58
Postbariatric surgery-Scope and Current Practice Sanjay Azad MS FRCSEd FRCSEd (Plast. Surgery) Consultant Plastic, Reconstructive and Aesthetic Surgeon Assistant Professor NOSM
Postbariatric surgery-Scope and Current Practice
Sanjay Azad MS FRCSEd FRCSEd (Plast Surgery) Consultant Plastic Reconstructive and Aesthetic
Surgeon Assistant Professor NOSM
Conflict of Interest Declaration Nothing to
Disclose
Presenter Sanjay Azad
Title of PresentationPostbariatric surgery-
Scope and Current Practice
I have no financial or personal relationships to disclose
Clinical photographs are of my patients with full consent for
presentation
Post Bariatric Surgery - Scope and Current Practice Sanjay Azad MS FRCSEd FRCSEd (Plastic Surgery) Assistant Professor Northern Ontario School of Medicine
Learning objectives Describe rationale and scenarios appropriate for referral of post bariatric surgical patients discuss the complexity of the surgical journey and its management analyze the limits of OHIP coverage and future issues in post bariatric patients
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Conflict of Interest Declaration Nothing to
Disclose
Presenter Sanjay Azad
Title of PresentationPostbariatric surgery-
Scope and Current Practice
I have no financial or personal relationships to disclose
Clinical photographs are of my patients with full consent for
presentation
Post Bariatric Surgery - Scope and Current Practice Sanjay Azad MS FRCSEd FRCSEd (Plastic Surgery) Assistant Professor Northern Ontario School of Medicine
Learning objectives Describe rationale and scenarios appropriate for referral of post bariatric surgical patients discuss the complexity of the surgical journey and its management analyze the limits of OHIP coverage and future issues in post bariatric patients
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Clinical photographs are of my patients with full consent for
presentation
Post Bariatric Surgery - Scope and Current Practice Sanjay Azad MS FRCSEd FRCSEd (Plastic Surgery) Assistant Professor Northern Ontario School of Medicine
Learning objectives Describe rationale and scenarios appropriate for referral of post bariatric surgical patients discuss the complexity of the surgical journey and its management analyze the limits of OHIP coverage and future issues in post bariatric patients
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Post Bariatric Surgery - Scope and Current Practice Sanjay Azad MS FRCSEd FRCSEd (Plastic Surgery) Assistant Professor Northern Ontario School of Medicine
Learning objectives Describe rationale and scenarios appropriate for referral of post bariatric surgical patients discuss the complexity of the surgical journey and its management analyze the limits of OHIP coverage and future issues in post bariatric patients
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Obesity costs Canada an estimated $16-billion annually in direct health care costs ndash 24 per cent of total health care spending Theres another $27-billion in indirect costs including lost productivity disability insurance
reduced quality of life and mental-health problems because of stigmatization and poor self-esteem the report says
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
CONSEQUENCE OF MASSIVE WEIGHT LOSS
bull Excess skin
bull Musculoskeletal drag effect of tissue
bull IntertrigoRash
bull Discomfort
bull Psychologically affected by excess skin
bull lsquoStill think and feel fat and deformedrsquo
bull Dressing up and QOL affected
bull Socially disengaged and depressed
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Am Surg 2015 Jan81(1)34-40 Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery Lanthaler M1 Mattesich M Nehoda H Puelzl P Matiasek J Nitto A Pierer G Kinzl J
Patients cannot imagine the degree of dissatisfaction they will
experience from the sagging skin that comes with weight loss Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and
reported an extreme improvement in body image Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery because most patients not forewarned suffer greatly from their body image after weight loss
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
06 September 2010 Philippa C Jackson Registrar Plastic Surgery Mr Sanjay Azad Consultant Plastic and Reconstructive Surgeon University Hospitals Birmingham
BMJ 2010
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Aesthet Surg J 2014 Jan 134(1)96-105 Desire for body contouring surgery after bariatric surgery do body mass index and weight loss matter Giordano S1 Victorzon M Stormi T Suominen E
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Plast Reconstr Surg 2012 Nov130(5)1133-9 Quality of life long-term after body contouring surgery following bariatric surgery sustained improvement after 7 years van der Beek ES1 Geenen R de Heer FA van der Molen AB van Ramshorst B
This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity CLINICAL QUESTIONLEVEL OF EVIDENCE Therapeutic IV
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
PROCEDURES PERFORMED
0 2 4 6 8 10 12 14 16
Circumferential body lift
Rubins mastopexy
Fluer de lys abdominoplasty
Liposuction
Standard abdominoplasty
Arm reduction
Hernia repair
Mastopexy + augmentation
Mastopexy
Upper body lift
Reverse abdominoplasty
Breast Augmentation
Fat transfer
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Face lift surgery
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Breast Reduction
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Breast Reduction
