Clarifying Weight Control in the Postbariatric Body Contouring Population

Goals/Purpose: Depending on the technique, bariatric surgery (BS) patients can expect to lose 11.7 to 25.5% over 5-7 years following surgery. Once patients achieve their maximum weight loss following BS, there is also a known trend of weight regain, which has been shown to be as high as 26.8% of weight lost following BS. A recent meta-analysis of postbariatric patients who undergo body contouring (BC) reported an additional 7% total weight loss (%TWL) and 19% excess weight loss (%EWL) if BC is performed after BS. However, the studies included in this meta-analysis are limited by inconsistent weight metrics reported and shorter follow-up periods. Most studies evaluating weight control in the BC population do not isolate BC procedures to specific body areas. Neither the long-term effects of BS nor the addition of BC have been studied in our geographic region. Thus, we sought to analyze this population and compare to published outcomes for postbariatric BC patients from other regions.

Methods/Technique: We performed a retrospective review of all postbariatric patients who underwent trunk-based BC from 1/1/2009 through 7/31/2020. Only patients with at least twelve-month follow-up following BC surgery were included. Each patient’s weight was assessed prior to BS, prior to BC, and at the time of last follow-up. The low weight “nadir” was also identified for each patient. Follow-up data evaluation was capped at six years following BC surgery. In addition to the change in weight, the %TWL and %EWL were recorded at the same intervals, as well as at six-month intervals following BC. These results were compared with published %TWL and %EWL rates for postbariatric body contouring (PBC) patients from other regions of the US. The endpoint weight, %TWL and %EWL were also compared against the same values for each patient prior to BC surgery. The weight regain following low nadir was also compared with published rates of weight regain for bariatric patients.

Results/Complications: Fifty-eight postbariatric patients underwent trunk-based BC. Average follow-up was 113.2 ± 172.7 months from BS and 38.1 ± 18.7 months from BC. At endpoint follow-up, the cohort experienced %TWL and %EWL of 26.24 ± 9.06% and 55.78 ± 22.77%, respectively. Published values for %TWL and %EWL were 36.9 ± 8% and 70.2 ± 12.9%. Compared to their own weight loss prior to BC, the addition of BC surgery did not produce an additional decrease in weight (29.24 ±10.61 %TWL, p=0.10; 62.56 ± 23.94 %EWL, p=0.12). Once nadir weight loss was attained, PBC patients regained 20.51 ± 26.28% of maximum weight lost. The published mean weight regain value for postbariatric patients is 26.8% of maximum weight lost.

Conclusion: This is the longest follow-up of any similar series evaluating weight control in PBC patients. The weight metrics collected, and the standardized intervals with which they were assessed, is of high quality for both the bariatric surgery and body contouring literature. Although the %TWL and %EWL of our PBC patients are less than what has been reported in the literature, the weight regain is less than would be expected if they did not undergo BC. In comparison to their maximum weight loss prior to BC, they maintain a generally stable weight over the long term. This allows surgeons to accurately counsel patients prior to body contouring surgery, noting that some weight regain can be expected. In our population, which is uniquely challenged by obesity, numerous comorbidities and high smoking prevalence, it is noteworthy that BC surgery continues to play a role in the prevention of excess weight regain.