الفهرس 
Hisham Aly HelalOnly 14 pages are availabe for public view
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Abstract
Conclusion and Summary
Severe obesity is associated with multiple comorbidities that affect every organ in the body. They reduce the life expectancy and markedly impair the quality of life. Many methods have been developed to manage morbid obesity. Most of them are successful in reducing extra weight and thus minimizing the incidence of morbidities and mortalities.
Proper education of patient by bariatric surgeon, nutritionist and plastic surgeon regarding the changes that occur in the body during the process of weight loss ”wax in a melting candle” beside the necessity of following up with a specialized nutritionist to supply them with proper diet and supplements to lead a healthy life in preparation for plastic surgery procedure when needed.
The deformities after MWL affect all areas of the body in variable degrees. Many scaling systems are used to describe these deformities which helps in the management plan and thus in the follow up of these patients.
Breast deformities that develops after massive weight loss are variable depending on; the rate of weight reduction, absolute change, and current BMI, age, general health and fitness, familial and gender-specific fat depositions, skin elasticity and its relation to underlying fascia, muscular status and skeletal form.
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These changes will affect the breast parenchyma, the skin envelope, the adjacent tissues, lateral chest wall and the IMF position. With the wide range of breast deformities developed after massive weight loss, it is crucial to wait until the patients reach stable BMI for a sufficient period before proceedings in any recontouring surgeries. Proper assessment of the breast deformity is the key to the successful treatment plan. There are many options of management of these deformities depends on the residual volume of the breast, the quality of the skin, the availability of nearby excess redundant tissues.
The breast is undoubtedly the most crucial part of the female body symbolizing attractiveness and femininity.
Frequently women seek for breast surgery to regain aesthetically pleasing and well-proportioned breasts with youthful curves. With the increasing demand, surgical techniques for breast reshaping evolved enormously within years and provide individualized correction for different types of breast deformities.
Despite the variety of deformities the fundamental goals in mammaplasty are constant and well defined. In any kind of breast surgery a symmetric, proportional and aesthetic appearance with
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adequate projection, medial and upper pole fullness and appropriately placed nipple areola complex is aimed. Besides, techniques developed for breast reduction and mastopexy focus on minimizing scars while providing a long-lasting result.
Correction of the breast deformity can be performed as part of a combined procedure together with reshaping of other regions such as abdomen, arms and thigh or staging the procedures can be preferred according to the medical condition of the patient and surgeon’s experience with major body contouring procedures
By revising different opinions recommended by plastic surgeons in literatures, there were many recommendations.
One of them was the algorithm presented here which was based on breast volume to help identify the appropriate technique needed to achieve the desired esthetic outcome in this complex patient population.
It is useful as starting point in planning breast operations for the MWL patient, and a way to organize the current techniques.
Many options of management of breast deformity after MWL were mentioned in the literature as breast reduction, augmentation using either implant or auto-augmentation using excess nearby tissues, or mastopexy.
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The main aim is to choose the proper procedure for each patient to reach acceptable aesthetic outcome with minimal complications and long term results.
In future it is better to use the more objective methods of analysis instead of rely on the subjective methods to allow better assessment of results.