Rubinrsquos technique
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Abdominal contouring
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Forms of abdominal wall contouring
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Our criteria for Body Lift procedure
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Spiral Lift
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Liposuction
Adjunctive or as sole procedure
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Arm Lift
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Staging of Surgery
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Staging and results of surgery
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Results
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
COMPARISON WITH LITERATURE
Complications Literature
Pierre
Vico et al
(n=80)
Jones
BM et al
(n=16)
Nemerofsky
et al
(n=200)
Our study
(n=14)
seroma 14 to 333 37 25 165 21 (n=3)
wound healing 13 to 325 225 187 325 21 (n=3)
hematoma 12 to 95 13 0 3 0
infection 05 to 210 38 0 35 7 (n=1)
necrosis 13 to 95 13 0 95 0
pulmonary
embolism 05 to 33 25 0 1 0
Total 17 to 50 35 44 50 43
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
PATIENT JOURNEY WITH ME
bull Initial consultation after referral bull Full discussion with power point presentation and
information pack given bull Second consultationreduce weightstop smoking bull Plan for surgery with preoperative buildup for at
least 4-6weeks bull Surgery bull FU 1w2w4mo and 1 year as mandatory bull Clinical photographs before and after (CMPA
recommended consent process)
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
PROTOCOL
bull Non smokers
bull Stable weight
bull Dual consultation
bull Nutritional stabilization
bull DVT prophylaxis
bull Antibiotics
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Preoperative preparation
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Am J Clin Nutr 2009 Jul90(1)15-22 Vitamin status after bariatric surgery a randomized study of gastric bypass and duodenal switch Aasheim ET1 Bjoumlrkman S Soslashvik TT Engstroumlm M Hanvold SE Mala T Olbers T Boslashhmer T
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
After surgery
bull Antibiotics 77 simple pain-killers
bull Garment to be worn for 3months
bull Swelling and bruising takes 3 weeks to settle
bull Scar maturation takes a lot longer (upto 2years)
bull Scar tapingmassagecreams
bull Day to day activities straightaway
bull Driving in 3-4 weeks
bull Aerobic and swimming 3months
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Consequences
bull Scars
bull Swelling
bull Bruising
bull Discomfort
bull Asymmetry
bull Temporary numbness of body part
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Complications
bull Poor scarring (hypertrophickeloidstretched scar) this can be partial or in the complete scar
bull Infection
bull Bleeding
bull Wound breakdown
bull Under resectionover resection
bull Revisional surgery
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
High BMI and smoking
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Breast J 2014 May-Jun20(3)274-8 Risk factors for complications following breast reduction results from a randomized control trial Srinivasaiah N1 Iwuchukwu OC Stanley PR Hart NB Platt AJ Drew PJ
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Ann Chir Plast Esthet 2014 Oct 25 Smoking and plastic surgery part II Clinical implications A systematic review with meta-analysis Pluvy I1 Panouillegraveres M1 Garrido I2 Pauchot J1 Saboye J2 Chavoin JP2 Tropet Y1 Grolleau JL2 Chaput B3
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
BREAST REDUCTION AND PANNICULECTOMY
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Indications for panniculectomy OHIP (Appendix D MOHLTC)
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
bull Poor functional outcomes as no muscle plication
bull Poorer aesthetic outcomes
bull Higher need for revisional surgery
bull Surgical procedure in itself with blood loss and morbidity
bull Balancing expectations with outcomes and issues with body dysmorphia
bull Long term scar management necessary
bull Social re-engagement
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
OHIP recommendations for breast reduction
bull Significant symptomatology
bull Gross disproportion
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Criteria for Breast Reduction
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
POST BARIATRIC SURGERY
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Can J Surg 2014 Feb57(1)33-9 Prioritization and willingness to pay for bariatric surgery the patient perspective Gill RS1 Majumdar SR2 Wang X2 Tuepah R2 Klarenbach SW2 Birch DW1 Karmali S1 Sharma AM2 Padwal RS2
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Aesthet Surg J 2013 Aug 133(6)878-85 Patients perceptions of cosmetic surgery at a time of globalization medical consumerism and mass media culture a French experience
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Obesity and management
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Bottomline
bull Increasing demand for postbariatric surgery
bull Complex procedures with not insignificant morbidity
bull Multidisciplinary setup mandatory
bull CNS supportPsychological support
bull OHIP funding for only two procedures
bull Ideal referral at 18mo or later after bariatric surgery stable weight for 6mo
Future directions
TBMS Winter School 2015
Future directions
TBMS Winter School 2015
