in May 2016 for relevant studies. Titles, abstracts, and full texts of studies retrieved were screened independently by two reviewers against inclusion criteria: (1) peer-reviewed primary research studies, (2) samples with adults who underwent BS, and (3) studies reporting the impact of excess skin and/or excess skin correlates. Thirteen quantitative and eleven qualitative studies met inclusion criteria. Negative physical, psychosocial, and daily life impacts of excess skin were reported in 67, 75, and 83% of studies, respectively. Women reported more excess skin and greater inconveniences of excess skin than did men. Based on the quantitative studies, pre-BS BMI, time since BS, and type of BS were not significantly associated with inconveniences of excess skin; findings were inconclusive for other correlates found (e.g. age, weight loss, BMI). Excess skin may adversely impact adults' physical and psychosocial functioning, as well as their activities of daily life after BS. However, evidence is lacking to determine which adults may be at heightened risk of developing or being negatively impacted by excess skin. More research on correlates of excess skill is needed to inform the development of tailored interventions in those more vulnerable to developing excess skin after BS to mitigate adverse consequences.

Quality of Life After Bariatric Surgery

PURPOSE OF REVIEW

The purpose of this review is to provide an introduction to quality of life (QOL) outcomes after bariatric surgery and a summary of the current evidence.

RECENT FINDINGS

QOL has been emphasized in bariatric surgery since the NIH Consensus Conference statement in 1991. Initial studies were limited to 1- and 2-year follow-up. More recent findings have expanded the follow-up period up to 12 years, providing a better description of the impact on long-term QOL. Overall, there is little to no consensus regarding the definition of QOL or the ideal survey. Bariatric surgery has the greatest impact on physical QOL, and the impact on mental health remains unclear. There are some specific and less frequently reported threats to quality of life after bariatric surgery that are also discussed. Obesity has a definite impact on quality of life, even without other comorbidities, and surgery for obesity results in significant and lasting improvements in patient-reported quality of life outcomes. This conclusion is limited by a wide variety of survey instruments and absence of consensus on the definition of QOL after bariatric surgery.

Autologous breast reconstruction in the postbariatric patient population

BACKGROUND

Over 175,000 Americans underwent bariatric surgery in 2013 alone, resulting in rapid growth of the massive weight loss population. As obesity is a known risk factor for breast cancer, plastic surgeons are increasingly challenged to reconstruct the breasts of massive weight loss patients after oncologic resection. The goal of this study is to assess the outcomes of autologous breast reconstruction in postbariatric surgery patients at a single institution.

METHODS

Patients who underwent autologous breast reconstruction between 2008 and 2014 were identified. Those with a history of bariatric surgery were compared to those without a history of bariatric surgery. Analysis included age, ethnicity, BMI, comorbidities, flap type, operative complications, and reoperation rates. Propensity matched analysis was also conducted to control for preoperative differences between the two cohorts.

RESULTS

Fourteen women underwent breast reconstruction following bariatric surgery, compared to 1,012 controls. Outcomes analysis revealed significant differences in breast revisions (1.35 vs. 0.61, P = .0055), implant placements (0.42 vs. 0.08, P = .0003), and total OR visits (2.78 vs. 1.67, P = .0007). There was no significant difference noted in delayed healing of the breast (57.4% vs. 33.7%, P = .087) or donor site (14.3% vs. 15.8%, P = 1.00).

CONCLUSIONS

As the rise in bariatric surgery mirrors that of obesity, an increasing amount of massive weight loss patients undergo treatment for breast cancer. We demonstrate profound differences in this patient population, particularly in regards to revision rates, which affects operative planning, patient counseling, and satisfaction.

Body Image and Body Contouring Procedures

Dissatisfaction with physical appearance and body image is a common psychological phenomena in Western society. Body image dissatisfaction is frequently reported by those who have excess body weight, but also is seen in those of normal body weight. For both groups of individuals, this dissatisfaction impacts self-esteem and quality of life. Furthermore, it is believed to be the motivational catalyst to a range of appearance-enhancing behaviors, including weight loss efforts and physical activity. Body image dissatisfaction is also believed to play a role in the decision to seek the wide range of body contouring procedures offered by aesthetic physicians. Individuals who seek these procedures typically report increased body image dissatisfaction, focus on the feature they wish to alter with treatment, and often experience improvement in body image following treatment. At the same time, extreme body image dissatisfaction is a symptom of a number of recognized psychiatric disorders. These include anorexia nervosa, bulimia nervosa, and body dysmorphic disorder (BDD), all of which can contraindicate aesthetic treatment. This special topic review paper provides an overview of the relationship between body image dissatisfaction and aesthetic procedures designed to improve body contouring. The review specifically focuses on the relationship of body image and body weight, as well as the presentation of body image psychopathology that would contraindicate aesthetic surgery. The overall goal of the paper is to highlight the clinical implications of the existing research and provide suggestions for future research on the psychological aspects of body contouring procedures.

The Psychosocial Burden of Obesity

Obesity is associated with several comorbidities, including cardiovascular disease, type 2 diabetes, sleep apnea, osteoarthritis, and several forms of cancer. Obesity and its comorbidities also come with a significant psychosocial burden, impacting numerous areas of psychosocial functioning. The evaluation of psychosocial functioning is an important part of the assessment and treatment planning for the patient with obesity. This article provides an overview of the psychosocial burden of obesity. The article also describes the psychological changes typically seen with weight loss. A particular focus is on the psychosocial functioning of individuals with extreme obesity who present for and undergo bariatric surgery.

Expectations and patients' experiences of obesity prior to bariatric surgery: a qualitative study

OBJECTIVES

This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions.

