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Aesthetic and Functional Satisfaction after Monsplasty in the Massive Weight Loss Population
Jacob M.P. Bloom, MD, MS, Emily Van Kouwenberg, BS, Peter F. Koltz, MD, Robert B. Shaw, Jr., MD, Howard N. Langstein, MD, Jeffrey A. Gusenoff, MD.
University of Rochester, Rochester, NY, USA.

Purpose
The most common procedure performed after massive weight loss is abdominal contouring, either by panniculectomy or abdominoplasty. The mons region is affected by massive weight loss, with decent of the pubic area due to skin laxity and fullness due to adiposity. Thinning and resuspension of this area is often performed concomitantly with abdominal contouring procedures. While the monsplasty technique has been described in the literature, outcomes including patient satisfaction have not been measured. We investigated whether there are significant improvements in patient satisfaction, functional outcomes, and aesthetic results in women undergoing abdominal contouring surgery after massive weight loss.
Methods
38 consecutive female massive weight loss patients (≥50 lbs) who had undergone either abdominoplasty or panniculectomy were surveyed. All patients were recruited from our prospective IRB approved registry and had a follow-up of at least 3 months. Monsplasty is routinely performed by placing the lower abdominal incision approximately 6 cm above the anterior vulvar commisure. The mons region is thinned by direct excision, and then resuspended to the abdominal wall with vicryl sutures. Subjects completed a Mons Satisfaction Survey. Additional demographic and procedural data were collected from the database. Descriptive statistics were preformed with significance set at p-value <0.05.
Results
Twenty-five patients (65.8%) completed the survey. Average patient age was 43.6 ± 10.5. BMI indices were as follows; Max BMI 52.2 ± 9.89, Current BMI 30.8 ± 6.51, Delta BMI 21.0 ± 6.42. Average pannus resection weight was 2.99 kg ± 1.97. 48% of patients underwent abdominoplasty while 52% had a panniculectomy (Table 1). Prior to surgery 28% of patients reported the ability to see their genital region compared with 100% postoperatively. On a ten point Likert scale rating satisfaction (zero being very unsatisfied, five neutral and ten very satisfied) patients rated the appearance of their mons as 3.18 ±2.11 prior to surgery and 8.58 ± 1.73 after surgery (p<0.01). 55% of patients reported an improvement in both sex life and hygiene. 40% of patients reported an increase in genital sensitivity while 60% had no change. 72% of patients reported the current position of their mons pubis to be at the right level; where as 12% of patients thought it was positioned too high. Rates of bladder incontinence were reported to decrease from 24% to 12%. Five patients (20%) reported a change in their urinary stream, only one of these patients identified this as problematic. Two patients (8%) reported incisional or pubic pain since surgery. 96% of patients would both undergo this procedure again and recommend it to a friend.
Conclusion
In massive weight loss patients, monsplasty at the time of abdominal contouring results in high patient satisfaction levels. Half of patients experience improvements in hygiene and sex life. With proper incisional design, monsplasty can be performed safely with high patient satisfaction to improve both form and function of the pubic region during abdominal contouring.
Table 1. Tabulated Survey Responses
Surgical Procedure
Abdominoplasty12/25 (48%)
Panniculectomy13/25 (52%)
Likert Satisfaction Scale (0- Very Unsatisfied, 5- Neutral 10- Very Satisfied)
Prior to surgery3.18 ±2.11p < 0.0001
After surgery8.58 ± 1.73
Visualize genitalia before surgery?
Yes7/25 (28%)
No18/25 (72%)
Visualize genitalia after surgery?
Yes25/25 (100%)
No0/25 (0%)
Position of Genital Region
Too High3/25 (12%)
Too Low0/25 (0%)
At the right level18/25 (72%)
Not sure4/25 (16%)
Problems with hygiene before surgery?
Yes11/25 (44%)
No14/25 (56%)
Improvement in hygiene after surgery?
Yes14/25 (56%)
No11/25 (44%)
Improved sex life since surgery?
Yes15/25 (55%)
No4/25 (16%)
Not sexually active6/25 (24%)
Change in genital sensitivity?
Yes10/25 (40%)
No15/25 (60%)
Urinary incontinence before surgery?
Yes6/25 (24%)
No19/25 (76%)
Urinary incontinence before surgery?
Yes3/25 (12%)
No22/25 (88%)
Change in urinary stream after surgery?
Yes5/25 (20%)
No20/25 (80%)
If yes, is it problematic?
Yes1/5 (20%)
No4/5 (80%)
Experience pubic pain?
Yes2/25 (8%)
No23/25 (92%)
Undergo procedure again?
Yes24/25 (96%)
No0/25 (0%)
Not Sure1/25 (4%)
Recommend this procedure to a friend?
Yes24/25 (96%)
No1/25 (4%)


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