Each year, well over 100,000 people undergo bariatric surgery in the United States in the battle against an obesity epidemic that affects nearly nine million Americans. In their first year after weight-loss surgery, those who comply with their physician’s diet and exercise advice typically lose a significant amount of weight.
While this weight reduction is a great victory for their physical and psychological health, many of these people are dismayed by the large amount of excess skin that remains on their arms, abdomen, waist, thighs, breasts and other areas.
Fortunately, plastic surgery offers an excellent solution to alleviate this problem. However, for a variety of reasons, post-bariatric surgery patients present special challenges for additional surgery and should, therefore, seek out a plastic surgeon who understands their special needs and has experience in this rapidly developing sub-specialty.
Safety is the most critical consideration for all surgery patients, but even more so for those who have had bariatric surgery. Because of the nature of stomach-reduction procedures, these patients often have altered hemodynamics (blood flow throught the body) and may have ionic imbalances, which can lead to such conditions as iron deficiency anemia and deficiency of vitamin B12 and/or folate. Therefore, thorough blood work to detect these and other possible complications is an absolute necessity prior to skin reduction surgery.
In addition, these considerations also place a limit on the length of time this patient should be in surgery. Because of this and the often great amount of skin to be removed, patients are normally counseled to expect a series of surgeries to accomplish all of the skin reduction they desire.
A plastic surgeon who is skilled in skin reduction for post-bariatric patients will know how to modify common plastic surgery techniques to accommodate the especially large amount of skin to be managed. For instance, the tummy tuck incision is started lower and modified to eliminate skin folds. Other incision changes are used to make adjacent body features look attractive and natural.
Surgeons familiar with the special needs of post-bariatric patients are careful to minimize the risk of pressure sores by padding key areas of the body during surgery. These patients are also at risk for hypothermia, so they are provided a warm room and intravenous fluids to keep their internal body temperature at an appropriate level.
Both during and after surgery, there is special attention given to minimizing the risk of blood clot formation. Surgeons give patients IV medication and place special compression garments on them while operating. As soon as possible after surgery, patients are encouraged to walk in order to deter the development of clots that can move through the body and damage vital organs or even threaten a heart attach or stroke.
Also following surgery, skin reduction patients are closely monitored to avoid variety of complications from diabetes, sleep apnea, a body mass index (BMI) greater that 35 and other conditions they may have developed while they were obese.
Overall, post-bariatric patients are to be commended for their diligence and perseverance in losing their excess weight. Skin reduction surgery goes the extra step beyond that achievement to finally give them the desired result of all their efforts.
Article by Arian Mowlavi, MD