Body Contouring After Massive Weight Loss
What is body-contouring after massive weight loss?
Body-contouring after massive weight loss (100 pounds or more) is the removal of excess skin that a patient is left with after losing a substantial amount of weight through surgery, diet and/or exercise. Its purpose is to reshape, tighten and recontour the different areas of the body that have become droopy, loose and/or stretched out. This is an important and integral part of the complete patient management after massive weight loss surgery.
Why does one develop sagging skin after massive weight loss?
After a patient undergoes weight loss surgery and loses a significant amount of weight, the skin may not retract and tighten to the new body frame. This is analogous to an overstretched rubber band. As a result, the excess skin will sag. The amount of loose redundant skin will depend on the degree of weight loss, age and skin quality of the patient, elasticity of the skin, the region of the body, and other genetic/anatomic factors. There is no way to "tone up" skin, and the only reliable way to deal with the redundant skin is to surgically remove it.
What are the potential problems one faces with the excess skin?
The sagging skin can develop folds especially in areas like the lower abdomen and inner thighs. Chronic chaffing, the moist environment and difficulty in maintaining hygiene can lead to rashes, skin breakdown and infections. The loose skin can be a nuisance while working out or fitting in clothes. Many people feel that after all the hard work and effort they have put into successfully losing weight, their body image is negatively influenced by the cosmetic appearance of their body. These problems can potentially be mitigated through body-contouring surgery.
What are the different body-contouring procedures?
Panniculectomy
Removal of the lower abdominal fold of skin without relocation of the umbilicus (belly-button) or tightening of the abdominal muscle layer.
Abdominoplasty
Removal of the redundant skin of the whole abdomen, with relocation of the umbilicus (belly-button), and tightening of the abdominal muscle layer.
Thigh Lift
Removal of the excess skin and tightening of the inner thighs.
Circumferential Body Lift
Removal of the excess skin of the abdomen, flanks and back, with resultant tightening of the abdomen and lifting of the outer thighs and buttocks.
Brachioplasty (Arm Lift)
Removal of the excess skin and tightening of the upper arms.
Mastopexy (Breast Lift) in women
Reshaping of the female breast to a more lifted position. Implants may also be used to add volume to the deflated breast.
Chest reduction in men
Removal of the excess skin of the chest.
Face Lift/Neck Lift
Rejuvenation of the face and neck through skin excision and tightening of the underlying layers of the face.
Who performs these procedures?
Plastic Surgeons at the Plastic and Reconstructive Surgery Clinic are trained to perform these procedures. The aim in all the surgeries is to remove the excess skin with the underlying fat, and where appropriate, tighten the deeper tissues, thereby reshaping the body.
Who is a candidate for body-contouring surgery?
The following criteria should be met:
Medical Health
These surgeries are elective surgeries that should be done on healthy patients. Medical clearance by ones primary care physician is required.
Stable Weight
Ideally, one should be 2 years out from their weight loss surgery (at least 1 year), and weight should be stable (fluctuations of less than 5 pounds) for 1 year (at least 6 months).
Nutrition
Weight loss surgery can result in malnutrition which negatively affects healing. One must have normal nutritional parameters before undergoing these procedures.
Realistic Expectations
One must have realistic expectations with regards to the outcome of the surgery. It is not possible to recontour the body perfectly or to restore it to the shape of what it was in one's youth/20s.
Smoking
One must be off all nicotine products at least 6 weeks prior to and after surgery. Serious wound healing complications are associated with smoking.
Psychologically Prepared
One must be psychologically prepared for major surgery and its associated recuperation.
Are all these procedures done at the same time?
After a detailed consultation with your plastic surgeon, an individual surgical plan will be developed. Usually the procedures are staged based upon the time to perform the surgery and time for recuperation. It is advisable to have a maximum of 6 hours of surgery at one sitting in an elective setting. Each stage is usually performed 6 months apart. For example if a patient is to undergo whole body-contouring, the first stage could be the circumferential body lift, the second stage could be the arm lift and inner thigh lift, the third stage could be the breast lift and the fourth stage could be the neck lift and facial rejuvenation.
What is the recuperation time for these procedures?
These procedures are done under general anesthesia and usually require hospital admission for 1-3 days. Most of the procedures require the placement of surgical tubes to help drain excess fluid from the surgical sites. These drains remain in place for 1-2 weeks (up to 4 weeks if necessary). Your pain is controlled with oral pain medication and, in some circumstances, a pain pump may also be placed. Every procedure has its own unique post-operative course, but in general, 4 - 6 weeks of recuperation time is needed. During this time period you will be seen by your plastic surgeon on a regular basis.
What are some of the side effects and risks of these procedures?
All these procedures will result in scars that are permanent, temporary swelling and bruising, pain and discomfort that will be controlled by pain medication, and some numbness.
Every procedure has its own unique risks. In general some of the risks include: poor scarring, mild infections, bleeding, numbness, wound healing problems, fluid collections, asymmetry, and unsatisfactory results. Rarer, but more serious risks include: deep venous thrombosis, pulmonary embolus, heart attacks, strokes, anesthetic issues, and severe infections.
Do health insurance plans cover these procedures?
In general, these procedures are considered cosmetic surgeries unless there is clear evidence of medical problems associated with the excess skin. Every insurance plan has its own criteria by which it measures medical necessity. A prior authorization is usually required before any body-contouring procedure is performed. This usually takes about 6 weeks to complete. Your plastic surgeon will write a detailed letter to your health insurance company detailing the medical reasons for you to undergo the particular procedure(s). It is helpful to have your primary care physician also write a supporting letter detailing the medical problems you have been experiencing (rashes, skin breakdown, ulceration, infections, prescription medication usage, chronicity of problems etc). It is also a good idea to document the rashes by taking digital photographs when they occur.
What happens if my health insurance plan does not approve the surgery?
If you receive a denial of authorization for the procedure(s), you have the right to appeal the decision. One should read the details of the denial letter to see why the procedure(s) were not authorized. One will then be able to assess whether those conditions can be fulfilled in time. It is a good idea to discuss this with your plastic surgeon, who will have to write an appeal letter on your behalf after the criteria are met. If the appeal is denied or one cannot fulfill the criteria by which the health insurance plan authorizes the procedure(s), the services will have to be paid out of pocket. We can provide you with a detailed, itemized quote of how much the cost will be for the procedure(s) if requested.
