Surgery on patients who have lost a lot of weight can take a lot of time. This is a problem for many reasons . The risk of complications can go up with a patient on the operating room table for an extended period of time - risks of wound infection, healing issues, risk of DVT or even pulmonary embolism can increase. New sutures are now available which can lessen the time on the operating room table. These sutures are an exciting advance especially for plastic surgeons working with Massive weight loss patients . The sutures are barbed which work to close the wound without knots. This decreases the time to close the wound and reduces the incidence of knot related issues such as stitch abscesses. I have been really pleased with the barbed suture - and especially the combination of the barbed suture and surgical glue to seal the wound. This combination is great for my patients - less time on the OR table, less tape and bandages and patients can shower right away ! A win for all!
Archive for the ‘Post Massive weight loss' Category
Liposuction has been the most common plastic surgical procedure done in the United States. In 2007 over 450,000 patients underwent liposuction. Liposuction is best used to reduce pockets of fat which have been unresponsive to weight loss. Liposuction removes fat only and does not remove skin. For this reason it is usually only used as an adjunct to skin removal for patients who have lost a lot of weight. There are several methods of liposuction available including traditional liposuction, Vaser or ultrasonic liposuction (UAL) and power assisted liposuction (PAL). A plastic surgeon may use one or more of these techniques in treating a patient depending on the areas being treated. For example fibrous areas such as the back or male chest are usually treated with either Vaser or PAL rather than traditional liposuction.
Patients who have lost significant amounts of weight often are concerned about the appearance of their breasts. For many patients they are unclear if the best procedure for them would be a breast reduction or a breast lift. A breast lift (also called a Mastopexy) repositions the breast on the chest wall but does not change the size of the breast. A breast reduction not only repositions the breast higher on the chest wall ( a lift) but also removes some of the breast tissue to make a smaller breast. In some cases if a large enough amount of breast tissue is being removed a breast reduction may be covered by insurance. A breast lift is not usually covered by insurance as it is considered a cosmetic procedure. In some cases during a breast lift a breast implant will be placed in order to restore breast volume lost by pregnancy or weight loss. If you are unclear about which procedure is best for you try and pinpoint what bothers you most about your breasts ( for example - I don’t like the droopiness but I am happy with the size) and then the best procedure to address those issues can be chosen.
Loose skin of the upper arms is of great concern for many women after weight loss. An arm lift (Brachioplasty) can remove the excess skin but it does leave a scar. The scar extends from the armpit to the elbow and may even extend onto the forearm if the excess skin extends there as well. The scar is placed on the inner surface of the arm in order to hide it but it will be visible when one’s arm is raised. For many women however the scar is a very acceptable alternative to the excess loose skin. The scar and the amount of excess skin should be discussed before deciding on an arm lift to see whether the procedure is right for you. Some women who still have very heavy arms despite weight loss may require a two stage procedure with removal of the fat first with liposuction and then removal of the excess skin at a later time.
For most patients after a large weight loss their abdominal area is of the most concern. For these patients an abdominoplasty or Tummy Tuck is the first procedure they consider. If the patient also has a lot of loose skin on their thighs and buttocks they may consider a belt Lipectomy or Lower Body Lift (LBL). In these procedures the removal of skin and fat continues all the way around the body lifting the buttocks and lateral thigh areas as well as removing the excess skin and fat of the abdominal area. The LBL can be done in two stages as well - first doing the abdominal area and at a later time doing the back area. The decision on whether a LBL or a tummy tuck is the right procedure for you depends on many factors including the looseness of the skin and what other procedures you are considering.
Plastic surgery after weight loss can involve several stages and the question patients often ask - is how many procedures can be done at the same time? Several procedures can be done at the same time. For safety sake most plastic surgeons try to plan for what can be accomplished in a time period of six to eight hours. This seems to be a good time frame within which patients can recover well from both the anesthesia and the surgery. For patients who want to push and try to do more - I will explain - lets face it - after six to eight hours I will also be tired and not doing my best work!
The second question is : how long do I have to wait in between procedures? The goal is that a patient gets back to their good health before they proceed on to the next surgery. For most patients this is a minimum of three months. For some patients it might even be longer. of course life has a way of getting in the way of our plans so that even if initially one might want to do everything as quickly as possible something might come up that would delay the process. There is no advantage as far as the final result to doing everything quickly and no disadvantage to spreading things out over time . What is important is what works for you and your life.
A recent article in Plastic and Reconstructive Surgery ( the official medical journal of the American Society of Plastic Surgeons) highlights the nutritional problems which can occur after bariatric surgery and can then lead to healing difficulties after plastic surgery. Not all patients who have undergone bariatric surgery will have nutritional problems but without good care some will and these nutritional problems can lead to increased complications and poor wound healing. Patients who have undergone a Lap band procedure usually do not have nutritional problems as this procedure encourages weight loss by a restriction on the size of the stomach. Patients who have undergone either a Roux-en-Y or Duodenal switch procedure , if they do not take their vitamins and are not vigilant about their protein intake , may have nutritional deficiencies. In my practice I like to see labs early on in the consultation process so that any deficiencies can be identified and corrected before the date of surgery. A lot of patients will benefit from supplementation , both protein and vitamins in the postoperative period, to help with the increased demands on their bodies as they heal. There are a huge number of protein supplements available and nowadays they even taste good!