The impact of preoperative anxiety, depression, and chronic pain on outcomes in abdominal wall reconstruction.

PURPOSE: An association of anxiety with surgical outcomes has been suggested, including with open ventral hernia repair (OVHR). This study examines the interaction of multiple comorbidities, including anxiety, depression, chronic pain, and hernia characteristics with outcomes after OVHR. METHODS: Patients with anxiety were identified in an existing, prospectively collected, data set of OVHR with preoperative work-up including CT scans (2007-2018). A patient with a diagnosis or prescription for anxiolytics, anti-depressants, or narcotics was considered to have anxiety, depression, or chronic pain, respectively. Hernia characteristics were analyzed using 3D volumetric software. Univariate and multivariate analyses were performed to assess for the impact of anxiety on surgical outcomes. RESULTS: A total of 1178 OVHRs were identified. The diagnosis of anxiety (23.9%) was associated with female gender (29.1% females vs. 16.9% males, p = 0.002), depression (56.7 vs. 18.8%, p < 0.0001), preoperative chronic pain (43.6 vs. 26.9%, p < 0.0001), COPD, arrhythmia, history of MRSA, and sleep apnea (p ≤ 0.05 all values). Patients with anxiety had larger hernia volume and defect size, and were more likely to undergo component separation, with higher rates of wound complication and intervention for pain (p ≤ 0.05 all values). After multivariate analysis controlling for multiple potentially confounding factors, the comorbidities of anxiety, depression, and preoperative chronic pain were not found to be significantly associated with adverse outcomes. CONCLUSIONS: The diagnosis of anxiety is associated with preoperative comorbidity, surgical complexity, and adverse outcomes after OVHR. However, when comorbidities are controlled for, the diagnosis of anxiety, depression or preoperative pain does not independently predict adverse outcomes. In this context, anxiety may be considered a marker of patient comorbidity in a complex patient population.

Validation of the Finnish version of the BODY-Q patient-reported outcome instrument among patients who underwent abdominoplasty.

BACKGROUND: Massive weight loss can notably affect patients' health-related quality of life (HRQoL) and body image. Yet, no body contouring specific instruments to assess HRQoL and body image after massive weight loss have been validated in Finnish. The BODY-Q includes 26 independently functioning scales and a single checklist that measure appearance, HRQoL, and experience of care. The aim of the present study was to translate and validate a Finnish version of the BODY-Q among patients who underwent abdominoplasty. METHODS: The BODY-Q was translated into Finnish using recommended guidelines. Eighty-two patients who underwent abdominoplasty due to massive weight loss were identified from hospital records using procedure codes. A postal survey including the BODY-Q, the 15D, and general health and pain instruments was used. Criterion validity, Cronbach's alpha, and floor and ceiling effects were analyzed. RESULTS: The BODY-Q translated well into Finnish. Fifty-three patients returned the questionnaires (response rate 65%) and were included. All but the Scars subscale correlated significantly with the 15D mean score, thus indicating strong criterion validity against a generic HRQoL tool. The Excess Skin and the Physical Function scales reached the ceiling effect (>15% of maximum points) in our postoperative sample. No floor effects were observed. Internal consistency of the BODY-Q scales was high (Cronbach's alpha range, 0.81-0.95). CONCLUSIONS: The Finnish version of the BODY-Q instrument is equivalent in terms of content, accuracy, and comprehensiveness to the original English version. The findings of the present study indicate that the BODY-Q has psychometric properties suitable for assessing outcomes and treatment effectiveness of abdominoplasty.

Aesthetic abdominoplasty has a positive impact on quality of life prospectively.

