title: Classifying severity of abdominal contour deformities after weight loss to aid in patient counseling: a review of 1006 cases.
abstract: BACKGROUND
  Abdominal contour deformities after massive weight loss are highly variable, ranging from a mild upper protuberance to multiple rolls. Correction of these deformities is challenging and may require advanced surgical techniques. Evaluating the incidence of patients presenting with various abdominal deformities and the factors influencing these deformities could aid patients undergoing weight loss.
  
  
  METHODS
  All massive weight loss patients presenting for abdominal contouring from 2002 to 2012 were reviewed, and abdomens were graded using a modified Pittsburgh Rating Scale. Data collected for each patient included body mass indices, history of bariatric surgery, and type of abdominal contouring surgery.
  
  
  RESULTS
  One thousand six patients were evaluated, with a mean age of 44.2 ± 10.5 years. The mean maximum body mass index was 51.7 ± 9.6 kg/m2, mean current body mass index was 30.0 ± 6.4 kg/m2, and mean change in body mass index was 21.7 ± 7.0 kg/m2. Sixty-four percent had a high-grade deformity. Patients with a larger change in body mass index had higher deformity grades (p < 0.001). Patients with higher deformity grades were more likely to undergo a fleur-de-lis abdominoplasty (p < 0.001).
  
  
  CONCLUSIONS
  Most patients presenting for body contouring after massive weight loss have high-grade abdominal deformities with multiple rolls. Change in body mass index is positively correlated with deformity grade and more aggressive contouring procedures. Patients interested in massive weight loss should be counseled that, depending on desire for eventual outcomes, more complex procedures may be required to correct the resultant abdominal deformity.
authors.affiliation: Pittsburgh, Pa. From the Department of Plastic Surgery, University of Pittsburgh Medical Center; and the Clinical and Translational Science Institute, University of Pittsburgh.
authors.forename: Lauren L
authors.initials: LL
authors.lastname: Zammerilla
authors.forename: Richard H
authors.initials: RH
authors.lastname: Zou
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Dong
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
mesh_terms: D000005:Abdomen / Q000473:pathology* / Q000601:surgery; D061645:Abdominoplasty; D000328:Adult; D050110:Bariatric Surgery; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012720:Severity of Illness Index; D015431:Weight Loss