DÄ internationalArchive5/2012Body Contouring Surgery
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Professor Runkel and colleagues provided a detailed description of bariatric surgical options in obese patients (1). The authors summarized the new interdisciplinary S3 guidelines for bariatric surgery in a comprehensible fashion.

We wish to explicitly support the necessity of setting out an interdisciplinary treatment plan, as requested by the authors. However, we miss any mention of the role of the body contouring surgical interventions that are indicated after massive weight loss.

These interventions, which fall under the remit of plastic surgery, are required in nearly all patients because of their weight loss subsequent to bariatric surgery, since the excess skin constitutes a functional and psychological burden (2). Such procedures cannot be considered in isolation; they are a direct and immediate part of bariatric surgery since secondary inventions may have to be explained to patients even before the initial bariatric surgical intervention. Accordingly, it is desirable for such patients to be treated in surgical centers in collaboration with plastic surgeons. The body contouring does not actually treat overweight but has functional aspects—for example, reconstruction of the abdominal wall if a plicature of the rectus abdominis muscle has been done to stabilize the abdominal wall. Furthermore, excess skin makes it difficult to maintain a satisfactory body hygiene, leading increasingly to macerations and fungal colonization in the skin folds, which can be adequately treated with body lifting procedures. Additionally, such body shaping interventions have a positive effect on patients’ physical and psychosocial rehabilitation (3) and quality of life (4). Accordingly, they are listed in the S3 guidelines for bariatric surgery as a crucial component of the interdisciplinary treatment regimen and should not be omitted in an article in this medical topic.

DOI: 10.3238/arztebl.2012.0078a

Dr. med. Steffen U. Eisenhardt, PD Dr. med. Nestor Torio-Padron
Prof. Dr. med. G. Björn Stark

Universitätsklinikum Freiburg, Abteilung für Plastische und Handchirurgie

steffen.eisenhardt@uniklinik-freiburg.de

Conflict of interest statement

Professor Dr Stark is a shareholder in the Erich-Lexer-Clinic for esthetic surgery in cooperation with the University of Freiburg Medical Center and has received financial funding from Baxter. Drs Torio-Padron and Eisenhardt declare that no conflict of interest exists.

1.
Runkel N, Colombo-Benkmann M, Hüttl TP, Tigges H, Mann O, Sauerland S: Clinical practice guideline: Bariatric surgery. Dtsch Arztebl Int 2011; 108(20): 341–6. VOLLTEXT
2.
Torio-Padron N, Stark GB: Körperformende plastisch-chirurgische Eingriffe nach massiver Gewichtsreduktion. Zentralbl Chir 2009; 134: 57–65. CrossRef MEDLINE
3.
Sarwer DB, Thompson JK, Mitchell JE, Rubin JP: Psychological considerations of the bariatric surgery patient undergoing body contouring surgery. Plastic and reconstructive surgery 2008; 121: 423e–34e. CrossRef MEDLINE
4.
Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH: Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring) 2006; 14: 1626–36. CrossRef MEDLINE
1.Runkel N, Colombo-Benkmann M, Hüttl TP, Tigges H, Mann O, Sauerland S: Clinical practice guideline: Bariatric surgery. Dtsch Arztebl Int 2011; 108(20): 341–6. VOLLTEXT
2. Torio-Padron N, Stark GB: Körperformende plastisch-chirurgische Eingriffe nach massiver Gewichtsreduktion. Zentralbl Chir 2009; 134: 57–65. CrossRef MEDLINE
3. Sarwer DB, Thompson JK, Mitchell JE, Rubin JP: Psychological considerations of the bariatric surgery patient undergoing body contouring surgery. Plastic and reconstructive surgery 2008; 121: 423e–34e. CrossRef MEDLINE
4. Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH: Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring) 2006; 14: 1626–36. CrossRef MEDLINE