BACKGROUND: In our previous retrospective study, we detected an increased quality of life after aesthetic abdominoplasty. In this survey, we analyzed quality of life, self-esteem, emotional stability, and mental health before and after aesthetic abdominoplasty prospectively. METHODS: Twenty-two female patients were surveyed before and six months after their surgeries. The testing instrument consisted of a self-developed indication-specific questionnaire and four standardized tests (Questions on Life Satisfaction plus a specified part body image, Rosenberg Self-Esteem Scale, Freiburg Personality Inventory, and Patient Health Questionnaire-4). RESULTS: Significantly increased values were found concerning feeling comfortable in swimwear in front of the mirror or the sexual partner and at social or professional activities (each p=0.000). Women had less problems doing sports (p=0.029) and felt more feminine (p=0.012). Sum scores of general life satisfaction (p=0.016) and scores of the items leisure activity (p=0.003), relaxing abilities (p=0.002), and sexuality (p=0.046) showed significant improvements. The body image improved in general (p=0.010) and in particular in the items abdomen, hips, and waist (each p=0.000). Emotional stability increased significantly (p=0.029). We detected a mild mental depression in 27% and a moderate depression in 32% of our patients before surgery. Depressive disorders were significantly reduced (p=0.004) down to mild depression in 18% and moderate depression in 9% of the patients. CONCLUSION: Positive results for quality of life shown in the retrospective study were confirmed. Abdominoplasty improves general life satisfaction and satisfaction with health and outer appearance and increases emotional stability. Depressive patients showed a significant improvement after aesthetic abdominoplasty.

Validation of the American College of Surgeons National Surgical Quality Improvement Program Risk Model for Patients Undergoing Panniculectomy.

Panniculectomy procedures have been reported to significantly improve quality of life, increase mobility, and improve hygiene in patients with a significant pannus formation. The primary aims of this study were to determine which preoperative risk factors may be used to differentiate postoperative complication rate among patient cohorts and to validate utilization of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator in patients undergoing panniculectomies. METHODS: This retrospective study included all patients who underwent a panniculectomy procedure at our institution from 2005 to 2016. Baseline characteristics, preoperative risk factors, medical comorbidities, and postoperative complications were collected via retrospective chart review. RESULTS: Two hundred sixty-four patients who underwent a panniculectomy were identified. The odds ratios of any postoperative complication were 8.26, 7.76, and 16.6 for patients with classes 1, 2, and 3 obesity, respectively (P < 0.05). Statistical modeling was utilized to evaluate the predictive performance of the ACS-NSQIP Surgical Risk Calculator. We calculated the C-statistic for the ACS-NSQIP model to be only 0.61, indicating that although the model is associated with the risk of complication, it does not have a strong predictive value for this particular procedure. DISCUSSION: This study is one of the first to characterize postoperative complication rate based on extremum of body mass index for panniculectomy patients. Our results show that the utilization of the ACS-NSQIP Risk Calculator in this particular patient population underestimates the complication risk as a whole, which may necessitate the future development of a separate risk assessment model for this procedure.

Does Body Contouring After Bariatric Weight Loss Enhance Quality of Life? A Systematic Review of QOL Studies.

Massive weight loss following bariatric surgery can result in excess tissue, manifesting as large areas of redundant skin that can be managed by body contouring surgery. This study aims to quantify the effects of body contouring surgery on indicators of quality of life in post-bariatric patients. A systematic review and meta-analysis of the literature revealed on indices of quality of life in post-bariatric patients, before and after body contouring surgery. Body contouring surgery resulted in statistically significant improvements in physical functioning, psychological wellbeing and social functioning, as well as a reduction in BMI. Body contouring surgery offers a strategy to improve quality of life in patients suffering from the functional and psychosocial consequences of excess skin after bariatric surgery.

Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq.

BACKGROUND: The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives. OBJECTIVES: Is there a gender difference in seeking body countering after bariatric surgery for weight loss? PATIENTS AND METHODS: A longitudinal observational study includes 209 obese patients with mean age of 31 ±â€¯8.6 years; (31 ±â€¯9, 31 ±â€¯7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ±â€¯9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ±â€¯7 cm in female and 118 ±â€¯4 cm in males. RESULTS: Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ±â€¯2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50-70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor. CONCLUSION: The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.

Fully Awake Breast Reduction.

