Patients having body contouring surgery after significant weight loss may benefit from nutrition screening and a personalized diet plan before surgery to support healing and reduce complications, according to a new review in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
“Good nutrition is essential for good wound healing,” said J. Peter Rubin, MD, MBA, of the University of Pittsburgh School of Medicine, senior author of the review. “Patients who are undergoing very significant weight loss tend to have some nutritional deficiencies.”
Different paths to weight loss, shared nutritional challenges
Patients have several options for significant weight loss, including GLP-1 medications, bariatric surgery or a combination of the two. Each strategy causes different nutritional challenges for patients, but each significantly restricts the number of calories eaten. This makes it difficult for significant weight loss patients to get enough protein, vitamins and minerals to support recovery after surgery. The review cited complication rates of 20 percent to 70 percent after body contouring in patients with major weight loss, with nutrition deficiencies linked to impaired healing. Body contouring surgery after weight loss has a strong track record of safety, and a majority of the complications are related to wound healing issues. While most of these wound healing issues are handled with office-based care, the risk can be reduced with attention to nutrition.
“The most common complication we see is a problem with wound healing,” said Dr. Rubin. “That may involve a higher rate of infection. That may involve opening or breakdown of incisions, even though we close the skin very precisely because a patient”s healing capacity may be reduced.”
Before surgery suggestions
The review recommended lab tests before surgery to determine patients’ nutrient levels. Protein is a major concern along with the B vitamins and vitamin D. A standard multivitamin may not be enough to correct every deficiency, and special supplement regimens may be recommended for patients who have undergone bariatric surgery and/or are using GLP-1 medications.
Small, protein-rich meals may help
The review suggested smaller, more frequent servings of concentrated protein and timing food for periods when appetite is stronger for patients with significant weight loss. An individualized diet plan with the guidance of a nutritionist or dietitian could be created to prepare patients for surgery and support their healing afterward.
Nutrition supports timing
Enhanced nutrition should begin at least several weeks before surgery and continue during recovery, when the body needs extra nutrients to heal.
“It is 100 percent vital that patients maintain that rigor and diligence around good nutrition after the surgery because that is the time when their body is healing from the stress of the surgery, when nutritional demands are the highest and when it’s very important to keep fueling the body with what it needs to heal,” said Dr. Rubin.
Nutrition is a key part of preparing for surgery. Early screening and a tailored plan can help patients and surgeons identify issues and approach body contouring with healing and safety in mind.
Plastic and Reconstructive Surgery® is published by Wolters Kluwer.
Click here to read “Nutritional Challenges in Post-Massive Weight Loss Body Contouring: Guidance for Plastic Surgeons on GLP-1 Agonists and Sleeve Gastrectomy”
Article: “Nutritional Challenges in Post-Massive Weight Loss Body Contouring: Guidance for Plastic Surgeons on GLP-1 Agonists and Sleeve Gastrectomy” (doi: 10.1097/PRS.0000000000012672)
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