Body Lifts (contouring or shaping)
Breast and body-contouring surgery, discussed in the literature for hundreds of years, has increasingly evolved over time. While new techniques are hardly ever actually new (once an intensive literature search is done), we do see change, whether it be the addition of a new suspension suture or a combination of techniques that were not combined before.
This field has applications across a broad swath of the population, from the petite “mommy” looking for a makeover to the male who lost more than 100 lb after gastric bypass surgery. There are many techniques to cover, and we aim to include an excellent representation. The endpoint of breast and body-contouring surgery is provision of the best possible contour while respecting important safety issues and continually innovating to improve outcomes.
Safety is of the utmost importance in surgery, unsurpassed by cosmetic result. Although complications including wound healing problems, seromas, venous thromboembolism (VTE), and bleeding occur, a sound surgical plan protecting against predictable pitfalls optimizes surgical outcome.
Certain medical conditions have a well-documented, negative impact on surgical recovery. Obesity includes a constellation of medical problems called metabolic syndrome, including hypertension, dyslipidemia, type 2 diabetes, coronary artery disease, stroke, gallbladder disease, osteoarthritis, obstructive sleep apnea, and cancers such as breast and colon.
Hypertension places patients at risk for postoperative bleeding and may be associated with coronary artery disease or chronic renal failure. Anemia, particularly in menstruating women, is common in massive weight loss patients and may require preoperative optimization or postoperative blood transfusion.
Asthma may be exacerbated by surgery and oxygen requirements may be greater, resulting in the greater need for blood transfusion and pulmonary care. Endocrine disorders such as hypothyroidism may impair wound healing. Patients with autoimmune disease also have impaired wound healing, often due to anti-inflammatory medication they take such as steroids.
Tobacco smoke causes vasospasm and decreases vessel caliber, resulting in wound healing problems. Any of these disorders that can negatively impact wound healing must be treated and addressed prior to surgery. Tobacco use must be stopped. Diabetes, endocrine disorders, and hypertension must be addressed and medicated if necessary, normalizing glucose and hormone levels and blood pressure.
History of VTE including deep venous thrombosis and pulmonary embolism is the greatest risk factor for future VTE, potentially the most deadly possible outcome after body-contouring surgery. Other risk factors for VTE include obesity, immobility, history of lower extremity trauma, hormonal therapy, history of cancer, and hypercoagulable states. High-risk patients require examination and clearance by physicians specializing in the treatment of VTE.
Prescription and herbal medications must be documented. Medications such as anticoagulants, anti- inflammatory, aspirin, and vitamin E increase bleeding risk after surgery and are best stopped weeks prior to surgery. Many patients will not voluntarily share that they regularly take aspirin or ibuprofen, and patients often do not define herbal supplements as medications. Many herbal medications result in anticoagulation effects, and it is important to elicit a history of herbal medication use in patients.
Many body-contouring procedures require complex positioning, including prone and lateral decubitus positions. Improper pressure to neurovascular structures throughout the body may lead to short- or long-term disability. Most reported sequelae associated with prone positioning are due to excessive pressure on the head and neck region, so attention to positioning of the head is extremely important. Stabilization of the neck is also important. The neck must be in a neutral, non-extended position to avoid pressure on nerves and vessels.