Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years
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).
References (40)
- et al.
Complications following body contouring surgery after massive weight loss: a meta-analysis
J Plast Reconstr Aesthet Surg
(2014 Mar) - et al.
Desire for post bariatric body contouring in South East Scotland
J Plast Reconstr Aesthet Surg
(2013 Jan) - et al.
Post-bariatric surgery body contouring in the NHS: a survey of UK bariatric surgeons
J Plastic Reconstr Aesthet Surg
(2012) - et al.
Bodylift complications
Ann Chir Plast Esthet
(2004 Dec) French creativity in body contouring surgery
Ann Chir Plast Esthet
(2010 Oct)- et al.
Abdominoplastic complications
Ann Chir Plast Esthet
(2004 Dec) - et al.
Circumferential body contouring in bariatric and non-bariatric patient
J Plastic Reconstr Aesthet Surg
(2010) - et al.
Prospective study on complications following a lower body lift after massive weight loss
J Plast Reconstr Aesthet Surg
(2013 Feb) - et al.
Circumferential superficial fascia lift of the lower trunk: surgical technique and retrospective review of 50 cases
J Plastic Reconstr Aesthet Surg
(2012) - et al.
No-drain abdominoplasty with progressive tension sutures
Clin Plast Surg
(2010 Jul)
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
Cited by (19)
One key to fit all locks? Routine internal drainage to minimize seromas during thigh lift surgeries
2022, Annales de Chirurgie Plastique EsthetiqueCitation Excerpt :Various, albeit poorly understood factors, came into play to yield these high rates of seromas [5]. Postoperative risk was influenced by smoking [6–9], current weight [10,11], body mass index (BMI) [9,12], the maximum prior BMI [4,8,9,13], BMI loss [1,8], age [4,13,14] and gender [1,15]. Some authors reported that the weight of excised tissue [9,16] and the volume of lipoaspirate [9] also influenced complication rates, with a 9% risk increase for every pound excised [2].
Study of satisfaction concerning the navel after abdominal dermolipectomy with transposition: A report of 96 cases
2018, Annales de Chirurgie Plastique EsthetiqueLower bodylift after massive weight loss: Retrospective study of satisfaction, complications and quality of life. About 76 patients over 4 years
2016, Annales de Chirurgie Plastique EsthetiqueMorbidity of bodylift. Evaluation of 111 patients over 5 years
2016, Annales de Chirurgie Plastique EsthetiquePostbariatric Abdominal Contouring: Technical Approach and Quality of Life
2022, Plastic and Reconstructive Surgery