Commentary on: Changes in Glucose Control and Lipid Levels Following Trunk-Based Body Contouring Surgery in Postbariatric and Nonbariatric Patients.
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ABSTRACT:
SUBMITTER: Shafqat MS
PROVIDER: S-EPMC9972514 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
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Commentary on: Changes in Glucose Control and Lipid Levels Following Trunk-Based Body Contouring Surgery in Postbariatric and Nonbariatric Patients.
Shafqat M Shuja MS Small Kevin H KH
Aesthetic surgery journal. Open forum 20230107
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Project description:Background. With the increase in bariatric surgery in the UK, there has been a substantial increase in patients undergoing massive weight loss (MWL) seeking postbariatric body-contouring (bariplastic) surgery. However, there is a wide variation of availability on the National Health Service (NHS). Aims. To (1) review the funding policies of Primary Care Trusts (PCTs) in England for bariplastic surgery and (2) analyse the number of procedures funded in two consecutive financial years. Methods. We sent out questionnaires to all PCTs in England regarding their funding policies for bariplastic surgery and requested the number of procedures funded in 2008-09 and 2009-10. Findings. 121/147 (82%) PCTs replied to our questionnaires. 73 (60%) excluded all bariplastic procedures. 106/121 (87.6%) PCTs had referral guidelines for plastic surgery. 46/121 (38%) PCTs provided the total number of funded abdominoplasty-apronectomy (A-A) in the two financial years: total number of A-A applicants rose from 393 to 531, but approval for funding fell from 24.2% to 19.6%. Only 3 (2%) PCTs indicated increase in their future spending on bariplastic procedures in the next 5 years, with 67% planning to decrease or unsure about future funding. Conclusion. There exists a postcode lottery for bariplastic surgery in England and we feel the need for guidelines on provision of bariplastic procedures following MWL.
| S-EPMC3980931 | biostudies-literature
Project description:BackgroundThe quality of perioperative patient education impacts surgical outcomes, patient experiences, and resources needed to address patient concerns and unplanned visits. We examined patient inquiries and education materials to assess the quality of perioperative education and identify areas of targeted improvement for postbariatric surgery body-contouring procedures.MethodsWe examined 100 consecutive postbariatric procedures at an academic center. Themes of patient-generated calls, e-mails, and electronic medical record portal messages during the perioperative period were identified via qualitative analysis. Understandability and actionability of perioperative educational resources were assessed using the Patient Education Materials Assessment Tool (PEMAT).ResultsAmong 212 communications identified, 167 (79%) were postoperative. Common themes were concerns regarding the surgical site (38%), medications (10%), and activity restrictions (10%). One hundred thirty inquiries were resolved through patient re-education (57%), but 36 (16%) required in-person evaluation including 4 unplanned emergency department visits and 3 readmissions for surgical-site concerns. The PEMAT scores for institutional materials were fair for understandability (69%) and actionability (60%). American Society of Plastic Surgeons materials were more understandable (84%) but less actionable (40%).ConclusionsPatient queries can be leveraged as a source of qualitative data to identify gaps in perioperative education. High-yield topics, such as education regarding the surgical site and medications, can be targeted for quality improvement through better communication and potentially reduce the number of unnecessary visits. Using the PEMAT, we also identified how directly the education materials can be revised. Improving perioperative education can promote mutual understanding between patients and surgeons, better outcomes, and efficient resource utilization.
| S-EPMC10230510 | biostudies-literature
Project description:BackgroundThe current study examined a range of body image concerns and associated distress and impairment in patients who have undergone bariatric surgery and are seeking subsequent body contouring surgery.ObjectivesThe aim of this study was to investigate the hypotheses that individuals seeking body contouring endorse a broad pattern of body image concerns and that overall body image concern is associated with greater impairment and disability.MethodsThe participants were 56 adults seeking body contouring surgery after bariatric surgery. All participants completed a self-report questionnaire designed for the present study to assess body image concerns specific to patients who have undergone bariatric surgery and a battery of established measures of disability, impairment, and eating-disorder psychopathology.ResultsThe most commonly endorsed concerns were related to loose skin (body dissatisfaction, feeling embarrassed in public, and skin rashes) whereas the least endorsed items included concerns related to scars from bariatric surgery (body dissatisfaction, avoidance of social situations, and difficulty concentrating). Participants endorsed a broad pattern of frequent distress and impairment related to physical body image changes post-bariatric surgery. Greater body image concerns were associated significantly with higher levels of disability, work-related impairment, and eating-disorder psychopathology.ConclusionsPatients seeking body contouring surgery reported a range of body image concerns with significant associated distress, disability, and impairment related to physical changes post-bariatric surgery. The present findings underscore that although bariatric surgery is effective for reducing weight and metabolic disturbances, additional interventions for addressing body image concerns that are frequently distressing and impairing may be needed.
