What is body contouring after weight loss?
It is the surgical removal of excess loose sagging skin, subcutaneous tissue and residual fat in different parts of the body (which occurs as a result of massive weight loss, usually between 25-50 kgs).
Who should get it done?
Any patient who has loose excess sagging tissue remaining after massive weight loss either from healthy lifestyle changes or after bariatric surgery ( surgery to reduce weight in morbid obesity) and has reached a BMI < 32.
Who are good candidates for this surgery?
- Patient who have attained their weight loss goals and maintained a stable weight for at least 3 Months thereafter.
- Patients with BMI (Body Mass Index) < 32.
- Stable patients who are committed to an active and healthy lifestyle.
- Psychologically stable patient.
- Patients not on blood thinners or herbal supplements.
- Patients with no history of heart or lung ailments.
- Non-diabetics or diabetics under good long term glycaemic control.
What does it involve?
The commonly performed procedures are
- Components of an Upper body lift: Arm lift (Brachioplasty), Mastopexy (Breast correction) and Lateral thoracoplasty (Correction for lateral chest wall rolls) separately or together
- Components of a Lower body lift : Anterior Tummy tuck (Abdominoplasty), Circumferential Tummy tuck or Circumferential Body lift involving Trunk + Lower back + Buttocks +
Lateral thighs together and a Medial thigh lift.
What are the gender differences with regard to body contouring after massive weight loss?
- Arm deformities: In males, fat deposition is predominantly near the axilla and upper half of the arm; while in the case of females, it often involves the axilla, entire arm upto elbow and sometimes forearm too.
- Chest deformities: In males, the anterior and lateral chest sag, whereas in females there is laxity in the breasts with significant reduction in volume as well as lateral chest laxity.
- Lower body: In males, fat deposition results in apple shaped pattern with more in the central abdomen whereas in females, it is a pear shaped pattern as the fat deposition is more in lower abdomen, buttocks and lateral thighs.
Do all patients require all the surgeries mentioned above?
It depends on which regions of the body each patient has loose sagging tissue in and wants it corrected and better contoured.
If it is multiple areas, then suergery is usually done in 2 or 3 different stages depending on the regions involved and taking into consideration the safety, patients concerns and expectations. For example, stage 1 may involve just a lower body lift and then usually after 3 months other procedures such as an arm lift ( brachioplasty) + mastopexy ( breast lift) + lateral thoracoplasty ( correction of lateral chest wall rolls) in stage 2. If a medial thigh lift is also required, it can be done in stage 3.
What is the preoperative process?
The patient is asked a detailed history and thorough physical examination is done as well as photographs are taken. They then undergo a full panel of pre-operative blood tests, Xrays and ECG to assess their fitness for the surgery and anaesthesia. Patients on blood thinners need to stop for a minimum period of 1 week prior to surgery and 48 hours post-op, after consulting with their physician / cardiologist. Patients should stop smoking for at least 3 weeks before surgery and 3 weeks after.
What is the postoperative course?
This will differ depending on the surgeon and the operated area, but the usual protocol is as below.
Perioperatively, most patients are put on lower extremity anti-DVT compression pumps to reduce the risk of Deep Venous Thrombosis and Pulmonary Embolism. Patient is educated to sense tension over the planned operative areas before surgery and then is allowed to ambulate post-operatively once fully awake. The patient is encouraged to take at least a few steps in the room the same evening, without placing tension on the operative areas. Suction Drains inserted in the operated areas to evacuate fluid and blood are removed in about 3-5 days. Patient is usually discharged 3-4 days after surgery. Patient is taught to walk with slight flexion at the waist during the first week, especially after a lower body lift procedure. Stretching of the arms beyond 90 degrees is not allowed if a upper body procedure has been done. Slowly thereafter the patient’s activity is gradually increased over the next 4-6 weeks. Patients are given a compression garment to be worn 24/7 after surgery for at least 8-12 weeks. In most cases, the sutures used are self absorbable. Post-op check dressings are usually done at 5 days, 10 days, 2 weeks and 3 weeks at the most. The final result is obtained by around 3-6 months, but in a few cases it can take upto a year.
When is it possible to do regular exercises and regular daily activities?
All routine daily activities can be started in about 4-6 weeks. Gym activites and vigorous exercises should be restricted for about 3 months of surgery and then started gradually, increasing the intensity over 2-3 weeks.
What are the likely complications?
Like any other surgery, this group of surgeries can also have complications like suture line breakdowns, skin necrosis and infection.
The common ones are
- Seroma: This is collection of serous fluid at the operated site. It is the most common complication. It requires aspiration of the collected fluid and compression over the area, usually once but rarely a few times before it resolves.
- Wound dehiscence: It is the breakdown in the stitches, resulting in a wound. Mostly, it can be managed only with dressing before it heals. Rarely, that part of the wound may need to be stitched up again.
- Tissue necrosis: It is devitalisation of the skin and underlying tissue, usually due to excessive tension or poor blood supply.
- DVT (Deep Vein Thrombosis).
- Pulmonary embolism (PE).
- Numbness in the operated area, which resolves in a few months’ time.
Dr. Sanjitsingh R. Sulhyan
M.Ch., M.S., M.B.B.S.
Consultant Plastic Surgeon.