• literature review;
  • quality of life;
  • reconstructive surgery;
  • weight loss

gilmartin j (2011) Journal of Nursing and Healthcare of Chronic Illness3, 209–221 A critical literature review: the impact of reconstructive surgery following massive weight loss on patient quality of life

Aim.  To critically review published papers on the impact of reconstructive surgery following weight loss on patient quality of life and identify areas of patient dissatisfaction.

Background.  The global obesity epidemic is a major health problem and a growing number of morbidly obese patients are seeking surgical solutions such as bariatric surgery. Massive weight loss often leads to excess of lax, overstretched skin causing physical dysfunction and psychosocial problems which impact on patient quality of life. Reconstructive surgery is a major growth intervention for body improvement and provides significant functional and aesthetic benefit following such massive loss. However, little collective evidence exists regarding the impact of body contouring on patient quality of life and psychosocial function.

Design.  Literature review conducted between May 2010 and July 2010.

Methods.  Database searches of CINAHL, Psychinfo, EMBASE and the Cochrane library using various keyword combinations related to reconstructive surgery following massive weight loss was performed.

Results.  A total of 10 papers matching the inclusion criteria were identified. The literature revealed that many patients reported an improved quality of life following reconstructive surgery such as improved well-being related to self-image and capacity, and some participants reported dissatisfaction with cosmetic results and health complications.

Conclusion.  Massive weight loss results in excess redundant skin creating physical, functional and psychosocial problems that impact on quality of life. There is ground for believing that possible long-term change in massive weight loss patient management will make its sustained appearance when national guidelines and policy recommend an ‘ideal’ care pathway for patients following reconstructive surgery.

Relevance to clinical practice.  The massive weight population continues to grow globally. Although patients experience a huge accomplishment with successful weight loss, excess skin, physical and psychosocial limitation coupled with a persistently poor body image can adversely affect their quality of life. Hence, quality of life and outcome research is vital in shaping health policy and developing National Service Frameworks impacting on the construction of an ‘ideal’ care pathway for such patients. Therefore, it is crucial that health professionals make critical use of evidence, engage with outcomes research, innovative practice, and challenge idealistic ‘media expectations’. The multidisciplinary team approach is essential in furthering the evolution of novel ideas and offering first class, individualised, long-term care.