Bariatric surgery refers to Plastic Surgery procedures for patients who have undergone significant weight loss (>50-100 lbs.). These patients often experience loose skin as a problem after having the weight loss and are often quite discouraged despite their accomplishment. They may be interested in multiple procedures to address the breasts, abdomen, thighs and arms. While these procedures are described elsewhere on the website there are several specific caveats for this special group of patients.
Firstly, any procedure should be delayed until completion of weight loss, ie achieving your weight loss goal. Secondly, not all of the corrective procedures can be performed at a single operation. Separate operations should be spaced out by approximately 6 months, at minimum. Thirdly, while some procedures may be covered by OHIP, this is not a guarantee after weight loss or prior bariatric surgery. OHIP may cover procedures if there are significant symptoms associated with the problem.
As a consequence of having so much extra loose skin, incisions for the procedures on breast and abdomen often will require longer incisions than for other patients. In considering breast surgery after massive weight loss, most often a lift (mastopexy) is required, however some patients may still require a breast reduction while others may desire augmentation. Several options exist for discussion purposes during the consultation. Similarly for the abdomen there are multiple options. Some patients will be served well with a standard abdominoplasty (tummy tuck), while others may require an extra vertical incision (fleur-de-lis pattern), and others may request a circumferential abdominoplasty (otherwise known as a body lift). Various pros and cons exist. Regardless of the procedure, it is not meant as a weight loss tool, only to improve a patients self-esteem and quality of life.
Post-operatively massive weight loss patients will often require drains in place for a much longer time than other patients, frequently >2 weeks duration. If drains are removed earlier there is a higher likelihood of seroma (a fluid collection occurring). This may require drainage with a needle on a repeated basis until it resolves. The skin will also loosen again after surgery, but to a much lesser extent.
Pre-op for surgery on the chest and abdomen. 4 month post op view of gynecomastia surgery and abdominoplasty.