Effects of abdominoplasty on female sexuality: a pilot study.

INTRODUCTION: Changes in the pubic region resulting from abdominoplasty may have a psychosexual impact. Thus, it is important to study the influence of physical changes on the sexuality of patients after abdominoplasty. AIM: To evaluate the effects of the elevation of the mons pubis and consequent exposure of the clitoris in the vulvar commissure on the sexual functioning and sexual satisfaction of women who underwent abdominoplasty. METHODS: Data were presented as mean±standard deviation. Nineteen women with a mean age of 35±7 years, mean body mass index of 23±2 kg/m(2) and who expressed a desire to undergo abdominoplasty were selected from consecutive patients attending the abdominal plastic surgery outpatient unit of a university hospital. MAIN OUTCOME MEASURES: Physical change (measured by the distance between the xiphoid process and vulvar commissure [xipho-vc]), sexual functioning, and sexual satisfaction (assessed with the Sexuality Assessment Scale), and body image (measured using the Body Shape Questionnaire [BSQ]) were evaluated preoperatively and 6 months after abdominoplasty. RESULTS: There was a significant reduction (P=0.0004; z=-3.53) in the xipho-vc distance 6 months after abdominoplasty compared with baseline (mean difference 3.63±2.79 cm), corresponding to an elevation of the mons pubis and consequent exposure of the clitoris. All patients reported a significant improvement in sexual functioning and sexual satisfaction 6 months after abdominoplasty when compared with baseline (P=0.0001; z=-3.83). BSQ scores indicated an improvement in the patients' concerns about body shape (P=0.0003; z=-3.58). CONCLUSION: Our results suggest that physical change and the new position of the clitoris may have a positive impact on sexuality.

Impaired abdominal skin sensory function in morbid obesity and after bariatric surgery.

BACKGROUND: Bariatric surgery reduces body weight, but creates the need for surgical correction of the patient's body shape, especially of the abdomen. The abdominal skin of the ex-obese has a lower quantity of fibrous and non-fibrous components; however, its functional status has not yet been studied. This study quantified, at different depths, the neurological function of the abdominal skin of the obese and morbidly ex-obese. METHODS: Semmes-Weinstein monofilaments were used to quantify sensory levels of abdominal skin at the supra-umbilical (SU), umbilical (U), and infra-umbilical (IU) levels in 25 currently morbidly obese, 56 post-bariatric patients (open Roux-en-Y gastric bypass), and 43 women with normal body weight and/or overweight without previous obesity (control). RESULTS: Only the control group showed a positive correlation between a worsening of sensory perception and age (p = 0.02). In the morbid obesity group, sensory threshold was higher at the IU level (9.60 g/mm(2)) than at the U (5.86 g/mm(2)) and SU (5.38 g/mm(2)) levels (p < 0.05). The mean sensory threshold for morbid obesity subjects (6.95 g/mm(2)) was higher than that of the post-bariatric patients (4.44 g/mm(2)), which in turn was higher than that of the control group (3.47 g/mm(2)), p < 0.01. CONCLUSIONS: Morbidly obese and post-bariatric patients have lost the normal positive correlation between age and skin sensitiveness. The IU region has sensitiveness compromised in morbid obesity. Sensory thresholds in post-bariatric patients showed improvement relative to morbidly obese, but remained worse than the control subjects.

Post-bariatric abdominoplasty: skin sensation evaluation.

BACKGROUND: The number of bariatric surgeries is progressively increasing in the USA and in Brazil. The number of post-bariatric plastic surgeries also increases as a response to this phenomenon. Abdominoplasties performed in former morbidly obese patients present a larger number of postoperative complications. Studies show that abdominoplasty caused postoperative skin hypesthesia. This study aims at evaluating skin sensibility/sensation in post-bariatric patients submitted to anchor-line abdominoplasty with clinical, qualitative, reliable and reproductive methods. METHODS: Thirty-nine former morbidly obese women after open Roux-en-Y Gastric Bypass were evaluated for skin tactile pain, touch in movement, noxious and innocuous thermal sensibility and vibration. Fifteen patients composed the Control group (which did not undergo abdominoplasty) and 24 patients composed the Study group (which was submitted to anchor-line abdominoplasty without flap undermining). The sensations were evaluated before and after the abdominoplasty. RESULTS: The Control group which did not undergo abdominoplasty showed nearly 100% of positivity to all sensory modalities exception made to vibration which was 56.4-62.2-64.9%. Surprisingly, the Study group showed the same sensation maintenance after the abdominoplasty for nearly all modalities, vibration showed improvement (56.7-71.1-78.3%) without statistical value (p = 0.67). CONCLUSION: There was skin sensation maintenance after anchor-line post-bariatric abdominoplasty. Non-undermining of xipho-pubic flap is a possible reason for this discovery.

A Cirurgia Plástica brasileira e o Código de Ética Médica / Brazilian Plastic Surgery and the Medical Code of Ethics", "_e": "n

Os cirurgiões plásticos devem conhecer o Código de Ética Médica que rege sua conduta profissional, pois cresce o número de processos contra esses especialistas. Este estudo é uma revisão do Código de Ética Médica vigente no Brasil, que monitora (controla, normatiza e/ou define) a atividade profissional, associando-o a exemplos da prática cotidiana. As fontes estudadas foram: Código de Ética Médica, PubMed, SciELO, LILACS, Google Acadêmico e Jornal do Cremesp. Foram estudados todos os artigos pertinentes à legislação que diz respeito à prática médica, sendo apresentados exemplos de cada situação. O cirurgião plástico deve estar consciente de seus deveres e obrigações, fundamentados no Código de Ética da especialidade, para evitar problemas jurídicos. Deve, ainda, aprimorar seu atendimento, detectando alterações psiquiátricas e pacientes mal-intencionados.

The number of lawsuits against plastic surgeons is increasing, and these specialists should be aware of the Medical Code of Ethics that governs their professional conduct. This study is a review of the Medical Code of Ethics in Brazil and gives examples of how ethical guidelines apply to everyday practice. We studied the Medical Code of Ethics and searched PubMed, SciELO, LILACS, Google Scholar, and CREMESP journals for articles pertaining to medical practice legislation. The Code of Ethics for Plastic Surgery requires that plastic surgeons be aware of their duties and obligations in order to avoid legal problems. They should also enhance treatment by detecting psychiatric disorders and litigious patients.