A. abdominoplasty

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permanent weight reduction from abdominoplasty see http://www.plasticsurgery.org/news-and-resources/many-women-have-long-term-weight-loss-after-tummy-tuck-reports-plastic-and-reconstructive-surgery.html

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  • 1. Permanent Weight Reduction after Abdominoplasty:Neurocrine Factors, A Pilot StudyRex Moulton-Barrett, MD & Jennifer Fuller, B.A.Plastic & Reconstructive Surgery Alameda and Brentwood, Ca

2. The Role for Abdominoplasty ? Just because you can, does not mean you should ? 3. After AbdominoplastySome Patients:Lost weight & Lost no weight 4. Questions Does abdominoplasty lead to long-term weight loss ? Which group of patients benefit most ? What are the cause(s) of weight loss after surgery ? 5. Obesity Epidemic BMI: Body Mass Index: weight kg/(height m) 2 40 6. Treatment of Obesity3 main methods of treatment: Life Style Modification Moderately effective but difficult to monitor and sustain Pharmacological Therapy Few effective treatments exist Surgical Treatment Significant and permanent weight loss Insurance criteria morbid obesity (BMI 40) 7. Life Style Modification Convert to negative energy gap Increased energy expenditure: reduce non-active time: car, chair, sofa increased exercise time increased energy lost during exercise Diet: high proteinlow carbohydratelow sugar+ ketogenic diets reduce appetite( Am J of Clin Nutrition, 2008: 87(1), 44-55 ) avoid exercise before meals: 20 minute run =20ozie avoid post exercise calorie rewards 8. Current Weight Reduction Drugs( 1% of 59 billion dollars spent to loose fat in USA / yr )1997:fen-phen (fenfluramine-phentermine) & Redux (dexfenfluramine) removed from market % body weight lost% pts lost at least minus placebo5% body weighta.c.t. placebo /x FDA Approved Meridia: Sibutramine 4.3 55/27 Xenical: Orllstat2.9 54/33 New drugs pending approval Qnexa9.0 67/19 Contrave 4.6 53/21 Lorcaserin 3.4 47/23 9. Mechanism of Action Meredia: Monoamine RI (serotonin & noradrenaline)(Abbott) may BP, HR: not to use if hypertensive unlike fenfluramine does not elevate serum serotonin controls binge eating Qnexa:Phentermine & Topiramate(Vivus) 56 week course: 37 lb loss: BP, glucose, cholesterolmay be useful in type 2 DMPhentermine: hypothalamic norepinephrine releasehigh dose: potential for dependenceTopiramate: ( Topamax ), anti-epileptic,anti-migraine,bipolar/binge eating 10. Surgical TreatmentGastric BandsPartial Gastric & Intestinal Bypass( Roux en Y )Abdominoplasty ? 11. Abdominoplasty Work-Up Obese versus abdominal laxity or symptomatic pannus ? First consultation: attempt weight reduction if >200lbs Charge about 25% more if over 200lbs 3 S plan: South Beach Diet, Sugarless house, Stationarybike with 45 minute 3x week TV contract after meals + Meridia if unsuccessful > 4 weeks & binge eating ? 12. Abdominoplasty Technique Low incision 4 cm above the anterior labial commissure Aggressive midline Rectus Abdominus plication Jack knife sitting / Trendelenburg position closure Closure: interrupted Scarpas fasciarunning dermal barbed 3.0 V -Lock Sutureskin glue and 1 inch Steri-Strips Lateral flank liposuction for contour 5 day pain pump & overnight in surgery center Rented surgical bed at home for 2-4 weeks Prolonged paper taping for 6 months when clothed 3 Ss starting 6 weeks post-op 13. MethodsRetrospective case review: chart & structuredinterviewsame surgeon and one post-graduate studentn= 21 patients post-abdominoplasty Follow up to > 1 year: 2007-2009 14. MethodsData collected included: Age, sex, and height Previous bariatric surgery ? Weight prior to abdominoplasty Changes in satiety Minimum weight and time attained Patients beliefs about cause of wt loss Time when weight regained Patient satisfaction with surgical Weight at 1 year post-surgeryresults Current Weight Changes in diet & exercise aftersurgery Complications of surgery Weight of pannus resected 15. Results: Patient Population 5/21 patients previously underwent bariatricsurgery RangeMeanAge21-61 years45 yearsHeight 50 6055Pre-op Weight105-245 lbs167.5 lbsPannus Weight1.8 12.5 lbs 5.74 lbs 16. Results: BMIsMy patients BMI mean: 27.66, lowest 18, highest 33.5My patientsBMI US population 21 % Normal33 % 50 % Overweight33 % 29 % Obese 33 % NoneMorbid Obesity3% 17. Results: Patient Weight loss 90.5 % reported weight loss 47.6% maintained weight loss > 1 yr after surgery 18. Results: Patient Weight Loss Percent of Mean Mean Mean Time Mean Time of Patients Pre-op Maximumof MaxWeight RegainWeight Weight Weight Loss (months)(lbs)loss (lbs) (months)Short term 42.9 161.8 8.7 2.37.1weight lossonly ( 1 year)n=10No Weight loss 9.5175.5 ______ ___n=2 19. Results: Patient Weight lossWeight loss as a function of Pannus Weight:Weight ofNo. of Pre-opMaximum % with long-term Pannus PatientsWeightweight loss weight loss (> 1 year) 4 lbs7144.95.3 33 %> 4 lbs 14178.7 14.7 54 % 20. Results: Patient Weight Loss The greatest predictor of weight loss: pre-operative weightPre-op WeightNo. of MeanMean Mean TimeNo. Patients(lbs)Patients Weight of MaximumMax Weight with longPannusWeight Loss reached term weight(lbs) Loss (lbs) (months) loss (>1year)< 140 lbs4 2.51.8 1.4 0140 to < 210 145.6153.5 9 (64.3%) 2103 9.28.6 2.2 1 (33.3%) 21. Pre-operative weight associated with long term weight lossLONG TERMNO LONG TERMWEIGHT WEIGHT LOSS WEIGHT LOSS (LBS)( >/= 4lbs & >1 YR ) ( < 4lbs & > 1 YR )< 140 & 2101 6 140 to 210 9 5p/= 4lbs & >1 YR ) ( < 4lbs & > 1 YR )