Post-Bariatric Terms:Putting Patients First

BMI stands for body mass index which is in units of (kg/m ^2)

BMI (kg/m2) = Weight in kilograms/Height in meters ^2.

People with a BMI below 18.5 are Underweight.
People with a BMI between 18.5-24.9 are Normal.
People with a BMI between 25-29.9 are Overweight.
People with a BMI above 30 are Obese.

Many insurance companies will authorize lap band surgery if patients meet the following indications:

1. An individual has clinical severe obesity, BMI >40, or BMI> 35 with co-morbidities such as heart disease, diabetes, hypertension, sleep apnea, or degenerative arthritis.2. An individual has suffered from morbid obesity for at least five years. 3. An individual has failed non-surgical attempts at weight loss over the years.4. An individual is at a high-risk for obesity-associated morbidity or mortality. 5. An individual is motivated and has an acceptable operative risk.

Once individuals have had their lap band surgery, they are usually candidates for post-bariatric body contouring surgery 9 to 12 months after. I stress to the patients in our program the importance of adequate protein intake prior to their body contouring operations. For the post-bariatric body contouring patients, it is important to eat 1-2 mg of protein for every kilogram of ideal body weight (IBW) provided they have normal kidney function.

When pre-operative labs are drawn before surgery, it is optimal to have serum albumin levels between 3.5-5 g/dl. It is optimal to have serum pre-albumin levels on the high end of normal levels 17-40 mg/dl. Pre-albumin has a half-life of 1.9 days compared to the half-life of albumin which has a half life of 21 days. Therefore pre-albumin levels tend to be more reflective of the more recent nutritional protein intake.

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Surgery After Weight Loss: RoxBariatric

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 Post-bariatic body contouring surgery is becoming very popular as we are seeing patients not only from Southern California, but now patients from the Midwest who travel to Beverly Hills and Newport Beach to have their post-bariatric surgery performed. More patients are coming to the RoxBariatric Center to meet our team of plastic & reconstructive surgeons and then be introduced to a bariatric surgeon who will perform either a lapband procedure or gastric bypass procedure.

Occasionally, in patients who undergo bariatric surgery or simply loose weight through a bariatric diet, they develop excess of overlying abdominal skin termed a “pannus”.

Patients are coming to the RoxBariatric Plastic Surgery Program from out of state to have their panniculectomy or body contouring surgery performed by our team of plastic & reconstructive surgeons.

Insurance companies will pay for patients to have a panniculectomy performed or removal of this overhanging skin as long as certain criteria are met that deem the procedure medically necessary. These criteria include:

1. Panniculus hangs below the level of the pubis; and
2. Patients have chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs for a period of over 3 months while receiving appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of 3 months.
Frequently patients with subcostal scars present for these operations. Subcostal scars are normally right sided scars used to remove the gallbladder. We have seen many patients who have been turned away for abdominoplasty or panniculectomy operations due to the presence of these scars.

These operations can be performed, but need to be performed carefully by plastic & reconstructive surgeons who have demonstrated experience in these operations to ensure proper wound healing. When addressing panniculectomy or abdominoplasty in these patients it is important to respect the remaining blood supply to ensure rapid healing and prevent infection. Adequate nutrition is paramount for proper wound healing.

Brian P. Dickinson, M.D.

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