Body
Contouring For The Massive Weight Loss Patients
Via Natural Means or Bariatric (Gastric Bypass) Surgery
As
Bariatric Surgery has become more popular in
the United States for the treatment of morbid
obesity, we are now faced with treating patients
that have an astonishing amount of excess skin.
This has led to a revolution in body contouring
surgery.
PROCEDURES
The
most frequent surgery for the massive weight
loss patient is abdominal / truncal reconstruction.
The most common of these surgeries is known as
a panniculectomy. This is typically the only
procedure that insurance sometimes covers, but
we don't recommend just a panniculectomy (just
removing the skin below the belly button without
any attention to the abdominal wall, umbilicus
or upper abdominal skin). We recommend a full
abdominoplasty and in our practice there are
three options for the massive weight loss patient:
1.
Standard Full Abdominoplasty - this is the most
common form of abdominoplasty. It involves an
incision from hip to hip, removing the excess
skin, plication (tightening) of the abdominal
wall, and making a new opening for the umbilicus.
2.
High Lateral Tension Abdominoplasty - this is
a most common type of surgery for the massive
weight loss patient. The incision here extends
more laterally into the flank area. This is ideal
for the patient who has skin rolls that extend
around towards the lower back. This surgery can
be combined with liposuction of the thighs to
dramatically recontour the anterior and lateral
thigh areas as well. The liposuction allows the
thigh skin to be elevated.
3.
Fleur De Lys - this is a more extensive operation
than the standard full abdominoplasty. It includes
a vertical excision of abdominal skin. This allows
for improved contouring of the flanks. The final
scar is an inverted T. It is an ideal procedure
for patients who have had an open gastric bypass
because they already have a vertical abdominal
scar.
Lower
Body Lift
This
involves continuing an abdominoplasty incision
completely around to the back. This allows for
the best overall contouring by elevating the
buttocks and removing excess skin from the flanks
and back, in addition to the abdomen. Although
this surgery can be done at one time, it involves
a significant hospital stay, longer recover,
and a higher complication rate. Therefore, we
recommend doing a High Lateral Tension Abdominoplasty
as a first surgery and then the postieor excision
can be done at a later date once the abdominal
incision has healed. This method significantly
decreases the recover and reduces the incidence
of dehiscence, seromas, and other complications.
Breast
Contouring
For
the massive weight loss patient, usually some
type of mastopexy (lift), is required. This can
be performed alone or in conjunction with placement
of implants in order to fill out and contour
the breasts better. Breast surgery can be combined
with a brachioplasty to achieve optimal contouring
of the chest area.
Brachioplasty
This
is also known as an armlift. It removes excess
skin from the upper arms. The scars typically
run from the elbow to the axilla (armpit). Occasionally
a limited procedure can be done that requires
only an axillary incision. On the other hand,
some patients require a more extensive surgery
where the axillary incision can be extended onto
the chest wall to remove excess skin lateral
to the breasts.
Thigh-Lifts
A
medical thigh lift is done by making an incision
in the groin crease and removing some excess
skin in order to elevate the medial thigh skin.
For patients who have a more significant amount
of skin on the thighs, the incision can be extended
down the medial thigh to the knee. This allows
for removal of skin in a circumferential manner
in addition to elevating the thigh skin.
Insurance
Usually
breast reductions may be covered by insurance
but breast lifts (mastopexy) or implants
are not. Occasionally panniculectomies
may be covered but abdominoplasties are
not.
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