POST BARIATRIC AND MASSIVE WEIGHT LOSS BODY CONTOURING SURGERY
Body Contouring Surgery in San Francisco Bay Area
Obesity is defined as accumulation of fat that leads to body dysfunction. This medical illness can lead to a variety of severe medical conditions such as hypertension, diabetes, heart disease, strokes, sleep apnea and joint dysfunctions.
Unfortunately, obesity has become a major public health problem in the USA. It has reached epidemic proportions. According to the National Health and Nutritional Survey, 65% of adults are overweight and the rate is increasing. The cause of obesity is not only overeating, but is much more complex. Inefficient caloric utilization, reduced metabolic activity, high set point for body weight, genetics, environment and psychological issues all contribute.
BARIATRIC SURGERY AND MASSIVE WEIGHT LOSS
The goal of bariatric surgeries and massive weight loss is to improve the overall health of morbidly obese patients. The outcome of the surgery is a significant reduction in the absorption of calories consumed. Bariatric surgery has advanced significantly over the years so that it is much safer, with less short and long-term complications and over 60%of the surgeries are performed endoscopically.
Patients who have had bariatric surgery have undergone a major life-changing event. His/her overall body shape has drastically changed, his/her health has improved and his/her life expectancy has been extended. In spite of this significant improvement in life-style the patient have issues with the redundant skin. This has given rise to a new division in research and development in the American Society of Aesthetic Plastic Surgery.
POST-BARIATRIC SURGERY BODY CONTOURING
The post-bariatric and massive weight patient has a new issue to address. How does one deal with the abundance of loose, hanging skin? Body contouring for massive weight loss patients is the answer.
Body contouring for massive weight loss is performed in two or more stages if the patient’s goal is to reshape multiple areas.
The advantages of staging are:
- Less anesthesia time
- Less blood loss
- Less surgical fatigue
- Avoidance of opposing vectors of pull
- Second chance to correct areas
- Multiple exposures to anesthesia
- Increased time off work
- Increased expense for the patient
Dr. Delgado and the anesthesiologist will discuss the different options with the patient. Due to the nature of massive weight loss surgery, the surgery will be staged but the order in which the procedures are staged can be customized.
BODY LIFTING AFTER MASSIVE WEIGHT LOSS
The approach for body lifting is to separate the procedures into upper and lower body lifting. The upper body lift is composed of breast surgery, arm surgery, axilla surgery and lateral chest surgery. This would complete the upper body lifting and tightening of the anatomic structures in this location. The lower body lift is composed of an abdominoplasty, the flank or back excision, also termed a belt lipectomy. A medial thigh lift completes lower body component. The medial thigh lift is best performed with a vertical incision down the leg to excise the most tissue and achieve a tighter upper leg. When both upper and lower body lifts are done, the procedure is called a total body lift.
BREAST SURGERY AFTER MASSIVE WEIGHT LOSS
For women, breast deformities after huge weight loss are very different than those seen in women needing the traditional breast lift. The deflation of the skin can cause severe asymmetries and flattening of the breasts. A short-scar lift is usually not a good choice, but an inverted-T technique, which can excise the armpit roll and use it for auto augmentation of the breasts, is a nice choice. It is a wonderful technique that re-suspends the breast tissue on the chest wall and uses the lateral armpit tissue to enhance the breast volume. A breast implant can also be used for added volume.
As for men who need chest contouring after immense weight loss, Dr. Delgado is particularly skilled in sculpting the male chest as well, with many hundreds of successful cases of gynecomastia reduction (male breast reduction) to his credit.
ARM LIFT (BRACHIOPLASTY) AFTER MASSIVE WEIGHT LOSS
The upper arms, axillae and adjacent chest area of a patient after considerable weight loss can be problematic. Women and men can develop challenging arm deformities extending from the arms to the chest wall and breast region. The draping of the skin can be awkward to cover up, even in long-sleeved clothing.
An arm lift can solve this problem. The incision goes from the elbow to the axilla (arm pit), down the upper chest area and blends into the breast region. This will tighten the entire area that needs to be tailored all together. The incision often blends, or fuses, the breast incisions to achieve a tapered and tailored appearance.
LOWER BODY LIFTING IN MASSIVE WEIGHT LOSS PATIENTS
Circumferential body lifting has been developing since the 1960’s to address the laxity of tissue occurring around the torso. Since the incision follows much of the line where a belt might be worn, it is called a “belt skin reduction.” This approach incorporates a tummy tuck and wide waist excision of tissue extending around both sides to the buttocks crease in the back. This will excise a substantial amount of tissue from the mid-torso region, additionally lifting the anterior-lateral thigh and buttock region.