DESIGN

A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques.

SETTING

Areas served by two bariatric surgery multidisciplinary teams in the north of England.

PARTICIPANTS

18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams.

RESULTS

The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of 'normality'. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed.

CONCLUSIONS

The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period.

Desire for Body Contouring Surgery After Laparoscopic Sleeve Gastrectomy

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is an effective approach for the treatment of morbid obesity. Surgically induced massive weight loss provokes skin deformities that can be addressed with plastic surgery. However, there is a paucity of data regarding the esthetic outcome of patients after LSG. The aim of the study was to assess the postoperative appearance and the request for body contouring surgery after LSG.

METHODS

All the patients who underwent LSG between August 2006 and September 2014 with a minimum follow-up of 1 year were interviewed using the Post-Bariatric Surgery Appearance Questionnaire. Postoperative satisfaction with their appearance, and the desire and frequency for body contouring surgery were assessed.

RESULTS

A total of 175 patients were interviewed. Overall, 75% of the patients rated that they felt attractive with their appearance. More specifically, 84% of men and 72% of women were satisfied with their appearance. Females were most dissatisfied with waist/abdomen, chest/breasts, and upper arms, in descending order. Males were dissatisfied with chest/breasts, upper arms, and waist/abdomen, respectively. The most desired procedures were abdominoplasty, chest/breast lift, and upper arm lift in females and abdominoplasty, thigh lift and upper arm lift in males. Only 3.6% of patients underwent body contouring surgery postoperatively.

CONCLUSION

LSG patients rated their overall appearance from slightly to moderately attractive. There was a strong desire for abdominoplasty; breast lift and upper arm lift in females, although only a small proportion of patients proceeded to plastic surgery.

LEVEL OF EVIDENCE II

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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

Body Contouring After Bariatric Surgery

Individuals who undergo bariatric surgery generally experience rapid and dramatic weight loss. While the weight loss typically confers significant health benefits, an undesirable consequence is often excessive quantities of hanging, surplus skin. Some patients undergo body-contouring surgery (BCS) in order to improve health, mobility, appearance and psychological adjustment. While the majority of post-bariatric patients desire BCS in one or more body regions, a small percentage of patients receive such surgeries. Lack of knowledge about procedures, cost and (in the USA and several other countries) difficulty obtaining insurance reimbursement likely prevents many patients from undergoing BCS. Those who do undergo BCS appear to be at heightened risk for wound-healing complications. Despite these complications, the majority of patients report satisfactory BCS outcomes. The extant literature in this area provides a great deal of information about these issues; nevertheless, additional research is needed to further inform clinical management and improve patient outcomes.

Health-related quality of life and psychological functioning 9 years after restrictive surgical treatment for obesity

BACKGROUND

Bariatric surgery leads to initial weight loss that is associated with improvement in mental health; however, long-term effects are uncertain.

OBJECTIVE

To investigate the impact of restrictive surgical treatment for obesity on weight loss, psychological functioning, and quality of life 9 years after surgery.

SETTING

University hospitals and obesity centers, Germany.

METHODS

152 patients undergoing restrictive surgical treatment (SURG), 249 individuals participating in a conventional weight loss treatment (CONV), and 128 obese control participants without weight loss treatment (OC) were studied using a prospective longitudinal cohort design. After 9 years, 55% of SURG patients, 51% of CONV patients, and 65% of OC participants were reassessed. Body mass index, anxiety, depression, self-esteem, and health-related quality of life (HRQOL) were explored.

RESULTS

The SURG group had significantly greater weight loss and improvements in physical HRQOL at all postbaseline assessments. Although SURG patients experienced initial improvements in depression, anxiety, self-esteem, and mental aspects of HRQOL, these improvements deteriorated at the 9-year assessment and were comparable to or worse than presurgical levels.

CONCLUSIONS

Bariatric surgery is an effective treatment for obesity and is linked to maintained improvement of physical aspects of HRQOL. Weight reduction after surgery is also associated with significant initial improvement in mental health that may erode over time. Therefore, psychosocial screening should be included at follow-ups, with referral to mental health professionals as appropriate.

Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning.

Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7).

Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains.

Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

Desire for body contouring surgery after bariatric surgery: do body mass index and weight loss matter?

BACKGROUND

There is disparity between the number of postbariatric surgery subjects who desire body contouring and those who receive it due to lack of resources or insurance criteria.

OBJECTIVES

The authors evaluate the desire for body contouring after bariatric surgery and its relationship with demographic patient characteristics.

METHODS

Three hundred sixty patients who had undergone bariatric surgery procedures >1 year previously completed a questionnaire designed by the surgical team to analyze each patient's desire for body contouring by area (face, upper arm, upper back, chin/neck, chest/breast, waist/abdomen, lower back, rear/buttock), scored from 0 to 3 (do not want, want somewhat, want, want a great deal). Data were compared with patient characteristics, postoperative body mass index (BMI), amount of weight loss, and BMI difference (ΔBMI).

RESULTS

Most patients desired body contouring surgery, with high or very high desire for waist/abdomen (62.2%), upper arm (37.6%), chest/breast (28.3%), and rear/buttock (35.6%) contouring. Many patients (36.4%) cited "very high" expectations for how body contouring might change their appearance. Patients >50 years old and >3 years postsurgery had a significantly lower desire. Patients with a ΔBMI >10 and with a weight loss >20 kg showed a significantly stronger overall desire for body contouring compared with other groups.

CONCLUSIONS

Most patients desire body contouring surgery after bariatric surgery, and our multivariate analysis showed a significant positive association between female sex, younger age, amount of weight loss, and ΔBMI with desire for body contouring.