Assessment of excess skin and outcome of body contouring surgery in post bariatric patients

Abstract: Aim: A negative effect of massive weight loss is the development of excess skin. Excess skin causes both physical and psychological problems for those affected and their families. The overall aim of this thesis was to improve the knowledge of the prevalence and associated problems of excess skin in post bariatric patients and to evaluate the outcome of abdominoplasty regarding HRQL. Patients and methods: A literature search was performed to evaluate the quality of evidence for health benefits of abdominoplasty. Thereafter, adult post bariatric patients were sent the Sahlgrenska Excess Skin Questionnaire (SESQ) together with a study specific questionnaire to evaluate their experience with excess skin regarding physical, functional and psychosocial impairments, amount and discomfort regarding the same and requested and undergone body contouring surgery. Further, post bariatric adolescents answered the same questionnaires as the adults, and measurements of excess skin were performed. Finally, post bariatric patients undergoing abdominoplasty answered the Short Form-36 (SF-36), a modified version of SESQ and the EuroQol-5D (EQ-5D) before and one year after abdominoplasty. Prior to the surgery, all study participants were randomly assigned to either undergo or not undergo rectus fascia plication, and measurement of the amount of abdominal excess skin was performed. Results: The quality of evidence of positive health effects for patients undergoing abdominoplasty was very low regarding HRQL. Most of the post bariatric patients, including both adolescents and adults of both genders, reported that they suffered from excess skin in several body parts. The majority of the post bariatric patients also requested body contouring surgery. Abdominoplasty increased the physical function subscale of the SF-36 and all 10 items regarding physical, functional and psychosocial impairments of the SESQ. However, plication did not influence the outcome of abdominoplasty regarding HRQL. In addition, low correlations were found between the measured amount of abdominal excess skin and discomfort with the same or change in the physical function subscale of SF-36 following abdominoplasty. Conclusions: Most of the post bariatric patients seem to suffer greatly from excess skin independent of sex or age, and a majority request body contouring surgery at several body sites. Abdominoplasty appears to improve physical and psychosocial dimensions of HRQL. However, the impact of the preoperative measured amount of abdominal excess skin on the improvements in HRQL is low.