| S-EPMC8845003 | biostudies-literature
Project description:BackgroundBariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown.ObjectivesDescribe the incidence and effect of BCS following bariatric surgery among adolescents.SettingUniversity Hospitals.MethodsTeen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin-related symptoms between those who did and those who did not undergo BCS.ResultsAmong the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n = 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P = .04 and P = .03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS.ConclusionFew adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.
| S-EPMC7027488 | biostudies-literature
Project description:Obesity is a disease rather than a state, and metabolic bariatric surgery (MBS) is its most effective treatment. Body contouring surgery (BCS) is an integral part of the continuum of care following MBS, provided that the body mass index (BMI) has stabilized for an adequate period. This study is an attempt to capture the current status of BCS following MBS in Greece, based on data from one of the country's highest-volume hospitals. We recruited patients from the Bariatric and Plastic-Reconstructive Surgery registries who had undergone both MBS and BCS and invited them to answer a structured questionnaire with components on demographics, safety and effectiveness of previous operations, quality of life (QoL), body image, social activity, sexual activity, and doctor-patient communication. Twenty-four patients participated in the survey (response rate 88.1%). The mean BMI pre-MBS was 43.8 kg/m2 and that pre-BCS was 28.6 kg/m2. Based on the Bariatric sub-cohort, only 2.5% of post-bariatric patients underwent BCS. The mean interval between MBS and BCS was 2.9 years. The distribution of patients by MBS was as follows: sleeve gastrectomy 8 (33.3%), gastric band 7 (29.2%), gastric bypass 5 (20.8%), and gastric plication 2 (8.3%). The distribution of patients by BCS was as follows: abdominoplasty 23 (94.7%), breast contouring 8 (33.3%), thigh contouring 3 (12.5%), and arm contouring 5 (20.8%). Most positive components (70.6%) regarding QoL were appraised by >80% of the participants, indicating overall satisfaction after BCS. Conversely, only 12.5% of negative components were endorsed by >20% of patients. In conclusion, BCS has a low prevalence after MBS, although it is related to an improved quality of life and body image.
| S-EPMC10179396 | biostudies-literature
Project description:AimsTo test the hypothesis that adipose tissue gene expression patterns would be affected by metabolic surgery and we aimed to identify genes and metabolic pathways as well as metabolites correlating with metabolic changes following metabolic surgery.Materials and methodsThis observational study was conducted at the Obesity Unit at the Catholic University Hospital of the Sacred Heart in Rome, Italy. Fifteen patients, of which six patients underwent Roux-en-Y gastric bypass and nine patients underwent biliopancreatic diversion, were included. The participants underwent an oral glucose tolerance test and a hyperinsulinemic euglycemic clamp. Small polar metabolites were analyzed with a two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC×GC-TOFMS). Gene expression analysis of genes related to metabolism of amino acids and fatty acids were analyzed in subcutaneous adipose tissue. All procedures were performed at study start and at follow-up (after 185.3 ± 72.9 days).ResultsTwelve metabolites were significantly changed after metabolic surgery. Six metabolites were identified as 3-indoleacetic acid, 2-hydroxybutyric acid, valine, glutamic acid, 4-hydroxybenzeneacetic acid and alpha-tocopherol. The branched chain amino acids displayed a significant decrease together with a decrease in BCAT1 adipose tissue mRNA levels. Changes in the identified metabolites were associated to changes in lipid, insulin and glucose levels.ConclusionsOur study has identified metabolites and metabolic pathways that are altered by metabolic surgery and may be used as biomarkers for metabolic improvement.
| S-EPMC8716486 | biostudies-literature
Project description:BackgroundAesthetic units (AUs) and zones of adherence (ZAs) have been previously noted in the face and torso. A systematic classification of common AUs and ZAs has not been previously described for the torso and extremities. Contour and scars are equally important in obtaining the best result. Therefore, the six principles to consider in body contouring surgery (BCS) are that the resulting scar be anchored at a zone of adhesion; at the interface of AUs; concealed within flexion or extension skin creases, or placed according to conventional usage and experience; positioned on the medial aspect of a limb; hidden when nude, topless, or in a variety of clothing such as one-piece and two-piece swimsuits, crop tops, short sleeves, etc; and positioned to avoid a contracture across a flexion joint crease or a dehiscence across the extension aspect of a joint.MethodsImages of male and female massive weight loss (MWL) patients with a history of MWL were reviewed and analyzed.ResultsAUs and Zas are described and codified. An algorithm is provided to aid in planning incisions for BCS.ConclusionWith the increase in BCS after MWL, a classification of AUs and ZAs is considered useful in planning surgery and optimizing the aesthetic result.
