Evaluation of modified abdominoplasty for excess skin in post-bariatric surgery patients with residual obesity

Excess skin after massive weight loss is especially discomforting on the abdomen due to physical and psychosocial symptoms, and many patients with excess skin have a lowered Quality of Life (QoL). Abdominoplasty may improve symptoms as well as QoL and is offered to post-bariatric patients in Sweden with a post--operative body mass index (BMI) < 30 kg/m2. However, since > 50% never reach a BMI < 30, they are often left with an abdominal pannus that may hinder further weight loss. The reluctance to operate on patients with BMI > 30 is the increased risk of complications reported in several studies. Contradictorily, many studies have not found BMI > 30 to be an independent risk factor. Thus, the aim of this study was to prospectively evaluate a modified abdominoplasty technique on patients with a residual BMI 30-40, regarding complications and patient satisfaction. To contextualize, this was compared to a group of post-bariatric patients with a BMI < 30 that underwent standard abdominoplasties. A total of 110 patients underwent either a standard abdominoplasty (BMI < 30 group) or a modified abdominoplasty (BMI 30-40 group). Pre-, peri-, and post-operative data were analyzed. The complication rates were similar, apart from that the patients with BMI 30-40 had significantly more bleedings requiring re-interventions. There were no other significant differences in the complication panorama. The results from the questionnaires implied significant improvements in QoL and perception of excess skin, particularly in the BMI 30-40 group. In conclusion, this modified technique for abdominoplasty may be an acceptable compromise to a standard abdominoplasty for post-bariatric patients with residual obesity. Clinical trials registry: https://www.researchweb.org/is/sverige/project/203961.