Different Modalities in Upper Body Lift after Massive Weight Loss

Abstract

Summary O besityisrecognizedbytheWHOasaworldwidepandemicandthefifthleadingriskfactorfordeaths. Obesityisapro-inflammatorymultifactorialdiseasewhichincreasestheriskofmanycomorbidities,themostprevalentofwhicharediabetes,hypertension,metabolicsyndrome,cardiovasculardisease,cerebrovascularabnormal-ities,respiratoryproblems,hepatobiliarydisease,cancers,psychologicalabnormalities,andsocialmalfunctioning. Theworldwideincreaseintheprevalenceofobesityisaccompaniedbyaproportionalincreaseinthenumberofpatientsundergoingbariatricsurgery.Therisingsuccessratesofthesesurgerieshaveledtotheemergenceofapopulationofpatientswhohavelostamassiveamountofweight.But,althoughmedicalproblemsassociatedwithobesityarebettercontrolledorcuredbythisweightloss,thesepatientsareleftwithvariousdeformitiesindifferentpartsofthebody. Skinofpatientswithmassiveweightlossismuchweakerandlessresistant;itlackstheintegrityofepidermisanddermis;theepidermiswassignificantlyaffectedwithmarkedthinning,irregularities,andatypicalcellswithobviouschangestothedermoepidermaljunction;thecollagenfibersareseendamagedindifferentdegreeswithlackofnormalshape,distribution,andevendensitymainlyinthereticulardermiswithmarkeddecreaseincollagenfiberdiameter;andareasoffibrosiscouldbeseenobviouslyinthedermis.Elasticfibersweredamagedandevenabsentinmanysubjects. Theinflationprocessofweightgaincausesthethorax,fromtheclavicletotheinframammarycrease,toexpandinacircumferentialandaverticalfashion. Afterweightloss,thethoraxisdeflatedasthelampshadewouldbe.Theresultantexcessistwodimensional:circumferential(horizontal)andvertical.Asthepatientlosesweight,thezonesofadherenceactassuspensionhooksforthehangingthoracictissuesleadingtothefinalconfigurationoftissues.Thoracictissueslocatedlaterallytendtodescendinmassiveweightlosspatientsbecausetheyarelocatedatthegreatestdistancefromeitheroftheanteriorandposteriorzonesofadherence.Thedegreetowhichanyofthesedeform