Treatment algorithm for abdomino-torso body contouring in massive weight-loss patients in the presence of scars - a comprehensive review

Background: Patients requiring surgical skin excision after massive weight loss are challenging and require a structured approach. The characteristic abdominal deformity includes a draping apron of panniculus, often extending to the glutaeal, back and thigh areas. Occasionally, these deformities are associated with previous surgical scars in the upper abdomen resulting from open gastric bypass surgery or from other procedures, such as open cholecystectomy. These scars can compromise the blood supply of the abdominal skin. For adequate and safe body contouring, both the excess skin and fat as well as the remaining perfusion of the remaining tissues must be addressed to achieve satisfactory results. Method: We propose an algorithmic treatment approach for body contouring of the abdominotorso area in the presence of scars in the upper abdomen. Results: The key to satisfactory results is a thorough analysis of the horizontal and vertical skin and fat excess of the abdomino-torso, buttock and flank areas and choosing an adequate and safe procedure addressing the respective areas of skin and fat excess while preserving the blood supply of the abdomino-torso area in a scarred abdomen. Our algorithmic approach can help in achieving these goals. Conclusion: Our algorithmic approach enables the surgeon to perform safe abdomino-torso body contouring through a structured analysis of the fat and skin excess in the respective body areas even in the presence of surgical scars in the upper abdomen. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.