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Introduction: Obesity is a chronic inflammatory disease associated with changes in inflammatory markers such as interleukins and CRP. This study evaluates the inflammatory response, through variations in interleukins and CRP, in patients undergoing abdominoplasty. Methods: Fourteen patients underwent abdominoplasty after weight loss achieved through bariatric surgery to maintain weight loss for at least18 months. Il4, IL6, IL10 and PCR levels were verified at times: preoperative, during surgery, 24 hours after surgery, 7th postoperative day and 14th postoperative day. Results: IL4 increased in the 24 hours postoperatively and continued on the rise until the 14th day. IL10 went up during surgery and began to fall in the 24 hours postoperatively to levels lower than the initial ones. IL6 began to rise during surgery, being more expressive in the 24 hours postoperatively, followed by a fall until the 14th day. CRP increased 24 hours postoperatively and remained discharged until the 14th day. Conclusion: Abdominoplasty reduced the chronic inflammatory systemic condition.

Introduction: Morbidly obese patients undergoing bariatric surgery after massive weight loss evolve with large skin folds in various body regions, including the abdomen. In patients with dermofat excesses throughout the abdominal circumference and ptosis of the gluteal region, circumferential abdominoplasty (simple or composite) has been an effective surgical solution conventional or “anchor” abdominoplasty brings unsatisfactory results in those patients with severe dysmorphia. The objective is to analyze the technical evolution of simple and composite circumferential abdominoplasty and its complications. Methods: Twenty-nine patients were evaluated, 28 females, with a mean age of 41.17 years, submitted to circumferential abdominoplasty between 2002 and 2012. This retrospective study, conducted through data collected from medical records, evaluated: surgery time, the weight of the resected surgical specimen, length of hospital stays, antibiotic therapy used, associated complications, and changes in the surgical technique in this period. Results: Composite circumferential abdominoplasty was performed in 23 patients (79.3%) and the simple one in six (20.7%). The mean surgical time was 346 minutes, and the surgical specimen’s mean weight was 4323 grams. Three patients (10.3%) had significant complications (symptomatic anemia and major suture dehiscence) and five (17.2%) minor complications (minor dehiscence, slight spontaneous bleeding, seroma, and hypertrophic scarring). Between 2002 and 2004, 75% of the complications occurred. The reoperation rate was 6.9%. Conclusion: There was a significant technical evolution in circumferential abdominoplasty performance, and the incidence of complications and the rate of reoperation were similar to those found in the literature.

ABSTRACT Introduction: bariatric surgery is the main treatment for cases of severe obesity and body contour surgery to correct body dysmorphia resulting from weight loss. However, these procedures are associated with a significant number of postoperative complications. Objective: this study aims to analyze complications in post-bariatric patients undergoing body contour surgeries and correlating them with the age and BMI of these patients. Methods: the current study is a retrospective study evaluating 180 consecutive patients undergoing body contour surgery after bariatric surgery within a period of three years (2014-2016). Data such as age, gender, Body Mass Index before bariatric and plastic surgeries, type of surgery performed and complications were collected, and correlated the age as well as the BMI of the patients in the pre-bariatric (PB) and pre-plastic (PP) periods with the complications presented. Results: of the 180 patients evaluated, 91.7% were females (n = 165), and the mean age was 46.3 ± 1.7 years. The most performed surgery was abdominoplasty (48.9%), followed by mammaplasty (21.1%). Some complications occurred in 26.1% of the patients with partial dehiscence (40.4%) and seroma (14.9%) being the most frequent. Patients who presented complications had a higher mean age (50.8 years) than those who presented with no complications, and major complications accounted for 2.7% of the sample. Conclusions: a statistically significant number of surgeries progressed without complications and, when they occurred, there were minor complications in most of the sample. Complications were more frequent in older patients with some of them having a BMI over 30 Kg/m2.

Abstract Purpose: To evaluate the serum variations of Interleukins (Il) and CPR of abdominoplasties in post-bariatric patients and, to equate the homeostasis (HOMA) from the variations of glycemia and insulin to evolute the metabolic modifications. Methods: Fourteen women were submitted to abdominoplasties with weight loss after a gastroplasty. Levels of IL4, IL6, IL10, CRP, glycemia and insulin were obtained during the pre-operative, trans-operative, 24 hours post, 7th and 14th postoperative days. Results: The IL4 was higher at 24 hours post-surgery, and after a moderate decrease, it remained high until the 14th day. The IL6 and CRP had an expressive increase during the trans-operative period. The CRP remained high, and the IL6 decreased on the 7th and 14th days. The IL10 increased during the transoperative period, and it posteriorly decreased to lower levels in comparison to the pre-operative period. The already increased glycemia during the pre-operative period was even higher during the trans-operative and then, returned to preliminary values on the 7th and 14th days after surgery. The HOMA accompanied the insulin. Conclusion: The inflammatory and glycemic serum levels decrease after abdominiplasty in obese post-bariatric patients.

