SPECIAL TOPIC Complications in Postbariatric Body Contouring: Postoperative Management and Treatment Joseph Michaels V, M.D. Devin Coon, M.D. J. Peter Rubin, M.D. Baltimore and North Bethesda, Md.; and Pittsburgh, Pa. Summary: Proper postoperative management of body contouring patients is essential to satisfactory long-term outcomes. Standard issues such as drain man- agement, nutrition, and activity limitations will be relevant to all patients. Al- though major complications are infrequent, effective strategies for management of common minor wound complications are invaluable. (Plast. Reconstr. Surg. 127: 1693, 2011.) P ostoperative management of the body con- touring patient has received comparatively less attention in the literature relative to sur- gical techniques. Many practices in this area are in need of better evidence and are currently based only on anecdotal experience. The principles of postoperative care for the general plastic surgery patient continue to apply, but consideration of the specific factors unique to body contouring is essen- tial for optimizing long-term results. Management of the body contouring patient after surgery can be divided into two major categories: general postop- erative strategies and complication management. GENERAL POSTOPERATIVE STRATEGIES Drains Seroma formation is one of the most common complications seen after major body contouring. Seroma formation has an estimated incidence of 13 to 37 percent, depending on the series. 1–4 Drains are placed for all procedures with extensive undermining of remaining dead space and typi- cally remain for an average of 10 to 14 days. Garments We will routinely use a garment or compres- sion dressing to minimize swelling. Although both can be useful, care must be taken to ensure that they do not impair ventilation or cause distal par- esthesias if they are used in the extremities. Cau- tion is suggested if drains are being used under garments or compression dressings, as they may cause skin indentations or potential necrosis. Once they are placed, we continue using them for a minimum of 3 weeks. For breast surgery, we recommend a sports bra for 2 to 3 weeks. We ask patients not to use underwire bras for 4 to 6 weeks based on our desire to avoid any pressure along the inferior incision line. Postoperative Nutrition We attempt to ensure that patients maintain a high level of protein intake following surgery. 5–7 In the immediate postoperative period, many patients do not have the appetite to maintain protein intake of greater than 70 g/day. Poor protein intake may contribute to slow wound healing and reduce the ability to heal any open wounds that occur. The use of protein supplementation is helpful to combat this problem, although there are not yet prospective data demonstrating a benefit. We have recently begun recommending the purchase and use of protein sup- plements both before and after any body contouring procedure. There are multiple brands that can be used; however, we caution diabetic patients to choose supplements that are low in carbohydrates. We routinely question patients about their protein intake at each postoperative visit to ensure that their nutrition is optimized. Positioning and Activity Elevation of the operative site, patient posi- tioning that minimizes tension on the suture line, and limiting strenuous activity are important to From private practice; the Division of Plastic, Maxillofacial, and Reconstructive Surgery, The Johns Hopkins Medical Institutions; and the Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center. Received for publication May 7, 2010; accepted August 30, 2010. Copyright ©2011 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e31820a649f Disclosure: The authors have no financial interest to declare in relation to the content of this article. www.PRSJournal.com 1693