Plastic Surgery Articles

Plastic and Reconstructive Surgery is the medical journal published by the American Society of Plastic Surgeons (ASPS).  There is a report in the December issue about a surprising negative impact on recovery from body contouring following surgery for massive weight loss – and that is malnutrition.

Bariatric surgery is the general term for a number of surgical options designed to assist in weight loss for obese patients.  These include stomach stapling and gastric bypass, both of which significantly reduce nutritional intake.  Following the surgery, the patient is on a low calorie diet for a year or more to slowly take off excess weight.  The typical diet is a thousand calories a day, which is not nearly enough to sustain an adult.

While the result is weight loss, there is also a reduced level of protein and of the vitamins that assist in healing.  A study conducted by a team of plastic surgeons who are also ASPS members looked at the impact of the reduced diet on post-operative care for body contouring patients.

Co-author Dr. Dennis Hurwitz notes that, “Body contouring procedures for massive weight loss patients are major operations with large incisions in many areas that demand a lot of the body during the healing process.”  He and his co-authors researched the literature on the impact of nutrition on surgical healing, and then looked at the dietary impact on a number of patients who had been through body contouring surgery following massive weight loss.

They used records on 75 body contour patients that had been operated on by Dr. Hurwitz and his colleagues from 2002 – 2005 without any attention to diet.  They then analyzed the experience of another 37 patients who had undergone bariatric surgery followed by a body contour from 2006 to the present who were provided with a nutrition supplement program prior to surgery.

Two thirds of the patients without the nutrient program had difficulties with wound healing, scar tissue and other post-op problems.  Nineteen percent of the group who had been given the nutrient support had similar post-op problems.  The comparison made the value of adequate nutrition obvious during the post-operative period.

It seems strange to think of patients undertaking a surgically supported massive weight loss program to be in a state of malnutrition, but that is what this study showed.  Denying the body calories also denies it nutrients that are important for the immune system, in blood clotting and in a number of other functions.  Vitamins A, B complex, C, iron, zinc and a number of others promote collagen production and strengthen immunity along with hastening wound healing.  Vitamin B can reduce the possibility of deep vein thrombosis, a threat following many plastic surgery procedures.

Sixty seven thousand patients went through this program of weight reduction and body contouring in 2007.  That is a significant number of patients, and if a nutrition program can reduce healing problems, bleeding, infection and reduce scarring from 66% of patients to under 20% it should probably be a mandatory regimen for patients seeking these procedures.  No doubt it is in many offices, including that of Dr. Hurwitz.