Abdominoplasty in the Weight Loss Surgery Patient

Abdominoplasty or body contouring procedures are common following gastric bypass surgery such as roux-y gastric bypass and sleeve gastrectomy.

After patients have lost weight and their weight has stabilized, they are candidates for body contouring procedures.

The abdominoplasty helps to restore the contour to the abdominal wall that is traditionally lost following weight gain. Often, when patients lose weight, they have excess skin which can be bothersome. The excess skin is often a reminder that they would like to get rid of.

Patient satisfaction is high following body contouring procedures.

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Brachioplasty. Arm Contouring.

 

When examining art throughout time, artists have traditionally had difficulty obtaining correct proportions of the upper extremity and hand in drawings, paintings, and sculpture.

Michelangelo’s painting on the Sistine Chapel ceiling shows excellent proportion's of the depiction of God and Adam's hands. However, one can easily ascertain how obtaining these proportions can be quite difficult.

Nonetheless to the Plastic & Reconstructive surgeon, obtaining the correct proportion in an "arm tuck" or brachioplasty can be quite challenging as well. Crucial to obtaining an optimal result is to avoid any pinching or constriction along the contour of the arm. Even more challenging is to gradually transition this contour into the "armpit" or axillae. Often liposuction is used in conjunction with the brachioplasty to adequately taper the contour.

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Brachioplasty. Post-Bariatric Body Contouring.

Successful brachioplasty or "arm tuck" surgery requires careful attention to detail to yield a natural contour to the arm. That is, it is paramount that their is an even and gradual contour of the arm from the forearm toward the axillae or "arm pit" often with modification of the lateral chest wall as shown in the above photograph.

Inadvertent over-resection of the skin and fat in the arm can lead to an abnormal pinched appearance. Successful brachioplasty surgery requires compliance on behalf of the patient to wear a compression garment or ace bandage on the arm for at least two weeks.

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Mastopexy. Post-Bariatric Body Contouring Surgery.

Mastopexy or "breast lift" surgery can be very rewarding for the patient and surgeon. Patients who loose greater than 100 lbs of weight with either lap band or gastric bypass procedures lose a significant amount of breast volume. This typically gives the breast a sagging or "ptotic" appearance. In addition, the position and volume of the breasts can interfere with physical activity or exercise.

The goal of breast lift surgery or mastopexy is to place the breast in a more youthful position on the chest wall. No only does this allow the breasts to appear more youthful, but also allows the torso to be elongated to give the body a better proportion-even more so if an abdominoplasty has been performed.

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Post Bariatric Body Contouring

Post-Bariatric Body Contouring Surgery is very rewarding to both the patient and Plastic & Reconstructive Surgeon.

Many patients ask me, Dr. D. what is bariatric surgery?

Bariatric surgery, or weight loss surgery, are procedures performed on people who are dangerously obese, for the purpose of losing weight and improving their overall health. Weight loss is achieved by reducing the size of the stomach, through removal of a portion of the stomach, or by resecting and re-routing the small intestines to a small stomach pouch. These procedures are called gastric banding, sleeve gastrectomy, or gastric bypass surgery, respectively. Not only can these surgeries produce significant long-term loss of weight, but also improve diabetes, lower blood pressure, improve cardiovascular risk factors, and reduce mortality.

Many patients then ask me, Dr. D. can bariatric surgery be covered or partially covered by my insurance?

Generally insurance will assist in covering these procedures for obese people with a BMI over 40 or people with a BMI of over 35 with coexisting medical conditions. Finally, patients will ask me, Dr. D. can the post-bariatric body contouring procedures be covered or partially covered by my insurance?
Patients who have bariatric procedures loose over 100 lbs of weight and are left with excess skin that they find impossible to loose. Occasionally, the abdominal skin that overhangs the pubis can cause rashes in the area between the skin. Typically, if patients have these rashes and they are not relieved by prescription medications or other conservative measures to treat them for over six months, then insurance will cover or partially cover a panniculectomy. A panniculectomy is the removal of the overhanging skin or pannus. Other post-bariatric procedures may be covered or partially covered by health insurance or patients may pay for these procedures out-of-pocket. .

I am frequently asked, Dr. Dickinson-What can I do nutritionally to prepare for surgery?

Post-bariatric body contouring procedures are significant surgeries that require a lot of energy expenditure for the body to heal. I typically tell patients to eat one to two grams of protein per kilogram of body weight 4 weeks prior to and 4 weeks after surgery to optimize their healing. This diet improves outcomes and prevents wound complications.

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Post Bariatric Plastic Surgery.

The post-bariatric body contouring surgery program continues to grow with more patients enrolling in post-bariatric body contouring procedures.Patients present to our office and are very excited about having their body contouring procedures.

We encourage all patients who desire to have post-bariatric body contouring procedures to bring their insurance cards with them during their consultations. It is a great time to utilize health insurance plans to undergo lap band procedures. Typically after patients undergo their lap band operation they return for their post-bariatric body contouring surgery within 9 months to one year.

Patients are very happy after having their panniculectomy and abdominoplasty surgeries and greatly look forward to having their mastopexy, breast reduction, brachioplasty, or medial thigh lift.

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Body Contouring. Abdominoplasty & Brachioplasty

Patients who have undergone weight loss of greater than 100 lbs. either through diet alone or with the assistance of weight loss surgery need to have their body contouring surgeries performed by a well trained team of physicians.

Post-bariatric patients have significant changes in their body musculature and body physiology, in addition to the excess skin which they are unable to remove with additional diet and exercise.

The patient in the before and after photos above lost greater than 100 lbs. of weight through diet and exercise alone. She was unable to remove the excess skin along her arms and abdomen. She underwent bilateral brachioplasty, or "arm tuck" as well as abdominoplasty with reconstruction of her abdominal wall musculature to restore contour.

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