INTRODUÇÃO: Os pacientes que apresentam perda poderal maciça evoluem com sobras dermogordurosas em várias áreas corporais, incluindo os membros inferiores. Diante da heterogeneidade de localização, forma e conteúdo das dismorfias coxofemorais, este trabalho oferece um roteiro de planejamento e sistematização para tratamento de cada uma das deformidades. MÉTODO: Foram avaliadas 28 pacientes do sexo feminino que realizaram coxoplastias e que apresentavam basicamente 3 tipos de deformidade, que poderiam envolver apenas o terço superior, os terços superior e médio ou toda a face medial das coxas. Para cada tipo de deformidade foi aplicada técnica específica; além disso, quando necessário, foi associada suspensão da face lateral das coxas e lipoaspiração. A satisfação das pacientes com os resultados cirúrgicos foi avaliada por meio da aplicação de questionários e notas atribuídas a cada resposta. Foram enumerados intercorrências, complicações e tratamento aplicado. RESULTADOS: Os itens mobilidade, higiene, desempenho sexual, vestimentas e cicatrizes foram avaliados como ótimo (80,5%), bom (14,5%) e regular (5%). CONCLUSÕES: Considerando-se a grande heterogeneidade de dismorfias das coxas em pacientes ex-obesos, um roteiro de tratamento relacionando a deformidade ao tratamento deve ser incorporado ao arsenal cirúrgico.BACKGROUND: Patients showing massive weight loss eventually develop excessive skin and fat in several body parts, including the lower extremities. Given the diversity of the localization, shape, and content of coxofemoral dysmorphia, this study proposes guidelines for planning and systematizing the treatment of each deformity. METHODS: Twenty-eight female patients who underwent thigh lifts and showed 3 types of deformities were assessed. The deformities encompassed the upper third of the thigh alone, the upper and middle thirds, or the entire medial aspect of the thighs. A specific technique was used for treating each type of deformity. Moreover, when necessary, suspension of the lateral thigh was combined with liposuction. Patient satisfaction with the surgical results was assessed by a graded questionnaire. Unexpected events, complications, and treatments were recorded. RESULTS: Mobility, hygiene, sexual performance, use of clothing, and scars were assessed as excellent (80.5%), good (14.5%), and regular (5%). CONCLUSIONS: Considering the broad heterogeneity of thigh dysmorphia in formerly obese patients, therapeutic guidelines correlating each type of deformity with a specific treatment are necessary.

INTRODUÇÃO: A partir da década de 1990 foram iniciados os primeiros tratamentos cirúrgicos da obesidade em adolescentes, seguindo a sequência cirurgia bariátrica, perda ponderal e dismorfismo corporal, criando demanda por cirurgias plásticas para readequação do contorno corporal. O objetivo deste estudo foi identificar fatores associados a cirurgias plásticas de readequação de contorno corporal (morbidade e mortalidade), realizadas em pacientes submetidos a cirurgia bariátrica durante a adolescência. MÉTODO: Entre janeiro de 2008 e janeiro de 2011, 5 pacientes submetidos a gastroplastia redutora durante a adolescência, com consequente perda e estabilização de peso, foram submetidos a cirurgias plásticas do contorno corporal. A média de idade no início das cirurgias plásticas foi de 19,7 anos, sendo 3 (60%) pacientes do sexo feminino. Foram realizadas dermolipectomias abdominais em todos (100%) os pacientes, dermolipectomias crurais em 4 (80%), dermolipectomias braquiais em 2 (40%), mamoplastia com inclusão de implantes de silicone em 2 (40%) pacientes do sexo feminino, mastopexia na terceira paciente do sexo feminino (20%) e correção de ginecomastia em 1 (20%), toracoplastia em 2 (40%), torsoplastia em 2 (40%) e torsoplastia reversa em 1 (20%). Foram realizadas, em média, 3 intervenções cirúrgicas por paciente, sendo operados 20 sítios cirúrgicos. RESULTADOS: Ocorreram deiscências em 3 (15% dos sítios cirúrgicos) casos e foi necessário revisar a ressecção dermogordurosa por flacidez residual em 3 (15% dos sítios cirúrgicos) casos. CONCLUSÕES: Foram identificados alguns fatores associados às cirurgias plásticas de readequação de contorno corporal na amostra de 5 pacientes submetidos a cirurgia bariátrica durante a adolescência, comparáveis aos da literatura específica.BACKGROUND: Surgical treatments for obesity in adolescents were introduced in the 1990s, resulting in individuals undergoing bariatric surgery, and exhibiting weight loss and dysmorphic body features. This produced a demand for plastic surgery in order to readjust the body contour. The aim of this study was to identify factors associated with morbidity and mortality for these corrective body contouring plastic surgeries in patients who underwent bariatric surgery during adolescence. METHODS: Between January 2008 and January 2011, 5 adolescent patients underwent gastric bypass surgery, with a consequent loss and stabilization of weight, and then underwent plastic surgery for correcting body contours. The average age of the patients at the time of plastic surgery was 19.7 years; 3 (60%) patients were female. Abdominoplasty was performed in all patients (100%), crural dermolipectomy in 4 (80%) patients, brachial dermolipectomy in 2 (40%) patients, thoracoplasty in 2 (40%) patients, torsoplasty in 2 (40%) patients, and a reverse abdominoplasty in 1 (20%) patient. In addition, mammoplasty with inclusion of silicone implants was performed in 2 (40%) female patients, whereas the other female patient (20%) underwent mastopexy. A male patient (20%) underwent correction of gynecomastia. An average of 3 surgical interventions were performed on each patient (range, 2 - 5), and the number of surgical sites was 20. RESULTS: Dehiscence occurred in 3 (15% of the surgical sites) cases, and it was necessary to revise the resection because of residual skin laxity in 3 (15% of the surgical sites) patients. CONCLUSIONS: Some factors associated with body contouring plastic surgeries in adolescents were identified and compared with the literature data.

