title: Plastic surgery after gastric bypass improves long-term quality of life.
abstract: BACKGROUND
  Excess skin after massive weight loss impairs patient's health-related quality of life (HRQoL). Therefore, body-contouring surgeries can be proposed. However, few data exist concerning the effect of body contouring after bariatric surgery on HRQoL, including control group with a long-term follow-up.
  
  
  METHODS
  In a prospective study, 98 consecutive patients who had body contouring after gastric bypass for obesity (BMI > 40) were included (group A). A matched control-group containing 102 patients who had only gastric bypass was selected (group B). HRQoL was measured by Moorehead-Ardelt questionnaire before (group A1) and after (A2) body contouring, and at different time points for group B until 8 years post-gastric bypass. To evaluate the effect of body contouring by two parallel methods, HRQoL was compared between groups A1 and A2, and between A2 and B.
  
  
  RESULTS
  We found that body contouring procedures improved significantly patients' HRQoL, in comparison to those who had only gastric bypass. Of the patients who had body contouring (group A2), 57 % evaluated their HRQoL "much better" in comparison to only 22 % of patients before body contouring (group A1) or those who never had body contouring (group B) (p < 0.001). The improvement was significant in all sub-domains of HRQoL: self-esteem, social life, work ability, sexual activity and physical activity (p < 0.001), and remained stable over time.
  
  
  CONCLUSIONS
  Our study confirms the important role of plastic surgery in treatment of patients after massive weight loss. We demonstrated that body contouring, despite important scars, significantly improves satisfaction and HRQoL of patients after gastric bypass. Therefore, the treatment of morbid obesity should not be deemed achieved unless plastic surgery has been considered.
authors.affiliation: Plastic, Reconstructive and Aesthetic Surgery Department, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland. ali.modarressi@hcuge.ch
authors.forename: A
authors.initials: A
authors.lastname: Modarressi
authors.forename: N
authors.initials: N
authors.lastname: Balagué
authors.forename: O
authors.initials: O
authors.lastname: Huber
authors.forename: M
authors.initials: M
authors.lastname: Chilcott
authors.forename: B
authors.initials: B
authors.lastname: Pittet-Cuénod
mesh_terms: D000328:Adult; D001828:Body Image / Q000523:psychology*; D016022:Case-Control Studies; D002921:Cicatrix / Q000523:psychology*; D003075:Coitus; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept; D013518:Surgery, Plastic / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D015431:Weight Loss