Postbariatric Reconstruction

Abstract

Postbariatric reconstruction begins with proper evaluation and selection of the massive weight loss (MWL) patient. Patients with a lower body mass index (BMI) can be offered a wider scope of safe surgical procedures. Traditional abdominoplasty techniques must often be modified for the MWL patient, as deformities vary significantly. The circumferential lower body lift (LBL) has a powerful effect on the lateral thighs, buttocks, and anterior trunk in a single operative setting. Because of opposing vectors of pull, the vertical thigh lift is best performed in a separate operative setting as the LBL. Vertical thigh lift, performed as a staged procedure relative to the LBL, will complete the aesthetic contouring of the thighs. Vertical thighplasty performed without an LBL in the staged plan will provide adequate results less commonly. Brachioplasty techniques must address the axilla to achieve satisfactory results. In addition, careful segmental resection of arm skin will avoid over-resection. Mastopexy in the MWL patient can be performed using a dermal suspension technique with selective autologous tissue augmentation. Several techniques for upper body lift can be used concomitantly, melding scars, depending on the deformities. Staging multiple procedures of the upper and lower body can maximize safety and aesthetic outcomes.