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Obesity is defined as a body mass index (BMI) of 30kg/m2 or greater. By this definition a third of men and a third of women in the US are obese. The prevalence of obesity in this country has doubled since 1980. This is a a major health concern because obestiy increases the risk of many diseases and health conditions, including but not limited to sleep apnea, diabetes mellitus, hypertension, osteoarthritis, dyslipidemia, certain types of cancers, gallbladder disease, stroke, and coronary heart disease. The associated health costs are quite high and have been estimated to be in the range of $75 billion per year. With more severity obesity of body mass indexes of 40kg/m2 or more the condition is considered morbid and weight loss surgery is usually recommended if dieting fails. Weight loss surgery has been proven to reduce the incidence and severity of medical conditions associated with morbid obesity. The American National Institute of Health guidelines state that bariatric weight loss surgery should be offered to patients with a BMI of 35–40 kg/m2 who have obesity related conditions such as diabetes mellitus or obstructive sleep apnea, or in those with a BMI of 40 kg/m2 or greater regardless of weight related co-morbidity conditions.
A medical journal article just published revealed on retrospective review that patients maintained weight losses greater than the amount of tissue removed at abdominoplasty/tummy tuck more than a year after the surgery. This amount of maintained weight loss was greater in people who were heavier prior to surgery (24.5kg/m2 or more) and was proportional to the amount of tissue removed at surgery for 4.5 or more pounds of tissue removal. When asked why the weight was lost and the loss maintained these patients responded that they felt full after and between meals so they ate less. In my experience patients lose additional weight because they like and want to maintain their results. That involves lifestyle changes including exercise and eating a healthier diet. Abdominoplasty however should not be performed primarily to lose weight because the complication rates are quite high for patients with BMI over 40kg/m2 and the results are less than optimal with BMI of 35 to 40kg/m2. Nearly every patient I have ever seen who underwent abdominoplasty when morbidly obese (by surgeons other than myself) had complications including disruption of suture lines requiring months to heal. The best results and fewest complications are seen in patients who have stable weights, are not morbidly obese and have good quality skin without stretchmarks.
A Swiss study published in Oct 2012 showed that patients who have abdominoplasty to remove excess skin resulting from weight loss surgery are more likely to keep the weight off after the procedures. These patients regain about a pound a year vs. a 4 pound annual gain for patients who have weight loss surgery without body contouring surgery to remove excess skin. The contouring surgery produces a second wave of elation that helps patients stay on track to lose more weight. The timing is usually 12 to 18 months after the weight loss surgery as the complication rate at that time becomes the same as for those who have never had weight loss surgery.
There is clearly a benefit to abdominoplasty or tummy tuck that goes beyond the initial look achieved by removing excess skin and tightening abdominal muscles. The procedure has a long lasting effect which is different from a facelift whose affect diminishes with time due to the unstoppable aging process.
The obvious weight loss in this patient after abdominoplasty surgery should be maintained.
Aaron Stone MD - Plastic Surgeon Los Angeles
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