Safety and Efficacy of Combining Multiple Body-Contouring Procedures in Massive-Weight-Loss Patients: A Retrospective Multicenter Study.

[INTRODUCTION] Significant weight loss often results in severe deformities affecting multiple body regions, negatively impacting patients' social and personal lives. Many massive-weight-loss patients (MWLP) seek treatment for multiple anatomical areas. Combining procedures in a single surgical session offers perceived benefits such as a single recovery period, reduced costs, and faster patient satisfaction. However, the associated risks and reliability require further evaluation. This study compares the safety and reliability of combined body-contouring procedures versus single procedures performed in a staged approach.

[PATIENTS AND METHODS] A retrospective study was conducted on 1182 MWLP patients undergoing body-contouring surgery. Patients were divided into four groups: Group A (single procedure, 389 patients), Group B (two procedures, 312 patients), Group C (three procedures, 272 patients), and Group D (four procedures, 209 patients). Medical records were reviewed for complications and patient satisfaction (BODY-Q).

[RESULTS] A total of 2665 procedures were performed with follow-up ranging from 12 to 34 months (mean 14.2 months). Overall complication rates were 3.6% in Group A, 5.1% in Group B, 20.2% in Group C, and 22.4% in Group D. Complication rates were similar between Groups A and B but significantly higher in Groups C and D, predominantly due to wound dehiscence. Major complications such as transfusions were significantly increased in Groups C (2.9%) and D (3.3%). Longer operative times and increased hospital stays were observed in Groups C and D, although drain durations were comparable across groups. Notably, despite the higher complication rate, patients in Group D reported the highest satisfaction scores on the BODY-Q questionnaire, with overall satisfaction increasing alongside the number of combined procedures.

[CONCLUSION] Combining body-contouring procedures in MWLP patients is safe and effective, especially for the combination of two procedures, when rigorous inclusion criteria (well-optimized MWLP with BMI ≤ 30 kg/m, stable weight ≥ 6 months, corrected micronutrient deficiencies, and ASA I-II) and patient management are followed. The benefits of combined procedures may outweigh the drawbacks for certain groups of patients, as the higher number of complications is considered as "minor." Treatment decisions should be tailored to individual patient needs and preferences, balancing risks and benefits to achieve optimal outcomes.

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