Plastic surgeons warn of malnutrition in body contouring patients

Identifying malnutrition before surgery in massive weight loss patients seeking body contouring will significantly decrease surgical complications, accelerate wound healing, improve scar quality and boost patient energy levels, according to a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Optimizing nutrition with the addition of supplements, such as powder drinks and multi-vitamin tablets formulated for massive weight loss patients, is vital to successful body contouring surgery, the study reveals.

"Body contouring procedures for massive weight loss patients are major operations with large incisions in many areas that demand a lot of the body during the healing process," said ASPS Member Surgeon and study co-author Dennis Hurwitz, MD. "By carefully monitoring nutritional deficiencies preoperatively and supplementing the patient with the necessary nutrients, minerals and vitamins, I have seen a significant decrease in complications and improved postoperative healing. In my practice, I won't do body contouring procedures on this patient population without a preoperative regimen of nutritional supplements."

The study was performed in two parts; First, medical literature regarding nutrition's effect on healing from the 1940s to the present was reviewed.

The authors then compared healing and wound problems in 75 of their massive weight loss body contouring patients from 2001 to 2005 who did not receive supplementation, with 37 patients from 2006 to present, who participated in a uniquely designed nutritional supplement program prior to surgery. The study also noted the role of each nutrient in wound healing and immune response.

The study found that complications and wound problems occurred in 66 percent of the 75 patients who did not receive supplementation before 2006. In the 37 patients on the nutritional supplement regimen after 2006, major complication rates were reduced to 19 percent. The study found specifically that improving nutritional deficiencies in massive weight loss patients improved the healing process, wound tension, and scar quality, in addition to increasing patients' energy levels.

Because of reduced calorie intake for massive weight loss patients, they are highly susceptible to malnutrition, the study observed. At one year after bariatric surgery, most patients' food intake remains at about 1,000 calories per day, not even close to meeting standard recommendations regarding calories and protein intake. The study also noted the role various nutrients play in wound healing: Protein, vitamins A, B complex, C, arginine, glutamine, iron, zinc and selenium promote wound healing, collagen production and immune response; Vitamin B complex has also been associated with reducing the risk of deep vein thrombosis.

According to the ASPS, nearly 67,000 body contouring procedures after massive weight loss were performed in 2007.