Body contouring procedures do not lead to improved long-term weight loss after bariatric surgery, study finds

For patients with massive weight loss following bariatric surgery, subsequent body contouring to remove excess skin is not in itself associated with long-term weight loss, reports a study in the June issue of Plastic and reconstructive surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The magazine is published in the Lippincott portfolio by Wolters Kluwer.

Contrary to previous studies, we found that body contouring procedures do not lead to improved weight loss or weight maintenance after bariatric surgery. Rather, the reported benefits of body contouring appear to be in improving quality of life.”

Teresa Benacquista, MD, ASPS member surgeon, Montefiore Medical Center, Bronx, NY

New look at how body contouring affects long-term weight loss

Body contouring refers to a series of surgical procedures to remove excess skin in patients with significant weight loss, with the aim of improving the patient’s appearance, reducing discomfort and improving physical function. Previous studies have suggested that patients undergoing body contouring have more sustained weight loss over time, although some studies have reported conflicting results.

The study included 2,531 patients who underwent bariatric surgery between 2009 and 2012. Of these patients, 350 patients underwent body contouring, an average of two years later. Another 364 patients consulted plastic surgeons about body contouring, but did not undergo surgery. The remaining 1,817 patients had not received any body contouring or consultation.

At follow-up, patients who underwent body contouring did indeed have more sustained weight loss. After one year, the average body mass index (BMI) was about 3 kg/m2² lower in the body contouring group, compared to patients who had bariatric surgery alone. By seven years of age, the BMI was 5 kg/m2² lower for patients undergoing body contouring.

However, weight loss was also greater in patients who had had a consultation but did not continue with body contouring. For this group, the average BMI was 1.5 kg/m² lower at one year compared to patients without consultation, and 2.3 kg/m² lower after seven years.

Further analysis focused on 259 patients from the consultation group who had lost enough weight to be eligible for body contouring. For these patients, the average BMI after seven years was about the same as for patients who underwent body contouring: 31 versus 30 kg/m²compared to 35 kg/m² for people without consultation or body contouring. Analysis by percentage of excess body weight lost showed a similar pattern.

Differences in long-term weight loss by type of surgery and race/ethnicity

Weight loss was also influenced by the type of bariatric surgery: patients who underwent a procedure called sleeve gastrectomy had lower sustained weight loss compared to gastric bypass. In patients with body contouring, the mean difference in weight loss was about eight percent at seven years of follow-up.

Black patients had lower sustained weight loss compared to other racial/ethnic groups. Unlike previous studies of weight loss after bariatric surgery, most patients in the new analysis identified as black (approximately 29%) or Hispanic/Latinx (62%).

The study raises questions about the effects of body contouring on long-term weight loss after bariatric surgery. Given the similar responses in patients undergoing body contouring versus consultation-only patients, Dr. Benacquista and co-authors: “[T]The influence of body contour on weight loss is likely to be minimal, and the difference in weight loss compared to the ‘bariatric’ only group is secondary to individual patient factors.”

The researchers add, “The apparent benefits of body contouring in patients with massive weight loss are likely psychosocial, related to improvements in physical function.”