The authors present 25 cases and an in-depth 4-minute video of fully awake aesthetic breast reduction, which was made possible by thoracic epidural anesthesia. There are obvious and important advantages to this technique. Not only does this allow for intraoperative patient cooperation (i.e., patient self-positioning and opinion for comparison of breasts), meaning a shorter and more efficient intraoperative time, there also is a reduction in postoperative pain, complications, recovery, and discharge times. The authors have also enjoyed great success and no complications with this technique in over 150 awake abdominoplasty/total body lift patients. The authors feel that the elimination of the need for general anesthesia by thoracic epidural sensorial-only anesthesia is a highly effective and efficient technique, with very few disadvantages/complications, providing advantages to both patients and surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Body Image & Quality of Life: Changes With Gastric Bypass and Body Contouring.

INTRODUCTION: Bariatric surgery has emerged as an effective method of combating the morbid obesity epidemic. However, the massive weight loss that follows may result in contour changes that can affect body image and quality of life. Our study examines the effects and consequences of bariatric surgery and subsequent body contouring on body image and quality of life. METHODS: Patients were prospectively followed up through their experience with bariatric surgery and subsequent body contouring surgery. Using 2 validated survey instruments, the Multidimensional Body-Self Relations Questionnaire and the Short Form 36 (SF-36), patients completed questionnaires preoperatively and at 6, 12, and 24 months postoperatively. Mean scores were determined by repeated measures analyses of variance F tests. RESULTS: One hundred seventy-five patients were surveyed before bariatric surgery, with noted declines in survey completion at 6, 12, and 24 months. Appearance Evaluation scores improved significantly at all intervals (P = 0.0033), as did Body Area Satisfaction Scale and Appearance Orientation scores (P = 0.0079 and P = 0.044, respectively). While Overweight Preoccupation and Self-Classified Weight scores decreased over time, only the latter was significant (P < 0.0001). The composite SF-36 score for patients awaiting bariatric surgery (54.1%) with postoperative scores at 6 (67.6%,), 12 (at 74.0%), and 24 (76.7%) months being significantly higher (P < 0.0001). The body contouring group consisted of 41 patients who primarily had lower body procedures, with 31 patients surveyed at 6 months and 27 patients at 12 months. For this cohort, Appearance Evaluation and Body Area Satisfaction Scale scores both improved significantly (P = 0.0001 and P = 0.0005, respectively) whereas Appearance Orientation scores declined significantly (P = 0.0055). Both Overweight Preoccupation and Self-Classified Weight scores decreased with only the latter being statistically significant (P = 0.0286). Postoperative SF-36 scores at 6 (72.9%) and 12 (64.5%) months were no different than patients awaiting body contouring (71.3%). CONCLUSIONS: Using 2 validated survey instruments, we show that patients undergoing bariatric surgery have improvements in body image and quality of life. Subsequent postbariatric body contouring surgery results in further improvements in body image. Our findings provide measurable evidence for the value of body contouring after significant weight loss, which may favor greater insurance coverage for this patient population.

Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty With Rectus Plication.

BACKGROUND: Substantial fluctuations in body weight can result in diastasis recti and weakening of the connections between the lateral abdominal muscles and the rectus sheath. OBJECTIVES: The authors sought to determine the postural and psychological effects of abdominoplasty with vertical rectus plication. METHODS: Forty women with substantial back and lumbar pain owing to abdominal lipodystrophy were evaluated in a prospective study. Preoperatively and 6 months postoperatively, patients underwent bidirectional radiography of the thoracic and lumbar regions. A visual analog scale (VAS), the Beck Depression Inventory (BDI), and the Nottingham Health Profile (NHP) were applied to assess physical, psychological, and quality-of-life changes following surgery. RESULTS: Significant improvements in posture, assessed in terms of lumbar lordosis, thoracic kyphosis, and the lumbosacral angle, were observed 6 months after abdominoplasty with rectus plication. Results of the VAS and BDI indicated significant improvements in pain and quality of life, respectively. Results of the NHP indicated significant postoperative improvements in fatigue, pain, and sleep. CONCLUSIONS: Abdominoplasty with rectus plication improves posture by tightening the thoracolumbar fascia. In selected patients, abdominoplasty can reduce back and lumbar pain, thereby improving quality of life.

Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact.

