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Massive weight loss procedures create challenges for body contouring surgery

Article-Massive weight loss procedures create challenges for body contouring surgery

Key iconKey Points

  • Belt lipectomy has been introduced as a more effective alternative for addressing circumferential lower-truncal-tissue excess in massive weight loss patients
  • Belt lipectomy has yet to be widely adopted by U.S. plastic surgeons

The success of bariatric surgery has created a new population of patients seeking body contouring, but the deformities they present with are unlike any that plastic surgeons had encountered before. The need to solve the technical challenges represented in these patients and a desire to help restore patient self-esteem has driven surgical innovation within the plastic surgery community.

Dr. Aly
As faculty members at the University of Iowa, the birthplace of bariatric surgery, Al S. Aly, M.D., and Albert E. Cram, M.D., had early exposure to massive-weight-loss patients needing body-contouring surgery, and they have become leading experts in the field. Recognizing that traditional abdominoplasty failed to address the circumferential lower-truncal-tissue excess present in massive-weight-loss patients, they introduced belt lipectomy as a more appropriate and effective alternative.

Using an incision that extends around the entire trunk to enable circumferential excision of skin and fat, the procedure not only improves abdominal contour, but also eliminates lower back rolls and provides a buttock lift, says Dr. Aly, clinical professor of surgery, School of Medicine, University of California, Irvine.

However, despite a number of publications in the peer-reviewed literature describing the technique and its outcomes, belt lipectomy has yet to be widely adopted by U.S. plastic surgeons. Hopefully, that situation will be changed by greater surgeon education and recent modifications in the technique (see sidebar, "Belt Lipectomy"), Dr. Aly says.

Complex deformities of the upper body are also a unique finding following massive weight loss and have resulted in the development of upper-body lifting and breast-reconstruction procedures specific for this patient population. Significant descent of the lateral inframammary crease is a major issue seen in both genders and is the indication for an upper body lift, Dr. Aly says.

"Whether the patient is a woman who would benefit from breast augmentation or a man who needs breast reduction, the breast surgery must be performed on a flat base, as if building a pyramid on an even base. Lifting of the inframammary crease into its correct position is a necessary first step," he says.

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