Polio Place

Post-Polio Health, Volume 28, Number 3, Summer 2012
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: I had polio in 1948, and I am now 65. Adapting was less difficult due to the helpful information gathered at support group meetings. However, I am not finding information or answers that address this issue: Has breast reduction and surgical reduction of abdominal fat been suggested and utilized with other post-polio women?

While remaining relatively active and napping daily, the genetic characteristics typical in my female family members have increasingly resulted in unwanted, exhausting weight gain.

The weight impacts the low back weakness and pain initially brought on by accidental injury before I discovered that recovery was hampered by post-polio syndrome. I'm in physical therapy three times a year and firmly believe a 30-pound reduction would resolve the repetitive back spasm episodes by better balancing the body load to this weight bearing area. Any response would be helpful and appreciated.

Answer: You ask a very difficult and controversial question. Surgically removing fat from selected areas of the body to achieve improved balance and proportion for activity, especially standing and walking, has been done but primarily in non-disabled people without chronic neuromuscular conditions, such as old polio weaknesses. I have been asked to render opinions on this subject because insurance companies often want non-surgical physician opinion that such procedures are indicated and appropriate for biomechanical reasons, and not cosmetic, or appearance reasons.

Nevertheless, I have no information from the few cases I have seen in my career or from any medical literature about the success and effectiveness of these procedures. My opinion is that results are probably unpredictable, and indications and the likelihood of benefit are highly individual. You would definitely want to get several opinions about your options, including from some physicians and therapists who are experienced with evaluating the biomechanics of posture among people with chronic neurological and neuromuscular disorders.

A formal gait laboratory evaluation may be appropriate. Among post-polio people, weakness issues may be more of the problem than the exact distribution of some excess weight from fat accumulation in certain areas.