This is a significant surgical procedure and it is sometimes done in two stages. Patients are very pleased with the results of this procedure.
FACE REJUVENATION AFTER MASSIVE WEIGHT LOSS
Vast weight loss that causes the body to deflate can affect the face as well. The loose body skin can be hidden under clothing, but it is not so easy to conceal loose skin on the face. Immense weight loss can cause slack skin in the forehead, drooping of the upper eyelids, bags under the eyes, new lines in the cheeks and a sagging jaw line and neck. Although the patient feels younger and more energetic than ever, he/she looks tired and older after the weight loss. For these patients, a facelift or neck lift is a good solution. For a balanced and natural appearing result, an eyebrow lift and upper and lower eyelid lifts may be indicated as well. All these procedures can be done at the same time. Recovery is approximately two weeks.
A skilled plastic surgeon has much to offer a patient who has undergone bariatric surgery and/or huge weight loss. Reconstructive plastic surgery allows the patient to complete his/her transformation and to enjoy his/her new shape and healthier life to the fullest.
Frequently Asked Questions
Body Contouring After Massive Weight Loss
1. When is the best time to consider having body contouring surgery?
The weight loss process usually stabilizes at about one year, so we look for a fairly stable weight history for this duration of time. Ideally, your age is less than 55 years old and you have a healthy blood count. The age requirement is not absolute, as no doubt, some 60 year olds are healthier than some 40 year olds. Nevertheless, due to the extensive amount of surgery entailed with body contouring after considerable weight loss, a person needs to be strong and healthy to tolerate the physical stress of the post-operative recovery period.
2. Will insurance cover any of the body contouring surgery?
Yes, insurance may cover some of the surgery. Often a breast reduction will be covered by medical insurance when the patient has a DD cup size or larger, there are skin breakdown issues, or the presence of back or neck pain. Sometimes a tummy tuck will be covered if there is chronic skin breakdown underneath the overhanging skin. Most of these procedures, however, are considered cosmetic.
3. Can I have all of the procedures at the same time?
Usually not. If you require just a few procedures such as a breast reduction or breast lift and a tummy tuck, then these two procedures can be done at the same time. However, many body-contouring patients, after immense weight loss, request multiple surgical procedures. The amount of surgery and the time needed to complete the procedures may dictate that they be done in two or three stages. In Dr. Delgado’s mind, safety is the most important aspect of body contouring surgery for vast weight loss. He will work with you to put together a plan that is both safe and affordable.
4. How much does a full body lift cost?
The cost varies greatly. Out-of-pocket cost will be fairly substantial for multiple areas of body contouring surgery. The cost will include the surgeon’s fee, use of the operating room facility, and services of a board-certified physician anesthesiologist, compression garments and all follow-up care. You should expect an additional fee for overnight nursing care for the first night after your surgery. The cost depends on the time required for the procedures and this will vary from patient to patient. Approximate costs would be $8500 for a breast reduction, $9500 for a tummy tuck and $9000 for an arm lift, to give just a few examples. Obviously, insurance coverage would be very helpful.
5. When can I resume normal activities like work?
It depends on what procedures are done. A tummy tuck or a body lift will require the longest recovery. Even so, you can drive a car, return to work or school and do most of your normal activities, other than exercise, usually by two to three weeks after surgery. Exercise can be resumed after six weeks. The breast reduction, medial thigh lift and arm lift require shorter recovery times. After those surgeries, you can drive, return to work or school and do most of your normal activities after one to two weeks, though exercise cannot be started until after six weeks. However, each patient’s situation is different and recovery time is a function of age, health and pain tolerance.
6. Who is the best type of surgeon to do the surgical procedures?
A board-certified plastic surgeon certified by the American Board of Plastic Surgery is the best choice. Plastic surgeons, like Dr. Delgado, perform these procedures on a frequent basis and, most importantly, have the experience to manage you preoperatively and postoperatively. You should study a physician’s before and after photographs to evaluate his/her artistic skill with body contouring.
7. Is there any way to avoid scarring?
No. A primary issue with body contouring after massive weight loss is the excessive amount of skin. This requires removal of skin to obtain a better shape and contour. Undergarments and most styles and cuts of clothing, however, will cover most of the incisions.
8. Are there any complications?
Yes, as with all surgical procedures, but even more so with body contouring after considerable weight loss. Complications include wound breakdown, fluid accumulation, skin loss, infection, bleeding and blood clots. The rate of these complications is approximately 25%-30%, depending on the health of the patient and the amount of weight loss. This is why an experienced plastic surgeon, like Dr. Delgado, is the wisest choice for this type of procedure.