Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years

doi:10.1016/j.bjps.2014.10.043

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 68, Issue 3, March 2015, Pages 410-418

https://doi.org/10.1016/j.bjps.2014.10.043 Get rights and content

Summary

Background

Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction.

Methods

All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated.

Results

A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2 kg/m² with a mean weight of 76.8 kg at the time of the procedure and a mean weight reduction of 49.6 kg. The mean operative time was 4.85 h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0 g/dl, and 12 (21.8%) patients required a blood transfusion.

Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications.

Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients.

Conclusion

Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit.

Level of evidence

III.

Introduction

Obesity and overweight are a growing global health problem, As of 2008, the World Health Organization¹ estimated that at least 500 million adults aged 20 and older (11%) were obese and 1.4 billion were overweight. In England, there was a marked increase in the proportion of adults who were obese from 13% in 1993 to 24% in 2011 for men and from 16% to 26% for women.² Accordingly, increasingly more patients are undertaking significant weight loss. However, major weight loss generates body deformities, which may then lead to functional problems and psychological distress, offsetting the benefits brought about by weight loss.3, 4, 5 Therefore, the demand for body-contouring surgery is steadily increasing.6, 7, 8, 9 Lower circumferential dermolipectomy removes truncal skin redundancy and lifts sagging tissue from the lower back and gluteal region; it can be associated with liposuction and an autologous fat re-injection to correct lipodystrophy. In spite of the removal of the lax skin, the buttocks will still be flat, square shaped and ptotic with a deficient projection. Autologous gluteal augmentation with a fat island flap restores the gluteal contour.10, 11, 12, 13 A high complication rate and a lengthy surgical procedure time can be expected during this procedure. It follows that the benefit/risk evaluation should be clearly defined for each patient for this high-risk surgical procedure. There are several studies assessing quality of life (QOL) and patient satisfaction following body-contouring surgery.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 They demonstrate improvements in QOL associated with body-contouring surgery following weight loss. However, none of them assess the patients' satisfaction specifically after lower body lift with gluteal augmentation.

The aim of this study was to describe the satisfaction and the complications inherent in a lower body lift with autologous gluteal augmentation by gluteal island flap.

Section snippets

Patients and methods

A 3-year study (between January 2010 and 2013) was performed including all patients who underwent a lower body lift with a gluteal island flap.

The complications were identified and classified as either major complications (thromboembolic or surgical revision) or minor complications (seroma, wound dehiscence, haematoma and surgical site infection).

Satisfaction was assessed using a questionnaire with minimal hindsight of 6 months after the surgery. The first question was: “Would you undergo this

Results

Fifty-five patients (including 49 women) underwent the procedure (Table 1), with an average age of 41.0 years. The average body mass index was 28.2 kg/m² with a mean weight of 76.8 kg following a mean weight reduction of 49.6 kg.

This weight reduction was achieved through bariatric surgery in 47 (85.5%) patients and through lifestyle change and diet in eight (14.5%) patients. The types of bariatric surgical procedures were as follows: a Roux-en-Y gastric bypass for 43 patients, a sleeve

Discussion

The complication rate in our series is quite similar to other series (50% for Nemerofsky,²⁸ 28% for Rohrich,²⁹ 35% for Vico,³⁰ 70% for Kitzinger³¹ and 26% for Koller³²). Associating an autologous gluteal augmentation with a lower body lift does not seem to augment complication rates.

One of the most common complications described following body-contouring surgery for major weight loss is seroma. In our study, we can note that our seroma rate (9.1%) is quite low compared to other series: 16% for

Conclusion

Lower body lift with autologous gluteal augmentation by fat island flap permits the resection of excess skin on the anterior and posterior trunk. It tightens loose skin tissue and allows one to produce a pleasant gluteal shape as well as a flat abdomen. Complications are minor and well tolerated for a radical body change. This procedure has a good overall satisfaction rate, and most of the patients would undergo this procedure again. The gluteus outcome is positively assessed, and even more so

Funding

None.

Conflicts of interest

None declared.

Ethical approval

This study is reviewed and approved by the ethical committee (Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire).

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Citation Excerpt :
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Obesity is a worldwide epidemic. Complication rates after body contouring surgeries in massive weight loss patients were quite high, with seroma development being the second most common complication, reported rates averaging 15%–40%, Methods described to reduce the annoying high rate of seroma did not have a statistically significant difference in reducing seromas.
Our aim was to find a universal solution that could be used with any body-contouring surgery to manage seromas. We tried this novel technique initially on thigh lifts. Instead of wading in the jungle of methods aiming at preventing seromas, we contemplated a drainage channel that would continuously drain any fluid accumulation. The idea was borrowed from the hypothesis of Thompson on lymphoedema management. By excising an area of deep fascia overlying the Vastus Medialis muscle, the muscle would be directly exposed to any seroma fluid and would imbibe it as blotting paper. Furthermore, this technique would open new drainage channels between the superficial and deep lymphatics. This technique was tried in 20 patients, with the excision of deep fascia carried only in one limb. The other limb was left as a control. Rates of seroma formation were noted and duration before it dried up.
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Cette technique a considérablement réduit l’incidence des séromes détectés et la quantité de liquide sérome.
Cette technique a réduit l’incidence de la formation de sérome et est recommandée pour une utilisation de routine lors de toutes les chirurgies de lifting des cuisses.
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Lower bodylift after massive weight loss: Retrospective study of satisfaction, complications and quality of life. About 76 patients over 4 years
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L’amaigrissement massif provoque des déformations cutanées importantes avec des répercutions physiques et psychologiques pour les patients. Le bodylift inférieur est une intervention qui permet de restaurer la silhouette corporelle. Le but de cette étude est d’évaluer le degré de satisfaction et la qualité de vie des patients ayant bénéficié d’un bodylift inférieur et de relever les complications de ces interventions.
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Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years

Summary

Background

Methods

Results

Conclusion

Level of evidence

Introduction

Section snippets

Patients and methods

Results

Discussion

Conclusion

Funding

Conflicts of interest

Ethical approval

J Plast Reconstr Aesthet Surg

J Plast Reconstr Aesthet Surg

J Plastic Reconstr Aesthet Surg

Ann Chir Plast Esthet

Ann Chir Plast Esthet

Ann Chir Plast Esthet

J Plastic Reconstr Aesthet Surg

J Plast Reconstr Aesthet Surg

J Plastic Reconstr Aesthet Surg

Clin Plast Surg

Statistics on obesity, physical activity and diet England

Psychological considerations of the massive weight loss patient

Plast Reconstr Surg

Body contouring following massive weight loss resulting from bariatric surgery

Adv Psychosom Med

Quality of life after gastric bypass for morbid obesity

Int J Obes

After massive weight loss: patients' expectations of body contouring surgery

Obes Surg

Autologous gluteal augmentation after massive weight loss

Plast Reconstr Surg

Remodeling bodylift with high lateral tension

Aesthetic Plast Surg

Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study

Obes Surg

Body image and quality of life in post massive weight loss body contouring patients

Obesity