Body Contouring After Massive Weight Loss: A Personal Integrated Approach.

[BACKGROUND] After massive weight loss, patients typically presented with skin redundancy, which causes enormous esthetic, physical, medical and psychological problems. The growing number of patients with these sequelae triggered an increase in the search for body contouring procedures, which in turn produced an important development in the post-bariatric reconstructive surgery.

[METHODS] The author describes the principles of a personal approach in post-bariatric reconstructive surgery. The concept is based on an integrative approach, attending to multiple anatomic segments in the same procedure, associated with multiple refinements of the surgical technique. A retrospective study was carried out, including all body contouring procedures in massive weight loss patients performed by the author between January 2009 and December 2013.

[RESULTS] The sample is comprised of 74 patients, in a total of 120 surgeries, of which 70% were performed on the pelvic girdle and 30% on the scapular girdle. The most common complication noted by the author was small wound dehiscence. In 2011, the author began performing Pollock´s technique in abdominoplasty, with fixation stitches to the deep planes, and double-layer sutures, instead of single intra-dermal suture. At the same time, he stopped using drains. Interestingly, the rate of complications, including hematoma, proved to be lower in this group of patients.

[DISCUSSION] The application of this integrated post-bariatric surgery concept enables multiple anatomic segment contouring in less surgical procedures, which in turn permits a more immediate final result, associated with lower hospitalization times and lower complication rates.

[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 .