Tummy tuck surgery (abdominoplasty) yields high patient satisfaction and improved quality of life in patients who are overweight or obese – despite a substantial risk of complications, reports a study in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
An "overwhelming majority" of overweight/obese patients are happy with the results of abdominoplasty, according to the study by Dennis C. Hammond, MD, and colleagues of Partners in Plastic Surgery of West Michigan, Grand Rapids. They write, "A real quality of life improvement can be obtained by offering body contouring even in the face of obesity, with the caveat that the risk of minor postoperative complications is high."
Risks Are Higher, But Body Contouring Has Real Benefits for Patients with Increased BMI
Abdominoplasty is an effective procedure to improve the appearance of the abdomen. However, this and other body contouring procedures have historically been discouraged in overweight or obese patients. That reflects concerns that increased body mass index (BMI) may increase the risk of wound healing problems and other complications.
The researchers analyzed the outcomes of tummy tuck surgery in 46 overweight/obese patients over a 12-year period. The patients were 41 women and five men, average age 49 years. All had a BMI of 25 or higher, with an average BMI of 32. (A BMI of 25 or higher is considered overweight, while a BMI of 30 is the cutoff point for obesity.)
Eighty percent of patients underwent abdominoplasty, most often including a procedure to restore weakened or separated abdominal muscles. The remaining 20 percent had a procedure called panniculectomy to eliminate excess, "hanging" abdominal fat and skin. The researchers analyzed the outcomes of surgery, including complication rates and patient-rated outcomes.
Nearly half of patients had some type of complication. About 39 percent had minor complications, requiring office procedures or antibiotics. About nine percent of patients had major complications requiring a return to the operating room – mainly due to wound healing problems and/or fluid collections.
Thirty-six patients completed follow-up surveys an average of 15 months after their procedure. Ninety-four percent of patients were satisfied with the results of abdominoplasty/panniculectomy, while 97 percent stated they would choose to have the procedure again. Ninety-seven percent of patients said the procedure had improved their quality of life. Nearly half of patients said they lost additional weight after surgery.
"Abdominoplasty and panniculectomy in the overweight and obese patient presents as a surgical decision-making challenge for the treating surgeon," Dr. Hammond and coauthors write. Due to their increased risk of complications, patients are commonly advised to lose weight before undergoing body contouring surgery.
The researchers note, "Even with weight loss, the excess skin and fat...will not completely recede and can still present as an impediment to normal function and exercise." While acknowledging the increased risks, they offered abdominoplasty or panniculectomy to overweight/obese patients "in an attempt to relieve the discomfort and physical effects of the excess skin and fat and offer the potential to jumpstart a weight loss process."
The authors believe their results support this strategy. Although complications were frequent, most were minor and readily manageable, and many patients lost more weight after surgery. Dr. Hammond and colleagues conclude: "[E]ven in the face of this elevated complication rate, patient satisfaction is overwhelmingly high, making body contouring procedures in this patient population an acceptable option in appropriately selected patients."
Hammond, D. C. et al. (2019) Abdominoplasty in the Overweight and Obese Population: Outcomes and Patient Satisfaction. Plastic and Reconstructive Surgery. https://journals.lww.com/plasreconsurg/Fulltext/2019/10000/Abdominoplasty_in_the_Overweight_and_Obese.14.aspx