Psychological Assessment in Post-bariatric Plastic Surgery: A Scope Review

Abstract

Introduction

Obesity can have physical, psychological, and social consequences. Bariatric surgery may improve the patient's biopsychosocial condition. However, excess skin after rapid and significant weight loss may result in psychological distress. Plastic surgery, as the only procedure for excessive skin removal, can improve self-image and encourage weight control.

Objective

Through a scoping review, this study investigated whether the basic psychological assessment performed during screening by plastic surgeons can identify psychological distress in patients who wish to undergo plastic surgery after bariatric surgery.

Method

The study consisted of a bibliographic survey of articles published from 2013 to 2023 in Portuguese, English, and Spanish in the MEDLINE, Virtual Health Library (VHL), and Embase databases.

Results

In the search strategy, 48 articles met the inclusion criteria, and the study mentions 18 of these papers.

Conclusion

The psychological assessment performed during plastic surgery screening allows the identification of suffering from excessive skin after bariatric surgery and previous psychological suffering, facilitating the medical decision about whether or not to refer the patient for specialized psychological evaluation. This approach broadens the patient's understanding of the relationship between body and mind.

Keywords

bariatric surgery - body - body image - contouring - mental disorders - psychosocial functioning - surgery plastic

Authors' Contribution

ACM: data analysis, interpretation, or both, statistical analysis, conceptualization, study concept and design, methodology, writing – original draft preparation, writing – review and editing, visualization; DN: final manuscript approval, supervision, validation; VYS: supervision; SSS: data collection; LMA: statistical analysis.

Publication History

Received: 24 March 2024

Accepted: 30 April 2024

Article published online:
15 July 2025

• Referências

• 1 Proczko M, Postrożny D, Szymański M, Pouwels S, Major P, Stepaniak P. Evolution of the body image perception of people with obesity on the pathway from bariatric surgery to body contouring lift surgery. J Plast Reconstr Aesthet Surg 2022; 75 (02) 860-869
• 2 Akkayaoğlu H, Çelik S. Eating attitudes, perceptions of body image and patient quality of life before and after bariatric surgery. Appl Nurs Res 2020; 53: 151270
• 3 Casselli DDN, Silva EDSME, Figueira GM, Demarchi ME, Souza JC. Comorbidade entre depressão, ansiedade e obesidade e complicações no tratamento. Res Soc Dev 2021; 10 (01) e16210111489
• 4 Geller S, Levy S, Goldzweig G. et al. Psychological distress among bariatric surgery candidates: The roles of body image and emotional eating. Clin Obes 2019; 9 (02) e12298
• 5 Soeiro RL, Valente GSC, Cortez EA, Mesquita LM, Xavier SCDM, Lobo BMIDS. Educação em Saúde em Grupo no Tratamento de Obesos Grau III: um Desafio para os Profissionais de Saúde. Rev Bras Educ Med 2019; 43 (1, suppl 1) 681-691
• 6 deMeireles AJ, Carlin AM, Bonham AJ. et al. A Longitudinal Analysis of Variation in Psychological Well-being and Body Image in Patients Before and After Bariatric Surgery. Ann Surg 2020; 271 (05) 885-890
• 7 Natvik E, Groven KS, Råheim M, Gjengedal E, Gallagher S. Space perception, movement, and insight: attuning to the space of everyday life after major weight loss. Physiother Theory Pract 2019; 35 (02) 101-108
• 8 Rosa SC, Macedo JLS, Canedo LR, Casulari LA. Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: A retrospective cohort. Surg Obes Relat Dis 2019; 15 (03) 447-455
• 9 Silva DNE, Rosseto M, Vargas KFM. et al. Strategies for early detection of psychopathologies in candidates for post-bariatric plastic surgery. Rev Bras Cir Plást 2020; 35 (01) 101-108
• 10 Poulsen L, McEvenue G, Klassen A, Hoogbergen M, Sorensen JA, Pusic A. Patient-Reported Outcome Measures: BODY-Q. Clin Plast Surg 2019; 46 (01) 15-24
• 11 Monpellier VM, Antoniou EE, Mulkens S, Janssen IMC, Jansen ATM, Mink van der Molen AB. Body Contouring Surgery after Massive Weight Loss: Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post-Bariatric Surgery Population. Plast Reconstr Surg 2019; 143 (05) 1353-1360
• 12 Ferreres-Galán V, Quilez-Orden AB, Osma J. Aplicación del protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales en pacientes post-cirugía bariátrica: estudio de efectividad y viabilidad en formato grupal. An Psicol 2022; 38 (02) 219-231
• 13 Elfanagely O, Othman S, Mellia JA, Messa IV CA, Fischer JP. Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring. Aesthetic Plast Surg 2021; 45 (03) 1105-1112
• 14 Bennett BL, Grilo CM, Alperovich M, Ivezaj V. Body Image Concerns and Associated Impairment Among Adults Seeking Body Contouring Following Bariatric Surgery. Aesthet Surg J 2022; 42 (03) 275-282
• 15 Bianciardi E, Di Lorenzo G, Niolu C. et al. Body image dissatisfaction in individuals with obesity seeking bariatric surgery: exploring the burden of new mediating factors. Riv Psichiatr 2019; 54 (01) 8-17
• 16 Buer L, Kvalem IL, Bårdstu S, Mala T. Comparing Bariatric Surgery Patients Who Desire, Have Undergone, or Have No Desire for Body Contouring Surgery: a 5-Year Prospective Study of Body Image and Mental Health. Obes Surg 2022; 32 (09) 2952-2959
• 17 Jiang Z, Zhang G, Huang J. et al. A systematic review of body contouring surgery in post-bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers. Obes Rev 2021; 22 (05) e13201
• 18 ElAbd R, Samargandi OA, AlGhanim K. et al. Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45 (03) 1064-1075