Mamoplastias em pacientes pós-bariátricos: experiência do serviço de cirurgia plástica em um hospital universitário

Abstract

In Brazil, severe obesity affects approximately 13.6 million people. Bariatric surgery is an effective treatment for severe obesity, generating significant and lasting weight reduction, but it results in sagging and excess skin and poorly positioned adipose tissue. Patient dissatisfaction with excess skin has become the main reason for the demand for reconstructive surgeries performed by plastic surgeons. This work is a retrospective study based on the survey of medical records of patients who underwent mammoplasty after bariatric surgery, between 2019 and 2023. The study analyzed the results of reconstructive plastic surgeries performed on 24 patients previously undergoing bariatric surgery, focusing on factors associated with complications and postoperative outcomes. The sample was composed mostly of women (95.83%), with a median age of 44 years and an average body mass index (BMI) of 27.05 kg/m². Patients with complications had a significantly higher BMI (27.6 kg/m²) compared to the group without complications (25.3 kg/m²; p=0.030). Mild complications (Clavien-Dindo I and II) were more frequent, especially in mastopexies with implants and reduction mammoplasties. Severe cases were rare, corroborating the overall safety of the procedures. The most prevalent complications included wound dehiscence without the need for surgical re-intervention and hypertrophic scars. The analysis identified a longer time interval between bariatric surgery and admission for reconstruction in the group with complications (p=0.02), but there were no significant differences in the type of procedure performed or in the weight of resected tissue. Geographically, the majority of patients were residents of Salvador (62.5%), with 37.5% coming from other cities in Bahia. Conditions such as hypertension and psychiatric disorders were observed, but without a statistically significant impact on the results. The mean surgery time was similar between the groups with and without complications. The findings highlight the need for preoperative optimization, especially in patients with high BMI, and highlight the importance of individualized surgical planning and rigorous postoperative monitoring to reduce complications and improve outcomes.