INTRODUCTION: Massive weight loss frequently leads to a ptosis or a pubic bulge. This deformation is a source of functional as well as aesthetic discomfort, and it also has psychological repercussions. We have analyzed the degree of satisfaction reported by 23 female patients having undergone a monsplasty procedure and have also proposed a decisional algorithm designed to facilitate surgical care according to type of pubic deformation. MATERIALS AND METHODS: This is a one-year prospective study involving 23 female patients having undergone a monsplasty procedure following massive weight loss. The interventions were all carried out in standardized fashion by the same surgeon according to stage of deformation. Analysis of the patients' degree of aesthetic and functional satisfaction was performed using a questionnaire filled out during preoperative and postoperative consultations, the latter taking place 6 months to one year after the operation. It included a self-esteem assessment based on the Rosenberg scale, appraisal of functional benefits (clothing, sexual activity, daily physical activities, intimate hygiene) and evaluation of the pubis in aesthetic terms. RESULTS: Assessment of impact on self-esteem revealed average improvement of 10.08 points, rising from 25.87 to 35.95. All of the patients, without exception, were satisfied or very satisfied with the impact of monsplasty on the different items under evaluation. stage 3 and stage 4 patients were particularly sensitive to improvement involving personal hygiene, physical activities and the clothes they wore. In most cases, they likewise reported a positive impact on their sexual experience. CONCLUSION: Abdominoplasty or body lift without monsplasty can entail long-lasting aesthetic and functional discomfort. Thorough preoperative semiological analysis is essential to optimized surgical care conducive to successful integration of the monsplasty. An appropriate caretaking attitude enhances both the aesthetic result and patient self-esteem.

Multiple timescales of body schema reorganization due to plastic surgery.

Plastic surgery modifies the distribution of mass centers of a person's body segments, changing his or her posture. The functional reorganization processes that lead subjects to re-integrate these body changes into a new stable body (posture) schema is poorly understood but current theories suggest the possible contribution of two components: a feedback mechanism that strongly depends on sensory input and an internal model that is relatively less dependent on sensory input and improves posture control, for example by compensating for delayed feedback. To assess the relative contributions of these two mechanisms during the functional reorganization of a posture scheme, we have conducted a longitudinal postural study in a population of healthy adults who were subject to breast plastic surgery to reduce or augment body weight. We measured participants' orthostatic posture and ground reaction force immediately after, after 4 months, and 1 year after the surgery. To investigate the role of visual sensory information in the reorganization process we tested the participants with eyes open and closed. Our results indicate that participants find a new dynamical equilibrium within a few days. However, posture maintenance remains sub-optimal long after the center of masses and the resultant of ground reaction force stop changing; in some cases, for more than 4 months. Furthermore, the re-adaptation process is faster and more efficient in the eyes-open than in the eyes-closed condition. These results suggest that the reorganization involves different subsystems (responsible for the biomechanical changes, the re-calibration of feedback mechanisms, and the re-adaptation of internal models), which act at different timescales.

A study of postural changes after abdominal rectus plication abdominoplasty.

PURPOSE: Factors such as body masses and humour are known to influence human posture. Abdominoplasty, which causes a sudden change in body masses, significantly improves body image and self-esteem. The aim of this study was to assess postural changes after abdominoplasty by studding the position and orientation through space of the body and the centre of pressure. METHODS: Patients affected by excess abdominal skin and/or significant abdominal muscular anterior wall laxity due to undergo an abdominoplasty were enrolled. Posture was evaluated both before and for 1 year after surgery by quantifying the centres of mass, using the Fastrak™ system, and the centre of pressure, using stabilometry. The Wilcoxon signed-rank sum test was used to compare changes. RESULTS: Forty-six patients were enrolled. A retro-positioning of the pelvis with a compensatory advancement of the head and shoulders, confirmed by the baropodometric analysis, was evident in the early post-operative period. The biomechanical system subsequently stabilized, achieving a state of equilibrium 1 year after surgery. CONCLUSIONS: We believe that the change in posture following abdominoplasty is a consequence of both surgery (changes in body masses) and psychological factors that influence posture. Indeed, redundant abdominal skin and abdominal muscular anterior wall weakness are often associated with kyphosis since patients try to hide what they consider to be a source of embarrassment. The discovery of a new body image eliminates dissatisfaction, reduces anxiety and increases self-esteem, which provide psychological and physical benefits that improve the quality of life.

