The vertical gracilis myocutaneous flap for breast reconstruction in a massive weight loss patient

The number of patients undergoing bariatric surgery is increasing worldwide. Different types of free flaps are often used for breast reconstruction following mastectomy. We present a not previously described case using a vertical myocutaneous gracilis flap for breast reconstruction in a massive weight loss patient. The patient was a 61 year-old woman who previously had a lumpectomy for an in situ ductile carcinoma of her left breast. Subsequently the patient underwent a full mastectomy in 2020 due to a recurrence. The massive weight loss population poses a challenge in reconstructive surgery, due to their higher risk of complications. However, we still believe free flaps should be considered as a valid option for breast reconstruction in these patients. Due to the often increased size of perforator vessels in these patients, other flaps may prove more suitable than the usually preferred ones.

Wide-Awake Brachioplasty: A Safe and Effective Technique for Local Anesthesia

Brachioplasty is a popular body contouring surgery which treats upper arm deformity related to both aging and massive weight loss. Demand for brachioplasty is growing, as the volume of bariatric surgery performed in the United States has doubled in the last decade.1 Local anesthesia offers multiple benefits for both patients and providers: it avoids anesthetic risks and anesthesia costs, decreases operating room time, and facilitates a more rapid recovery for patients. Brachioplasty is typically performed under general anesthesia or moderate sedation; this study details a successful technique to perform brachioplasty under wide-awake local anesthesia with high patient satisfaction and an excellent safety profile.

Upper trunk and breast surgery after massive weight loss

This chapter discusses upper trunk and breast surgery after massive weight loss in females and males.

Thigh lift

The skin of the medial thigh is thin and inelastic, and laxity here is often the earliest sign of ageing in the thighs. The medial thigh skin is also one of the areas most affected following weight loss. The majority of skin laxity occurs at the junction of the anterior and medial thigh, where the skin tends to hang in a dependent, pleated fashion. This can interfere with walking, toileting, and various other day-to-day activities, resulting in irritation due to chaffing between the thighs. Body contouring techniques are routinely combined in stages to achieve a more harmonious result. Medial thigh lift is frequently combined with upper body lift or breast surgery, or both, whereas brachioplasty is usually combined with abdominoplasty/lower body lift. Opposing vectors of pull and excessive damage to local vascularity are thereby avoided. However, staging surgical procedures has the potential to reveal additional areas of dissatisfaction to the patient. Abdominoplasty patients often report increased dissatisfaction with the medial thighs as a consequence of this previously hidden deformity becoming visible to them postoperatively. In fact, massive weight-loss patients’ dissatisfaction with their thighs is almost as great as with the changes to their breasts in terms of their severely decreased self-esteem, sexuality, and quality of life.