Body Contouring after Massive Weight Loss
Body Contouring after Massive Weight Loss. Edited by Al S. Aly, MD, FACS. pp 383. Quality Medical Publishing, Inc., 2006, $450 USD Amazon.com
DOI: 10.1007/s00268-006-0500-z
Published Online: 8 December 2006
Body Contouring after Massive Weight Loss is a beautiful first edition book, edited and contributed to by Al Aly MD. Dr. Aly is in private practice in Coralville, Iowa and based this book on his extensive personal experience in dealing with massive weight loss patients. His initial interest was generated by the numerous patients he saw at the University of Iowa, where, during the 1970’s, the techniques for vertical banded gastroplasty were pioneered. The needs of the many patients who had lost weight but not improved their body contours led Dr. Aly and his partner to develop systems for evaluating the massive weight loss patient and to refine techniques for surgical correction of their unique contour deformities. In this, his first book on the topic, Al Aly has compiled information from bariatric physicians and surgeons, plastic surgeons, including the late Ted Lockwood, and industry specialists on the fundamentals of obesity as well as surgical techniques for body contouring in the bariatric patient population.
Body Contouring after Massive Weight Loss emphasizes the difference between these patients and the more routine, normal-weight, body contouring patient. A more aggressive approach using traditional plastic surgery techniques is not sufficient to achieve excellent results in these challenging patients. Dr. Aly, in his preface, calls for a paradigm shift, and in the body of this book, he and his contributors effectively present ways to analyze, plan for, and execute surgical strategies. The best of the photographic results presented in this book, illustrate a standard that emphasizes complete, balanced correction rather than simply, dramatic improvement.
Much of this book is pictorial making its 383 pages quick and easy to read. The generous use of patient photographs is very effective and provides invaluable visual information. The best chapters in this book are written by the editor. Dr. Aly has made a career out of thinking about the massive weight loss patient and his chapters reflect a clear, well-organized methodology. His descriptions of surgical techniques are thorough, and his results, excellent. There is some redundancy in the chapters and some conflicting opinions about ways of approaching these patients. If anything, I found this difference of opinion, helpful. The extensive photographic documentation allows the reader to analyze and compare the different approaches as well as the outcomes achieved by the respective authors.
Three areas deserved more attention than they received. The first is breast recontouring for both women and men. In comparison to the comprehensive approach to the abdomen, buttocks and extremities, the myriad problems of the breasts in this patient population were superficially addressed. The second area is post-surgical complications. Despite opening the book with the statement that the risk of major complications with this type of surgery is significant, complications throughout the book were downplayed. When addressed at all, only estimated rates of the most common adverse events were given. Nevertheless, the information presented was pertinent, and useful. Finally, abdominoplasty in the gastric band patient with an indwelling subcutaneous port was not addressed.
In the preface, Dr. Aly writes that this book is for plastic surgeons. I would add that this book would benefit bariatric surgeons and their patients as well. These photographs give a true accounting of the effects on the body of massive weight loss. The morbidly obese patient should be prepared in advance for the inevitable results, and be given information and hope for surgical corrections, if needed. The book also includes two DVDs, which will benefit plastic surgeons of all levels who undertake belt lipectomy and upper body lifting procedures. I have happily added Body Contouring after Massive Weight Loss to the plastic surgery library at my academic institution. It will provide both faculty and residents with a clear direction in approaching these extremely challenging patients and a set of standards for evaluating results.
We are all aware that there is a global epidemic of obesity in adults and children. According to current estimates, more than 1 billion adults are overweight. The UK Department of Health predicts that one in three adults and a fifth of all children, a total of 13 million people, will be clinically obese in the UK by 2010 and will present a crippling burden to the NHS. There has been a huge increase in surgical procedures to facilitate weight loss in the US. Figures from the American Society of Plastic Surgeons show that the biggest increase in demand for cosmetic surgery in the last 2 years has been to remove skin excess in massive weight-loss patients. This book with two CD-ROMs edited by an experienced surgeon, Dr Aly, is therefore timely.
The book opens with a very good review of the surgical treatment of morbid obesity of which the laparoscopic adjustable gastric band procedure is just one of five surgical possibilities. The authors emphasise the importance of a team approach to such patients, including a psychiatrist, dietician, exercise physiologist, bariatric surgeon and a plastic surgeon.
The main part of the book describes surgical techniques to excise redundant skin divided into anatomical regions. Procedures such as belt lipectomy, lower body lift with medial thigh lift, and buttock lift are all well presented with the appropriate anatomy and very good illustrations. This is reinforced by the two CD-ROMs – one clearly demonstrates the operation of belt lipectomy and the second, upper-body lift.
Dr Aly rightly emphasises the high complication rate associated with operating on this group of patients. In a consecutive series of 70 patients having belt lipectomy, 56 had at least one major complication, for example, seroma, wound dehiscence, psychiatric difficulty, infection, tissue necrosis as well as pulmonary embolus and deep vein thrombosis. At the end of each chapter, Dr Aly’s experience is highlighted in a ‘Summary of Pearls’. Surgical operations of the upper half of the body are equally well covered.
The presentation of this text is extremely high as one would expect from Quality Medical Publishing. The list of contributors to the book is both impressive and comprehensive and each chapter is well annotated with the appropriate references to the scientific literature.
Overall, this book is a must for the presumably small group of surgeons who will become involved with this group of patients. It is not for the faint-hearted: the possibility of major complications is real but this is a good start for surgeons developing on an interest in this area. My only criticism is that the CD-ROM on upper body lifting could have been better edited but otherwise I strongly recommend this book and give it five stars.
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