Body Contouring After Massive Weight Loss

Introduction

Each year over 200,000 individuals undergo a surgical procedure to help them lose weight. Many other individuals achieve massive weight loss with diet and exercise alone. Weight loss patients experience significant improvement in their physical and psychological health, but frequently have a residual loose skin and contour deformities that lead them to seek reconstructive surgery. The American Society of Plastic Surgery reports that in 2013 about 42,000 body contouring procedures were performed after massive weight loss procedures. Many factors contribute to an individual’s decision to seek body contouring after weight loss. Among these is the desire to improve overall appearance, a specific loss of a body contour (such as breast projection or a flat buttock area), how clothing fits, hygiene problems and/or skin irritations.

When should I consider body contouring after weight loss?

In general, your weight loss should be complete and your weight stable for several months. This usually occurs about 18 months after a surgical procedure. Patients who have lost weight through diet and exercise should have maintained their weight for a minimum of 3 months. It is important that patients considering contouring procedures have an adequate dietary protein intake. Low iron levels are occasionally an issue resulting in low blood counts that need to be corrected prior to any elective surgery. Medical conditions that were present at your higher weight likely will have improved, but any residual problems need to be addressed by your medical physician. You should also be emotionally and psychologically prepared to undergo a surgical procedure.

What about my Body Mass Index (BMI)?

There are no hard and fast rules regarding what BMI should be attained before undergoing a contouring procedure. In general, if you are closer to an “ideal” BMI (19 to 24.9), the result obtained from a contouring procedure is likely to be better. At higher BMIs, it is expected that a reconstructive procedure will still improve your appearance but the result may be less than ideal.

Which body areas can be improved?

Abdomen In our practice, patients most frequently request correction of the abdomen (tummy) first. Loose abdominal skin with or without a residual fat pad (panniculus) can cause significant hygiene problems leading to skin rashes, breakdown, and yeast infections. Clothing (particularly jeans and slacks) are difficult to fit properly due to the need to accommodate “tucking in” the excess skin. Scars from previous surgery (C-section for example) can contribute to other contour irregularities. Hernias or other weaknesses of the abdominal wall are not uncommon. Your surgeon will recommend the best procedure to address your specific problem area(s) and ranges from a full abdominoplasty (tummy tuck) to a simple panniculectomy. These procedures are normally done on an out-patient basis with a 2 to 6 week recovery time.

Upper Arms When present, upper arm skin laxity is very resistant to improvement with exercise and toning alone. Removal of excess skin and any residual fat from the upper arm is referred to as an arm lift (brachioplasty). This procedure is frequently requested by weight loss patients to both improve appearance and to help clothes to fit properly. Surgical incisions are designed to be partially hidden on the inner aspect or back of the arms. This is also an out-patient procedure with a short recovery time and few complications. We recommend use of compression garments for several weeks after the procedure to control normal post-operative swelling.

Breast (female) Women who have achieved a significant weight loss will often present with “deflated” breasts- abundant loose skin and inadequate breast tissue to fill the skin. It has been our experience that women wear a larger cup size brassiere to accommodate the excess skin rather than excess breast volume. Patient who are treated with a breast lift alone (no removal of breast tissue) almost always wear a smaller cup size bra after the procedure. Correction of the breast contour loss may require breast augmentation with an implant, a breast lift, or combination of all available procedures which may be done in one surgery or as a series of procedures. The goal is to restore a full, more youthful appearing breast. If lateral chest rolls (the skin/fat that drapes over the side panel of the brassiere) are present, they are usually removed or repositioned to augment the volume of the breast with the contouring procedure. Correction of breast contour after weight loss is normally an out-patient procedure with a short recovery time.

Breast (male) Men who have achieved significant weight loss may have deflated folds of skin in the breast area that extend like a drape to the lateral chest wall. This contour will not improve with conditioning and toning. Surgical correction normally requires removal of the excess skin and repositioning the nipples to a normal male location. This is also an out-patient procedure with a brief recovery time. We recommend the use of compression garments or athletic undergarments for 6 to 8 weeks to help with resolution of the post-operative swelling.

Buttocks Weight loss patients frequently loose the definitive contour of the buttocks and complain of having a flat backside. This results not just from the loss of fat but also the loss of the structural support of a “normal” buttock. In some cases simple excision of the excess skin may result in the desired improvement. Other cases are better treated with skin excision combined with repositioning of part of the skin/fat to achieve a fuller buttock contour. Buttock lifts are commonly combined with abdominoplasty (known as a belt lipectomy or body lift). Despite being a longer operative procedure, body lifts are still routinely done as an out-patient. Recovery time is similar to a tummy tuck procedure.

Thighs Improving the contours of the thighs after massive weight loss can be complex. In some cases liposuction of thighs that are still “heavy” may be required prior to a procedure that removes the excess skin. The outer thigh is best improved with a body lift procedure (tummy tuck and buttock lift combined). The excess inner thigh skin including the skin just above the knees is removed with a medial thigh lift. The incisions for this procedure run from the high upper thigh to just above the knee in most cases. Minor excess may be corrected with an upper thigh incision only. Thigh lifts are generally performed as an out-patient and rarely combined with other contouring procedures. Recovery time varies with the extent of the surgery but up to 6 weeks may be required before resuming all normal activities. Compression garments are recommended for 3 months after the procedure(s).

Face/Neck After weight loss, some individuals will have markedly loose skin in their face and/or neck. In general, face lift and neck lift procedures in weight loss patients require a more aggressive approach to restore a youthful appearance. In patients with poor skin elasticity two or more procedures may be necessary to achieve the best result. Your surgeon will be able to assess your individual needs and recommend the best treatment options.

Safety First!

Body contouring surgery after massive weight loss represents a significant financial and time commitment for each patient. Patients may want to “get it all over with” in a single operative setting. While certain procedures can be done together (for example- tummy tuck and arm lift or breast lift) with minimal increased risk to the patient, “marathon” procedures in general are to be avoided. The prolonged anesthetic time and multiple surgical site healing produces an increased physiologic stress on your body, can increase the risk of complications, and can be associated with an increased recovery time. Developing a priority list of body areas to be improved with your surgeon and planning to complete these in multiple stages avoids any increased risk to you. This staged approach can allow for minor touch ups of previously operated areas or to do a preliminary procedure to help with a planned second surgery (such as liposuction of the thighs at the time of an abdominoplasty in preparation for a thigh lift to be done at the next surgery). It is important to remember that your safety is our first priority.

Smoking

The use of any product containing nicotine (all tobacco products, nicotine gum/patches, some e-cigarettes) profoundly reduces blood flow to the skin. With body contouring procedures, the skin blood flow at the surgical site is stressed both by elevating the skin and also by the tension required to close the skin. The additional effect of the use of nicotine at the time of these surgical procedures can lead to major wound healing problems and skin loss. For this reason, we insist patients stop smoking/using nicotine products 8 weeks prior to the surgery and 8 weeks after the surgery.

Does Insurance cover body contouring after weight loss?

Insurance coverage for most body contouring procedures is limited. Some carriers will pay for a panniculectomy (removal of excess skin/fat that hangs from the lower abdomen) if there are documented medical problems such as severe rash or open sores that do not respond to medical management. Coverage of contouring procedures for the breast and extremities is rare. You should check with your specific insurance plan to determine what procedures may be covered.