Body Contouring after Massive Weight Loss (MWL)

Your New Body

With the growing popularity of bariatric surgery to treat morbid obesity, body contouring after massive weight loss has become a focus of the plastic surgery community. In genereal patients look and feel better. All of your daily activities are a new experience. While these are generally positive changes in your life, the excess hanging skin can still effect your comfort and your self image. Not all patients experience the same problems, but the majority will have difficulties with one or more parts of their body. The elasticity of your skin will greatly influence the need for contouring after weight loss. With body contouring, we can improve the shape of the skin but we cannot improve the quality of the skin. Patients seeking body contouring after massive weight loss must be realistic in their expectations. Skin stretched by weight gain is less elastic. The larger the weight loss, the greater the amount of excess skin and the worse its quality. Age, smoking, sun and genetic factors also influence skin elasticity.

Massive weight loss patients should be aware that body contouring may require surgeons to address the entire body circumferentially and not just one or two specific areas, as is the case with body contouring in more normal weight patients.The most common area is the central body and specifically the abdomen. Excessive skin hanging over the groin region is called a “pannus” or apron. This can interfere with clothing, can create a rash and skin irritation and on occasion can develop small infections (panniculitis). These same problems can occur in folds under the breasts, arms, back, and thighs.

It is generally best to wait for plastic surgery till your weight is stable, usually 12 to 18 months after a bariatric procedure or reaching a plateau or goal of weight loss.

Considerations for timing of surgery include, your general nutrition and physical health. A nutritionally sound diet and exercise program are helpful for upcoming surgeries. The timing of surgery and healing relative to family, work and social activities are important. It is important to understand your treatment priorities as there are likely to be several staged surgeries treating the areas of greatest importance to you first.

Some procedures may be covered in part by insurance. It is important to find an experienced plastic surgeon who is interested in taking care of weight loss patients. The planning and completion of these procedures requires a board certified, and experienced surgeon. Complication rates are high, but the outcomes are very rewarding. Both you and your surgeon should be clear about these issues and willing to venture forward together to get the best possible outcome. Inexperience may lead to increased complications, or poor outcomes which can be costly and difficult to correct or improve.

In general, most surgical procedures will leave long scars. These may fade to white or widen and stay red for lengthy periods of time. Scars can sometimes be improved with topical care or lasers but will never be gone. This is usually considered a worthwhile trade-off by most patients to remove all of the hanging skin and fat. Specific procedures are listed below but there are many variations from the standard methods used for non weight loss patients. These different methods will vary depending upon the patients sex, previous surgeries, combinations of contouring procedures, the location and amount of loose skin and placement of incisions to get the best possible result.

Abdominoplasty/panniculectomy can have many variations: a side to side incision to remove skin only; and additional incision in the midline up and down; a reverse lift, under the breasts; tightening of the muscles; a mid-body incision.

Belt lipectomy/body lift: usually continues around from the abdominoplasty; may be done as a second stage; can sometimes lift and contour the buttocks and posterior thigh.

Liposuction: may be used alone in areas such as the back rolls, outer thigh, inner thighs,or in conjunction with all of the other contouring procedures to enhance the results

Brachioplasty/armlift: can be combined with liposuction to greatly reduce the “bat wings” of the arms. This incision may be carried down the sides of the chest for people with excess skin in these areas.

Thighlifts: include inner thigh at the groin, vertical thigh (lengthwise down the leg), lifts at the buttock fold, mid buttock or above the crest

Breast surgery: may be a reduction to lift the breast and decrease the size or a mastopexy to lift the breast with or without an implant for shaping. On occasion skin and fat from the abdomen or chest can be used to help fill and shape the breast.

Face/necklift: is often helpful even in younger patients to tighten excess hanging skin in these areas. Injectable fillers can help contours.

Gynecomastia: is male breast enlargement which can be treated by liposuction alone or in combination with skin excision.

Upper body lift: can include direct excision of rolls of skin from the upper back or sides of the chest. These operations are individualized for each situation.

In general, the techniques used in body contouring surgery have grown and improved over the last several years in response to the large number of patients who have had massive weight loss. Updated and innovative methods that adjust treatment according to body type are creating improved results and enhancing the shape of patients' bodies. With massive weight loss in a short period of time, skin does not retain its shape, leaving the patient with excess, baggy skin. Also, patients lose different amounts of body fat before the weight loss plateaus, leaving them either thin, moderate or still heavy.

Although previous body contouring techniques worked well on smaller patients who had gastric bypass surgery, larger patients often had visible scars above and below the underwear region after surgery as well as skin that did not conform well to the body.

Effectively mapping incisions before surgery as well as using a combination of new and current shaping techniques leads to the most successful surgeries for moderate to larger body shapes.

All the patients who participated in a recent study at the University of Pittsburgh are extremely pleased with the end result. It was reported that 39 of the 40 patients in this study rated the outcome of their surgery very good or excellent.

With moderate to larger patients, not only is it important to map the excess tissue to be removed but to anticipate the movement of the skin left behind. This allows the plastic surgeon to visualize where the scars will be after the tissue is removed and place them where they will be hidden by underwear or in a belt-like position. Ultimately, it allows the patient to feel better about their body after the surgery.