Plastic Surgery after Massive Weight Loss

This posting is in response to a request to comment on cosmetic surgery for excess skin in the abdomen and other places, after weight loss surgery.

Body contouring, body lift, body shaping or body reshaping are alternative terms used to describe a group of plastic surgery procedures performed after massive weight loss, to manage hanging excess skin. Patients have to have reached a stable plateau weight before any such plastic surgery procedures. The person should have lost at least 100 pounds or achieved the target or maximum weight loss, had a stable weight for a good length of time after the weight loss surgery, and be in good health and not planning on becoming pregnant. Good candidates for a body lift should also have no medical problems that prevent them from going under general anesthesia for major surgery, and should not smoke. Smoking decreases blood flow to the tissues and, therefore, may slow healing.

Plastic surgery procedures after weight loss surgery include the following:

1. Panniculectomy: This is excising the "pannus", which is the excess hanging skin that is present below the belly-button.

2. Abdominoplasty (Tummy Tuck): Includes dissection and preservation of the umbilicus itself, and a more extensive skin mobilization and more aggressive skin removal than panniculectomy. A complete abdominoplasty also includes tightening of the abdominal wall muscles. Abdominoplasty and incisional hernia repair can be combined into a single procedure.

3. Arm lift or brachioplasty.

4. Breast lift or mastopexy.

5. Lower body lift is a combination of an abdominoplasty, plus a thigh and buttock lift. It requires a large incision around the belt line to lift the lower body.

6. Liposuction uses small, narrow tubes to remove fat and is often used in combination with other lifting procedures to help achieve better contouring in various parts of the body.

Combining multiple "lifts" entails longer operative time, and more potential blood loss, but is very appealing to many patients, from the stand-point of time off work and out-of-pocket costs. Combined procedures are avoided if there is active smoking history or medical problems that make a longer operation a particularly risky undertaking.

Insurance coverage varies from carrier to carrier, and a carrier may have different plans with different provisions. Almost all insurance carriers specify that coverage of aesthetic (cosmetic) surgery is excluded. Definition of medical necessity, that is essential for coverage, is variable.

Possible complications after body-contouring surgery include seroma (collection of thin serous or serosnaguineous fluid), hematoma (collection of blood), wound separation (usually minor), swelling and scarring. All patients will have scars, and basically the surgery trades excess skin for scars. For a small number of patients, scars can be excessively thick or inflamed. Before going for body contouring surgery, any nutritional deficiencies (as protein malnutrition, anemia, loss of muscle mass, and osteopenia/osteoporsis) need to be addressed and corrected.

Body contouring is considered major surgery. The outcome of body shaping is generally extremely satisfying to patients. It may take several months to see the final results of the procedure.