Optimization of patient safety in postbariatric body contouring: a current review

Postbariatric body contouring is a major growth field in plastic surgery as a direct result of the increasing incidence of bariatric surgery performed in the United States. As experience has accumulated in this subspecialty, technical procedures have been refined and dramatic aesthetic benefits have been seen in postoperative results. However, few objective guidelines exist on the optimization of patient care and safety in this complex patient population. This study sought to review the literature on body contouring after massive weight loss and patient safety to provide the reader with a summary of current recommendations. A literature review was performed with PubMed and MEDLINE. Eighty relevant articles, ranging from case reports and expert opinions to prospective randomized trials, were identified and reviewed in detail. Literature consensus guidelines included completion and stabilization of weight loss before surgery with a body mass index ideally less than 32, smoking cessation, nutritional assessment, anemia screening, usage of mechanical prophylaxis against thromboembolism, and strong consideration for usage of chemoprophylaxis with low molecular weight or unfractionated heparin. Procedures should be performed in accredited facilities with appropriately trained staff, and special intraoperative consideration should be given to patient positioning and avoidance of hypothermia. Postoperative management is optimized by the development of clinical pathways involving the surgeon, patient, and support staff.