| S-EPMC10448935 | biostudies-literature
Project description:Chronic inflammation during morbid obesity significantly alters cutaneous tissue. Large weight loss achieved after bariatric surgery minimizes or halts damage caused by metabolic syndrome, but further deteriorates the clinical condition of skin. Postbariatric skin flaccidity produces major difficulties to plastic surgery. In this study, we analyzed differences in protein composition of the skin between patients with morbid obesity and those after large weight loss and established correlations between differentially expressed proteins and clinical characteristics of postbariatric skin tissue, to improve body contouring surgery techniques.MethodsSkin fragments were removed from the abdomen of 32 patients, who were allocated into 3 groups: morbidly obese, large weight loss without surgery, and postbariatric surgery. Samples were subjected to proteomic analysis, and the protein profiles of the groups were compared. Six differentially expressed proteins of clinical interest were validated by immunohistochemistry and statistical analysis.ResultsComparative analyses confirmed differences in protein profile of the skin between morbidly obese and large weight loss groups. A persistent increase in inflammatory markers such as haptoglobin was observed in all groups and decrease in the expression of collagen XIV, which regulates the physical properties of cutaneous tissue, was observed in the postbariatric group.ConclusionsHigh expression of haptoglobin associated with the decrease of Collagen XIV, vinculin, and periplakin in the groups after major weight losses, mainly postbariatric, confirm that the inflammatory lesion remains active in the skin and causes changes in its structural organization, with serious repercussions on its clinical characteristics and physical properties.
| S-EPMC6756662 | biostudies-literature
Project description:IntroductionVenous thromboembolism (VTE) has been identified as a major public health issue. Postbariatric body contouring surgery represents a major challenge for VTE prophylaxis due to the presence of multiple risk factors and broad areas of dissection that potentially increase the risk of postoperative bleeding.AimTo define current VTE prophylaxis practices among surgeons of the American Society of Plastic Surgeons, performing postbariatric body contouring surgery in the United States.Material and methodsA total of 4081 surveys were sent to registered members of the American Society of Plastic Surgeons by e-mail. We received 596 (14.6%) responses.ResultsA total of 596 surgeons returned completed surveys, with 83% of respondents in private practice and 17% in academic practice. Deep venous thrombosis (DVT) was reported by 40% surgeons, pulmonary embolism (PE) by 34%, and 7% had at least 1 patient having died of a postoperative PE. About 39% to 48% participant surgeons reported providing no chemoprophylaxis to their postbariatric body contouring patients. The most common reason for not using routine prophylaxis was the concern for bleeding (84%), followed by lack of evidence specific to plastic surgery practice (50%). Academic surgeons were more likely to provide chemoprophylaxis when compared with those in nonacademic practice (P < 0.05).ConclusionFor postbariatric body contouring surgery, DVT has occurred in over one-third of plastic surgeons' practices with 7% of surgeons reporting a patient death from PE. A substantial proportion of surgeons performing postbariatric body contouring are not using chemoprophylaxis due to bleeding risk and perceived lack of evidence. VTE prophylaxis in postbariatric body contouring remains a topic that deserves further study.
| S-EPMC4505806 | biostudies-literature
Project description:BackgroundBody-contouring surgery is commonly performed to address functional and aesthetic issues that can arise following bariatric surgery. However, there is limited understanding of the psychological impact of this procedure on Saudi Arabian patients who have undergone bariatric surgery. This study aimed to explore the effects of body-contouring surgery on the psychological well-being, quality of life, and body image of individuals who have undergone bariatric surgery.MethodsThis cross-sectional study assessed the psychological impact of body-contouring surgery by measuring levels of depression and generalized anxiety disorder using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively.ResultsThe study included a total of 227 participants, with 112 (49.3%) undergoing body-contouring surgery. Among the entire sample, 77.5% experienced excess skin folds following bariatric surgery. The prevalence of depression was 6% in the body-contouring group, lower than the 8% observed in the non-body-contouring group (P = 0.073). Notably, anxiety was significantly lower in the body-contouring group, with a prevalence of 4% compared with 6% in the non-body-contouring group (P = 0.006). Additionally, patients who had undergone body-contouring surgery reported higher scores for emotional well-being when compared with those who had not undergone body-contouring (P = 0.011).ConclusionsThe study suggests that body-contouring surgery improves the physical appearance of bariatric-surgery patients and reduces anxiety and depression, leading to improved psychological well-being. Further research, including larger and more diverse populations, such as multicenter studies at a regional or international level, is needed to validate these findings.
| S-EPMC10950165 | biostudies-literature