Elsevier

Surgery for Obesity and Related Diseases

Volume 8, Issue 1, January–February 2012, Pages 92-97
Surgery for Obesity and Related Diseases

Integrated health article
Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery

https://doi.org/10.1016/j.soard.2011.06.022Get rights and content

Abstract

Background

Bariatric surgery (BS) produces rapid, massive weight loss, often leaving patients with excess skin that can be esthetically disappointing and can present barriers to physical and psychosocial functioning. Thus, body contouring surgery (BCS) is frequently sought by post-BS patients. The objectives of the present study were to characterize the frequency at which post-BS patients desire BCS and the extent to which patients are satisfied with the excess skin in specific body regions before and after contouring. Furthermore, the present study sought to identify the predictors of which patients might be most desirous of BCS. This was a study conducted at 2 academic research centers.

Methods

Patients approximately 2 years or 6–10 years after BS were recruited and completed the Post-Bariatric Surgery Appearance Questionnaire.

Results

The participants expressed the greatest dissatisfaction with the skin at the waist/abdomen and thigh regions. The most commonly contoured site was the waist/abdomen, and patients rated greater satisfaction with this body region after BCS. Few significant predictor variables were identified. A greater BMI at survey completion was independently associated with lower satisfaction with excess skin, and the time elapsed since BS predicted the desire for contouring.

Conclusion

These findings underscore the importance of educating BS candidates about the issues with redundant skin after weight loss and the possible need for subsequent BCS. With this education, patients might have more realistic expectations concerning BS outcomes and be better positioned to seek BCS when indicated.

Section snippets

Methods

In the absence of a psychometrically validated instrument to assess BCS outcomes, the Post-Bariatric Surgery Appearance Questionnaire (PBSAQ) was previously developed for research in this area. The PBSAQ is a self-report questionnaire that takes approximately 15 minutes to complete. The PBSAQ can be viewed in a recent publication by Ertelt et al. [12], and contains questions on demographics (age, gender, height, weight pre- and post BS), level of desire for BCS, and current degree of

Participants

Data were collected from a total of 207 participants. Of those, 43 participants completed the survey within the first 18 months after gastric bypass and were excluded from the present analysis because they may not have achieved their weight nadir and would potentially be premature for BCS. Patients with missing data for the date of survey completion or BS or gender were not used in the analyses (n = 4). The final analyzable sample consisted of data from 160 participants. The demographic

Discussion

Contrary to our hypotheses, the only predictor of satisfaction with excess skin among patients who had not undergone BCS was the current BMI. The greater the patients' current BMI, the more likely they were to be dissatisfied with excess skin. Similarly, only 1 significant independent predictor of a desire for contouring was identified—the time elapsed since BS. The longer the interval from BS, the less likely the patients were to desire BCS.

The relationship between the current BMI and

Conclusion

Future research should attempt to prospectively determine the variables associated with more extreme difficulty with excess skin after surgery. This information would allow clinicians to tailor patient education to those at greatest risk and prospectively address any modifiable risk factors that might be present.

Disclosures

Dr. Sarwer has been a principal investigator/investigator and received research grants from ASMBS, ASPS, Ethicon Endo-Surgery, and National Institutes of Health; has received consulting fees as a consultant to Allergan, BaroNova, Enteromedics, and Ethicon Endo-Surgery; and has served on the Board of Directors of the Surgical Review Corporation. The other authors have no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

Ross D. Crosby, Ph.D., Li Cao, M.S., and Ann L. Erickson, B.A. for statistical assistance and Troy Ertelt, Ph.D. for assistance with manuscript preparation.

References (19)

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