BACKGROUND: Patients who experience massive weight loss often require a thighplasty procedure to reduce excess skin and reshape thighs and lower body contour, improving movement, hygiene, posture, self-image, and quality of life. METHODS: After weight loss and stabilization of weight, eight patients in the postoperative period of gastric bypass were subjected to a thighplasty. Measurements of upper and lower circumferences of the thighplasty and thigh heights were obtained in the preoperative and postoperative periods of 60 and 180 days for comparison of volume change after the surgical procedure. RESULTS: The average volume reduction of each thigh at a postoperative period of 180 days was 1,135 cm³ or 1.135 liters. All patients had small areas of dehiscence along the scars on the medial thigh, and dressings were applied for healing by secondary intention. One (12.5%) patient had cysts in both thighs, confirmed by ultrasound, and required surgical intervention for resection and subsequent resolution. CONCLUSIONS: It was possible to demonstrate significant reduction in the volume of each thigh after plastic surgery for contour refitting. Patient satisfaction and complications associated with the procedures performed were also documented.INTRODUÇÃO: Pacientes que apresentam perda maciça de peso muitas vezes precisam reduzir o excesso de pele e remodelar o contorno das coxas e parte inferior do corpo, melhorando os movimentos, higiene, postura, autoimagem e qualidade de vida. MÉTODO: Oito pacientes em pós-operatório de gastroplastia redutora, após perda e estabilização do peso, foram submetidas a coxoplastia. Medidas das circunferências superior e inferior e da altura das coxas foram obtidas em pré-operatório e pós-operatório de 60 dias e 180 dias, para comparação de alteração de volume consequente ao procedimento cirúrgico. RESULTADOS: A redução média de volume de cada coxa, aos 180 dias de pós-operatório, foi de 1.135 cm³ ou 1,135 litro. Todas as pacientes apresentaram pequenas deiscências ao longo das cicatrizes em face medial das coxas, sendo realizados curativos com cicatrização por segunda intenção. Uma (12,5%) paciente apresentou cistos em ambas as coxas, confirmados por ultrassonografia, sendo necessária intervenção cirúrgica para ressecção e consequente resolução. CONCLUSÕES: Foi possível demonstrar redução significativa do volume de cada coxa após cirurgia plástica para readequação do contorno, além de documentar a satisfação das pacientes e as complicações associadas aos procedimentos realizados.

ABSTRACT Objective: to evaluate patient satisfaction and surgical results obtained after mastopexy with breast implant inclusion. Methods: we conducted a prospective study of 20 consecutive female patients with a mean age of 39.9 years, submitted to augmentation mastopexy. We applied semi-directed psychological interviews pre and postoperatively. The answers to the evaluations were tabulated, categorized, and allowed patient satisfaction analysis. We evaluated surgical results through photographic analysis of three independent plastic surgeons, in the pre and postoperative periods, when scores were attributed to the following items: breasts shape, breasts volume, breasts symmetry, nipple-areolar complex position, and scar quality and extent. Results: nineteen patients (95%) referred satisfaction with the surgical results attained (p

OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.