外科与临床实践杂志

Combined surgery in postbariatric patients

Claudio A Guerra

Post bariatric patients are often interested in adressing as many possible surgical problems with the minimal amount of procedures. To plan combinations, it is important to consider the topographic proximity of the areas to address allowing the treatment of units thoroughly, for example brachioplasty and breast lift or an abdominoplasty combined with a breast lift. Another strategy is the combination of remote areas that can be addressed separetly in different surgical fields, as in a vertical lift thighs combined with mastopexy or brachioplasty. The lower body lift should be performed together, or prior to the thigh lift to get better and lasting results; and the treatment of the trunk, lateral thigh and buttocks as a single aesthetic unit. Also, the circumferential belt tummy tucks in the lower lifting and the excess tissue resection is performed in the trunk, raising buttocks and lateral thigh. Liposuction techniques generally can be used either during or after excisional procedures to achieve better contour results. When planning a combined surgery, one must visualize the postoperative period and the patient must be warned of the limitations that he or she will have in the near future, for the recovery may be long and cumbersome especially in certain combinations. The great advantage of combinations is the relatively quick solution for at least two of the most concerning issues that a patient may have. One surgery with judicious and safe combinations may be a good option for most of these patients.

Claudio A Guerra has completed his graduation from Universidad de Chile Medical School. He got trained in General Surgery and practiced for 5 years before starting his training in Plastic Surgery. He was a research Fellow at University of Alabama from July 2009 to February 2011. He currently works at Universidad Católica de Chile in the Plastic Surgery Unit performing most of the post bariatric surgery refered to the unit.

The prevalence of bariatric surgery in the United States has increased significantly during the past decade, increasing the number of patients requiring postbariatric surgery follow-up care. Our objective was to develop and implement an efficient, financially viable, postbariatric surgery practice model that would be acceptable to patients. The setting was the Mayo Clinic (Rochester, MN).