A new study, using assessment tools especially designed for massive weight loss (MWL) patients, shows quality of life and positive body image, which improve after bariatric surgery, receive an added boost with body contouring. Study author and plastic surgeon J. Peter Rubin, M.D., assistant professor of surgery at University of Pittsburgh Medical Center (UPMC), says that plastic surgeons have known, anecdotally, that body contouring procedures have a positive impact on the lives of MWL patients.
"We wanted to apply scientific methods to generate some data to confirm this," Dr. Rubin tells
"For example, this is a survey that refers specifically to symptoms of rash and skin irritation related to excess skin and how those change with body contouring surgery," explains Dr. Rubin. "We also ask specific questions relating to difficulty shopping for and fitting into new clothing related to excess skin. The survey assesses for feelings of embarrassment and self esteem related to excess skin."
In addition, the researchers modified an existing QOL assessment tool, creating the Post-Bariatric Surgery Quality of Life (PBSQOL) to address such criteria as feelings of attractiveness, skin rash and infection, ease of exercise, public embarrassment of loose skin and more.
Finally, they developed the Current Body Image Assessment (CBIA) tool. CBIA allows patients to diagram those areas of their body with which they are most uncomfortable on a simple anatomic model which resembles a gingerbread man.
"With the gingerbread men, patients indicated what bothered them most," relates senior author Madelyn H. Fernstrom, Ph.D., C.N.S., associate professor in psychiatry, surgery and epidemiology, and director of the Weight Management Center at UPMC. "Typically, you think with body contouring surgery, everybody would point to the stomach, but there are so many variations on this theme."
Data from the CBIA indicate that the three most frequent areas of distress at the initial body contouring consultation were abdomen (69 percent), flanks (56 percent) and hips/outer thighs (44 percent). At the three-month assessment, only one of the 18 patients said the abdomen was a top area of distress; rather, subjects began focusing more on the arms, back and buttocks, with the top three areas of distress being hips/outer thighs (45 percent), medial thighs (38 percent) and flanks (31 percent). At six months, their top complaints remained medial thighs (54 percent), flanks (36 percent) and hips/outer thighs (27 percent).
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