Upper Body Reshaping for the Woman with Massive Weight Loss: An Algorithmic Approach

Body contouring after massive weight loss represents a rather new surgical field. Many areas of the body are affected such as the back, the upper arms, and the breasts in the upper body. Combining more than one such area in a single operative step can yield many advantages. The author proposes a single-step approach to the upper body of the woman with massive weight loss and offers an algorithm to simplify the operative plan. Based on the characteristics of the individual, each adjacent region is analyzed for the potential of surgical improvement. Several lifting techniques can be used to restore the shape of each region. The breast represents a rather unique entity in which three basic types can be recognized. Accordingly, a surgical plan is formulated and discussed with the patient. The presented algorithm was used successfully for 17 consecutive women after massive weight loss. Although the time for these combined operations was increased, patient safety was not reduced nor were the number of complications increased compared with multiple smaller operations. The overall treatment plan for this patient group was greatly enhanced and simplified with this approach and resulted in great patient satisfaction. Body contouring after massive weight loss presents a steadily increasing surgical field. Typically, multiple operative steps are required to achieve the patient's ultimate goal. The author offers a surgical algorithm that aids in the operative planning for the upper body of such patients that simplifies this operation and yields great patient satisfaction.