Introduction

Authors: Magnus Balslev Avnstorp, MD, Mette Ydo Jacobsen, Med. Stud., Anne Mosebo, MD and Emir Hasanbegovic, MD

Patients who have undergone a massive weight loss (MWL) are bothered by loose excess skin, causing difficulties such as skin entrapment, impaired physical activity as well as moisture and infection in the skin folds. These complications can have a severe psychological impact on a patient’s well-being and resection of the excess skin may have a great ameliorating effect. In the following chapters we address the examination of the MWL patient and the surgical techniques used on the arms, abdomen, back, and thighs. Techniques used on the breast when performing mastopexy (breast lift) will be addressed in the chapter:

Breast surgery

Definitions

Massive weight loss (MWL): Loss of at least 15 BMI units, calculated using the patient’s highest known weight (pregnancy not included) compared to the current weight.

Abdominoplasty: Excision of excess skin on the abdomen.

Brachioplasty: Excision of excess skin on the arms.

Thigh plasty: Excision of excess skin on the thighs.

360-degrees belt lipectomy: A combination of abdominoplasty and circumferential excision of skin and fat on the lower trunk.

Pathophysiology

In obese patients, the stretching of the skin will decrease the biomechanical capabilities of the tissue over time. When a MWL is achieved the skin therefore cannot retract properly resulting in skin excess and laxity.

Historical background

Brachioplasty

Correa Iturraspe and Fernandez described aesthetic brachioplasty in 1954. Over the years, the method has been reshaped, to improve the scar aesthetic, the resulting arm shape and the overall safety of the procedure.1

Abdominoplasty

Massive weight loss was first described in 1899 by American surgeon Kelly HA, who performed a herniorrhaphy through a transverse incision extending across both flanks. The hanging abdominal pannus was resected, and the incision closed without undermining. The umbilicus was sacrificed. Kelly called the procedure “transverse abdominal lipectomy”.  In 1972 surgeon Regnault P, described the technique still used today, the low “W” incision. The procedure may be combined with liposuction or the excised tissue may be used as a flap for breast reconstruction, based on the deep inferior epigastric artery perforator known as the DIEP-flap.