Abstract
Background: Bariatric surgery is an effective treatment for obesity, leading to significant weight loss and improvements in metabolic health. However, massive weight loss often results in excess skin, which can negatively impact body image, psychological well-being, and quality of life. Abdominoplasty is commonly performed after bariatric surgery to address these concerns. Our study aimed to evaluate the effects of post-bariatric abdominoplasty on psychological well-being, body image, social relationships, and sexual functioning in formerly obese patients. Methods: A single-center, cross-sectional recall study was conducted on 35 patients, out of 135 invited, who underwent sleeve gastrectomy followed by abdominoplasty 12-24 months after the initial surgery. Participants completed validated questionnaires assessing psychological well-being, depression, anxiety, self-esteem, body perception, social relationships, and sexual functioning. Pairwise comparisons were performed to assess changes across the preoperative, post-bariatric, and post-abdominoplasty stages. Results: Psychological well-being significantly improved post-bariatric surgery, with further reductions in anxiety and depressive symptoms after abdominoplasty. However, body shape perception and self-esteem improved after bariatric surgery but did not show additional enhancement following abdominoplasty. Social support remained largely unchanged, except for modest improvements in attachment and reliable alliance. Sexual functioning improved significantly after bariatric surgery but showed no further significant gains after abdominoplasty. Conclusions: While abdominoplasty is associated with additional psychological benefits, particularly in reducing anxiety and depressive symptoms, it does not significantly enhance body perception, self-esteem, or sexual functioning beyond the effects of bariatric surgery. These findings highlight the importance of setting realistic patient expectations regarding the benefits of body contouring surgery in post-bariatric care.