The Effect of Massive Weight Loss Status, Amount of Weight Loss, and Method of Weight Loss on Body Contouring Outcomes
This study investigates the risk effect of massive weight loss status, the method of achieving massive weight loss, and the interaction effect between the amount of weight lost and the method of weight loss.
Methods/Technique:
A retrospective review of 1,801 complex, plastic surgery procedures were analyzed over a four-year period. Body contouring cases that included abdominoplasty, brachioplasty, thighplasty, breast mastopexy/reduction, lower body lift, body lift, buttock lift, and liposuction were included in the analysis. Utilizing relevant patient demographics and common comorbidities, outcomes were measured first with univariate analysis and then with multivariate logistic regression. Massive weight loss status was indicated if a patient had lost 50 or more pounds. Massive weight loss patients were classified as having achieved weight loss through diet and exercise, restrictive procedures (gastric banding and gastric sleeving), or gastric bypass. Odds ratios were estimated using four multivariate logistic regression models (1) a base model including massive weight loss status; (2) a model adjusting for the amount of weight lost; (3) a model adjusting for the method used to achieve massive weight loss; (4) a model measuring the interaction between method of weight loss and the amount of weight lost.
Results/Complications:
Four hundred fifty cases met inclusion criteria for analysis with 124 cases involving a massive weight loss patient. There was an overall complication rate of 19.1 percent. Massive weight loss status was a statistically significant predictor of wound problems (OR, 2.69; p=<0.001). Patients with 50-100 pounds of weight loss did not have a statistically significant increased risk of wound problems (OR, 1.93; p=.085), while patients with over 100 pounds of weight loss did (OR, 3.98; p=<0.001). All three methods of weight loss demonstrated significant increased risk of wound problems, but gastric bypass (OR, 3.01; p=<0.001) had a higher risk than diet and exercise (OR, 2.72, p=.023) or restrictive bariatric surgery (OR, 2.31; p=.038). Regardless of weight loss method, patients who lost 50 to 100 pounds did not demonstrate increased risk of wound problems. Patients who lost over 100 pounds did demonstrate increased risk of wound problems if they achieved this weight loss through gastric bypass or restrictive procedures.
Conclusion:
Massive weight loss status was a significant factor in determining wound complications in the body contouring population. The amount of weight lost and the means through which this weight loss was achieved also demonstrated significant effects on predicting wound complications. Surgeons should be cognizant of these factors when discussing body contouring procedures with patients.