Macroscopic anatomic changes of subcutaneous fat tissue in massive-weight-loss patients

After massive weight loss (MWL), patients are known to experience significant improvement in obesity-associated comorbid conditions and metabolic disturbances, but almost two-thirds of them require reconstructive body-contouring surgery.

The authors present an anatomic study of surgical pieces obtained from 28 patients (17 women and 11 men) during torsoplasty and abdominoplasty procedures performed in their department from January 2007 to January 2008. The patients ranged in age from 39 to 52 years (mean, 43.3 years). The patients were divided into three groups. Group A consisted of 9 patients who had a normal body mass index (BMI) and stable weight (±5 kg) over the preceding 3 years. Group B consisted of 10 patients who had followed a nutritional diet over the preceding 3 years, achieving a mean weight loss of 42.2 kg (range, 38-52 kg). Group C consisted of 9 patients who had undergone bariatric surgery and insertion of a gastric band before 2004, achieving a mean weight loss of 47 kg (range, 40-57 kg). The authors evaluated the anatomy of the subcutaneous tissue in four body areas: the epigastric, umbilical, hypogastric, and lumbar regions.

The macroscopic anatomic results of the subcutaneous tissue in the three groups are presented. The patients who underwent bariatric surgery (group C) had significant alterations of the subcutaneous tissue anatomy in all four body areas studied. Plastic surgeons who perform composite body-contouring procedures for this group of patients, combining truncal liposuction and lipoabdominoplasty procedures, should be aware of these anatomic changes. The possibility of a cannula perforating an internal organ during liposuction may have been higher for the group C patients than for the group A and group B patients.

Knowledge concerning the anatomy of the subcutaneous fat in post-MWL patients allows a better choice of contouring procedure from an anatomic point of view, performance of a more rational and effective procedure, and differentiation of the technique depending on the area of the body, avoiding major complications.