Approach to the lower body after massive weight loss: the Innsbruck experience with abdomino-torso and thigh-contouring after massive weight loss
Background: The number of patients requiring post-bariatric body-contouring after massive weight loss (MWL) is steadily increasing. The management of this demanding clientele of patients is challenging and requires a structured approach. The aim of this article is to provide a detailed overview of the contouring approach to the lower body after MWL practiced at Innsbruck Medical University, Department of Plastic, Reconstructive and Aesthetic Surgery, along with an analysis of the procedures over a 10-year period. Special attention is given to the surgical challenges, such as patients presenting with pre-existing scars in the upper abdomen.
Methods: A detailed overview of the patient selection as well as the patient evaluation process requiring abdominal, trunk, and thigh-contouring is outlined. The anatomic basis for abdominal and thigh-contouring is depicted along with a detailed depiction of the relevant procedures for abdominal and thigh-contouring, both in presence and without pre-existing scars. Furthermore, an analysis of the patients treated at Innsbruck Medical University for lower body-contouring between January 2002 and June 2012 with respect to selected patient demographics and epidemiology of procedures is performed.
Results: The key to satisfactory results is a thorough analysis of the horizontal and vertical skin and fat excess of the abdomino-torso, buttock and flank areas as well as the thigh areas and choosing an adequate and safe procedure addressing the respective areas of skin and fat excess. Special attention must be given to the distribution and position of pre-existing scars. Within the 10.5-year period, a total of 624 abdominal-contouring and 46 medial thigh-contouring procedures were performed. In 41 cases, tailored techniques were applied paying attention to pre-existing scars. The majority of patients were female (91 %). The average patient age equaled 40.6 years.
Conclusions: A structured approach, analyzing the distribution and composition fat and skin excess in the respective body areas allows for functional, aesthetic and safe and lower body-contouring.