[Influence of lifting of muscular aponeurotic tissues of the hypogastrium area on quality of life in abdominoplasty patients].

An analysis of complex clinical and ultrasonic investigations of the abdominal wall and the following surgery in 42 women with ventral hernia of big size accompanied by the ptosis of the abdomen was made. The patients were divided into two groups, each consisting of 21 patients.The endoprosthesis replacement of defect of the abdominal wall was made with standard polypropylene implant in the first group. The endoprosthesis replacement was complemented by lifting of muscular aponeurotic tissues of the hypogastrium using the implant of the original construction in the second group. The polypropylene endoprosthesis includes the main flap (15 x 15 cm) with rounded corners and the additional flap (5 x 40 cm) as a broad band situated at the lower edge of main flap in across-track direction. The increase of physical component of health was noted in 1.8 times in the second group patients and psychological component raised in 2.5 times.

Overweight/obese patients referring to plastic surgery: temperament and personality traits.

BACKGROUND: Correlations between psychiatric disorders and overweight/obesity are reported in the literature. However, temperament/personality traits have been less frequently studied even though the correlation with Axis-1 diseases is well defined. The present study aims to detect correlations between psychiatric disorders, temperament traits and body image perception in overweight and obese patients who seek surgical lipostructuring treatment. METHODS: Seventy overweight/obese patients (age 18-60 years, BMI 25-34.9 at recruitment) referring to the outpatient service for obesity-related lipodystrophism were enrolled in the period March 2008-March 2012. Psychiatric disorders, temperament traits, and body image perception were evaluated and compared with a control group (N = 33) from the general population sharing clinical/demographic features. RESULTS: Patients had higher scores in lifetime depression, with moderate/mild concern with body shape. Regarding personality traits, tests revealed higher scores on subscale RD4 (dependence/independence) in patients, whereas controls scored higher on the "openness to experience" NEO Five Factory Inventory sub-scale. Obese patients had a higher prevalence of obsessive characteristics. CONCLUSIONS: The affective sphere is an important feature in obese patients, as are obsessive traits, since negative body shape perception and temperament and personality characteristics appear to be involved in leading patients to seek surgical advice. These aspects should be involved in medical/surgical outcomes and compliance with treatment. The future possibility of identifying patients who show alterations in these traits or psychic characteristics may represent a possible instrument to avoid early post-treatment relapse and to implement the service offered to patients, with appropriate psychiatric care before and after surgery.

Shame and self-acceptance in continued flux: qualitative study of the embodied experience of significant weight loss and removal of resultant excess skin by plastic surgery.

This study explored the embodied experience of body change using a qualitative design. Eight previous plastic surgery patients of a London hospital took part in in-depth, semi-structured interviews 1 year post a plastic surgery procedure to remove excess skin around their abdomen, resulting from weight loss. Participant interviews were analysed using Interpretative Phenomenological Analysis. Two sub-themes titled 'Shame of the hidden body' and 'Lack of acceptance; the future focused body' are presented in this article. Findings are considered in relation to theories of 'Body Shame' and in the current cultural context.

The impact of abdominoplasty after massive weight loss: a qualitative study.

A sharp increase in bariatric surgery has resulted in a spike in the population of patients seeking plastic surgery after massive weight loss. This study was undertaken to determine how patients experience plastic surgical removal of an overlap flap and how they benefit from the surgery. A content analysis of interviews with 10 patients who underwent abdominoplasty was carried out approximately 12 months after the procedure. All interviews were audio-taped, transcribed, and analyzed using inductive reasoning. The data were then organized into categories that reflected emerging themes. All patients reported benefits in areas such as mental health, quality of life, or body image. Plastic surgery after weight loss improves psychosocial well-being. These results will influence the indication for a reconstructive operation in future and underline the need for reconstructive surgery in a multidisciplinary care program after weight loss surgery in morbidly obese patients.