November 5, 2008 (Chicago, Illinois) — Complications of body-contouring surgery after massive weight loss are not higher in patients who had bariatric surgery than in patients who lost weight through diet and exercise alone, a new study has found. However, another study, conducted by the same group, found that body-contouring complications, including bleeding, are higher in men than in women.
The results were presented here at Plastic Surgery 2008, the American Society of Plastic Surgeons (ASPS) Annual Meeting.
The research findings stress the importance of preoperative screening of patients seeking body-contouring procedures to remove excess skin and fat, said J. Peter Rubin, MD, a coauthor of the studies and chair of the ASPS Post-Bariatric Task Force.
Dr. Rubin and coworkers from the University of Pittsburgh Medical Center, in Pennsylvania, examined several factors that could affect complication rates of body reshaping after a weight loss of more than 50 pounds in an attempt to improve patient-selection criteria. In their study, the team looked at the potential effect of the method of weight loss (gastric bypass surgery or diet and exercise).
The authors assumed that nonsurgical weight-loss patients would have fewer complications because of a better nutritional status, Dr. Rubin said in an interview with Medscape Dermatology. Bariatric surgery is known to cause caloric and nutritional deficits.
Surprisingly, however, the total complication rate was higher in patients who lost weight without surgery (50% vs 41% in the bypass group), although the difference was not statistically significant. Complications occurred more often despite these patients having a higher protein intake and serum albumin level before body contouring than postbariatric patients, Dr. Rubin said.
"Patients who lose weight through diet and exercise have comparable outcomes to gastric bypass patients," Dr. Rubin told Medscape Dermatology. "It's useful to know that the way patients lose weight is not a contraindication to body-contouring surgery."
Complications included wound dehiscence, infection, hematomas, and seromas. Only infection rates reached individual statistical significance (P = .03) in the diet-and-exercise group, but the difference was not significant when the analysis matched procedures in both groups, the authors reported in their abstract.
The groups had similar demographics for age, sex, and body mass index. The size of the diet-and-exercise sample was small, however, representing only 29 (6.5%) of 449 patients in the prospective study, the abstract showed.
Small Sample
The study findings are interesting but speculative, said Walter Erhardt, MD, past president of the ASPS and a plastic surgeon in private practice in Albany, Georgia, in a telephone interview. Dr. Erhardt facilitated the session in which this presentation was made.
"We shouldn't start making conclusions based on small numbers of patients," said Dr. Erhardt.
Dr. Erhardt said he found it interesting that patients in the diet-and-exercise group more often had multiple contouring procedures performed at once than did postbariatric patients (74% vs 61%; not statistically significant). He said: "Plastic surgeons may be more cautious about doing multiple procedures in gastric bypass patients, because we're programmed [to realize] that bypass patients have significant wound-healing issues."
"The real message," Dr. Erhardt said, "is that no matter how the patient loses the weight, significant postoperative complications that can occur, and you have to be conservative with all patients."
Dr. Rubin attributed the difference in multiple procedures to the fact that patients who lose a lot of weight through lifestyle changes are likely more motivated to change their lifestyle and appearance.
Male Sex an Independent Risk Factor
In a separate study evaluating the effect of sex on complications after body contouring, Dr. Rubin and coauthors found that men had a significantly higher risk for hematoma (odds ratio [OR], 4.7; P < .01) and seroma (OR, 2.12; P < .03) formation than women did, but the difference was not associated with a higher reoperation rate, the abstract showed. Men represented only 10% of cases (48 of 481), according to study findings reported today.
"We don't know why men had more of these complications, but we need to bear gender in mind when we talk to patients about the risk of complications," Dr. Rubin said.
Dr. Rubin disclosed that he receives educational support from Covidien. Dr. Erhardt has disclosed no relevant financial relationships.
Plastic Surgery 2008: American Society of Plastic Surgeons (ASPS) Annual Meeting: Abstracts 6 and 98. Presented November 2, 2008 and November 5, 2008.
Medscape Medical News © 2008 Medscape
Cite this: Kathleen Louden. ASPS 2008: Body-Contouring Complications Comparable After Bariatric Surgery and Nonsurgical Weight Loss - Medscape - Nov 05, 2008.
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