Book Review: Atlas of Body Contouring After Weight Loss

Reviewed by Sumesh Kaswan, MD; Jeffrey A. Gusenoff, MD; and Howard N. Langstein, MD

Bariatric Times. 2011;8(6):11

The rising obesity epidemic over the last few decades has resulted in over one-third of the adult population being obese and two-thirds of the adult population being either overweight and or obese, leading to an exponential increase in the number of bariatric procedures performed. Paralleling this, there has been a similar rise in the number of body contouring procedures performed by plastic surgeons, with post-bariatric body contouring surgery being one the fastest growing areas of plastic surgery. Over time, body contouring surgery has evolved from simple excisional procedures to complex surgical procedures to restore form and symmetry. This has led to an increasing recognition of post-bariatric body contouring surgery as a distinct subspecialty in plastic surgery. While several textbooks are dedicated to body contouring surgery, few exist that cover the entire spectrum of body contouring surgery. The Atlas of Body Contouring After Weight Loss by Loren J. Borud, MD; Samuel J. Lin, MD; and Kristen M. Rezak, MD is the first attempt to fill this void.

The book covers the entire spectrum of body contouring surgery starting with a review of preoperative assessment of deformities, postoperative complications, and intraoperative patient positioning. Each chapter is arranged in an organized format detailing the indications/contraindications, algorithms for evaluation and management, preoperative markings, and operative techniques with representative photographs, which are easy to follow. Pictures in the atlas are high-quality and are also easy to follow, with a detailed accompanying text. The accompanying illustrations efficiently reinforce key points—a great strength of this atlas. Each chapter ends with postoperative photographs and a brief bibliography.

In The Atlas of Body Contouring After Weight Loss, the authors not only cover the traditional body contouring procedures like panniculectomy, abdominoplasty, thigh lifts, and brachioplasty, but also cover newer and specialized procedures, including perforator flap-based gluteal and breast auto-augmentation, male chest rejuvenation, fat grafting, and lateral thoracoplasty for transverse skin excess. In many chapters, multiple techniques are described for a single procedure. Guidelines about that safety of combining multiple procedures and staging of procedures are discussed adequately.

Perhaps the most useful part of The Atlas of Body Contouring After Weight Loss is the commentary section at the end of each chapter. These commentaries are honest, detailed, and in-depth reviews written by surgeons who are well-known leaders in their respective fields. The commentators add their own individual concepts and/or techniques, which provide practical tips, underline common pitfalls, and are quite helpful. The commentaries are supplemented with pictures when necessary. Finally, the commentaries end with a succinct review by the authors.

The authors and commentators should be congratulated for emphasizing patient safety, complications, and factors that contribute to poor outcomes. It cannot be overemphasized that complications and risks in the post-bariatric population are indeed higher than the general population, and the authors wisely advocate spending sufficient time with patients before surgery in order to manage expectations. Specifically, the authors emphasize the importance of body mass index (BMI) measurements before body contouring surgery, and state that a BMI beyond 32kg/m2 may contraindicate surgery. Many people now believe that there may be no true “cutoff” for body contouring, but rather a continuum in that increasing BMI correlates with increasing complications and suboptimal aesthetic results. Irrespective of BMI and complications, this textbook provides useful guidance to achieve optimal aesthetic outcomes by emphasizing artful decision making not based on anatomic landmarks but is based on the actual deformities of the patient.

Body contouring surgery for massive weight loss patients has become an established field of surgery, which requires a dedicated and comprehensive approach to optimize outcomes and minimize complications in this challenging patient population. Borud et al have done an admirable job in distilling the important parts of this discipline into a well-written and well illustrated atlas. As such, it is an excellent resource for anyone who is seriously interested in body contouring surgery in massive weight loss patients, be it residents, fellows, or practicing plastic surgeons. As with all good atlases, the reader is reminded that there are many other techniques to accomplish the goals described in each chapter and the surgeon must have comfort with these techniques to fully master the craft. The Atlas of Body Contouring After Weight Loss underscores this and is a valued addition to the field of body contouring surgery.

About the reviewers
Dr. Kaswan is the Fellow in Post-Bariatric Body Contouring Surgery at the University of Rochester Medical Center. Rochester, New York, and a board-certified general surgeon. Dr. Gusenoff is the Director of the Life After Weight Loss Program and the Post-Bariatric Body Contouring Fellowship at the University of Rochester Medical Center. Dr. Gusenoff is an Assistant Professor of Surgery. Dr. Howard Langstein is Professor of Surgery and Chief of the Division of Plastic Surgery at the University of Rochester, Rochester, New York.

Atlas of Body Contouring After Weight Loss
By Loren J. Borud, MD; Samuel J. Lin, MD; and Kristen M. Rezak, MD.
Series Editor: Daniel B. Jones, MD, MS
• $225; $157 for residents
• 323 pages
• Published by Ciné-Med Inc.
• Color illustrations
To place an order, call Ciné-Med Inc. at 800-253-7657 or visit www.cine-med.com.

Category: Book Reviews, Past Articles