Surgery after Massive Weight Loss
Surgery after massive weight loss is often not a single procedure but many. When patients experience massive weight loss, often designated as 100 pounds or more, there is often significant skin loss and sagging in multiple areas of the body including the abdomen, hips, thighs, arms, breasts, neck, and face, all of which may require surgery to correct the effects of this “deflation”. Surgery following massive weight loss is a relatively new area of plastic surgery. These cases were fairly uncommon 25 years ago but have increased significantly since that time. As more people became obese, we saw more patients responding to this problem with medically supervised diets, gastric bypass and banding procedures, medications, and old-fashioned diet and exercise. The result is that we are now seeing patients after their successful weight loss journey that have lost 100 pounds or more on a fairly frequent basis.
With their weight now controlled and overall health improved many of these patients may be disappointed with the appearance of their loose skin. The good news, however, is that plastic surgeons have gained increasing experience and have responded to this challenge by developing new and better procedures to correct the affects of massive weight loss. We are happy to be a part of this ever evolving field and to be able to help patients who have achieved this significant weight loss.
Surgery after Weight Loss Overview
Initial Consultation
At your initial visit we will evaluate your areas of concern and discuss options for treatment. Often our patients have multiple areas they wish to correct and we’ll develop a treatment plan to address these areas. If multiple procedures are needed we we may suggest completing your transformation in stages rather than performing all operations in one setting. This can give our patients the best results with the greatest safety. In some cases we may recommend not pursuing surgery, particularly if we feel the potential risks of surgery outweigh the benefits. Once a treatment plan has been developed, we can discuss how we can plan you surgical procedure(s) to fit your lifestyle.
The No-Drain Technique
For many years we routinely placed drains following abdominoplasty. However, a few years ago we changed our technique, placing progressive tension sutures internally to both better shape the tissues, avoid tension at the incision, and make drain placement unnecessary. We have expanded this technique to other body contouring operations we perform after weight loss, such as brachioplasty, thigh lifts, and others. The benefits to our patients have been dramatic. Many people who have undergone these procedures in the past said that having a drain was one of the most bothersome aspect of their recovery. We now find we rarely use drains and have better results with happier patients.
Best Candidates
Our most successful and happy patients have been those that have dropped their weight to a normal range, maintained a stable weight, planned carefully for their surgery and recovery, had realistic expectations about their results, and have been otherwise healthy.
Planning Your Surgery
Planning begins with your initial consultation at our office. As stated above, we want our massive weight loss patients to be at a stable weight for at least 6 months before surgery, but can see you before that time to begin discussing and planning your surgery. At the initial consultation we will evaluate and discuss your problem areas and suggest an operative plan for addressing these areas. If several areas can be addressed safely in a single operation, we can begin planning and scheduling this. Alternatively, we may suggest a staged approach and help you prioritize your surgical plan. We will discuss risks, recovery time, costs, and expectations to help you decide when an how to proceed. To help you in your decision, we might refer you to other patients who have undergone the same or similar procedures to gain some firsthand insight as to the actual surgery and recovery process.
Our goal is to help you develop an plan for correction that meets your needs, expectations, finances, and your schedule.
Special Considerations
Surgery after massive weight loss must be approached somewhat differently than other procedures to achieve the best possible results while minimizing complications. Our experience, as well as that of others in this field, has helped us develop several guidelines for approaching surgical correction of the problems associated with weight loss.
- Patients must be at a stable weight before surgery, usually for 6 months or more. Not only does this help prevent a patient’s results from being “undone” by weight fluctuations after surgery, but allows the body’s metabolism to stabilize following significant weight loss.
- Patients should wait at least 18 months after gastric banding or bypass procedures before undergoing surgery, for reasons outlined above.
- Multiple staged operations may be preferable to a single operation that tries to do everything at once. As multiple areas of the body my need to be addressed, it is sometimes not practical or safe to address all areas at once.
- An overall plan should be developed for correction. We suggest starting with the area most troubling to the patient, then correct other areas in stages as the patient’s health, schedule, and finances permit.
- Safety should be the most important consideration. These operations are sometimes long and complex, and we feel that if they cannot be done safely and with minimal complications, they should not be done at all. We will tell you if we think the risk of the operation you desire outweighs the potential benefit we may give you.
Types of Operations
Every massive weight loss patient is unique and may require a single or multiple operative procedures to achieve their goals. Operative procedures we may discuss include:
Panniculectomy
Abdominoplasty
Inner thigh lift
Outer thigh lift
Lower body lift
Brachioplasty
Liposuction
Facelift
Necklift
Breast lift
Breast augmentation
Labiaplasty
Etc.
All of these procedures are described elsewhere on our website in detail, and we will explain and discuss them with you during your consultation. We will help you develop a plan so you can address the areas which are the most troubling to you and where we feel you would see the most benefit
Insurance Coverage
We have worked with multiple weight loss patients and their insurance companies over the years and become familiar with most of their policies and procedures. In fact, your insurance company may have specific policies regarding coverage for surgery following massive weight loss available online and we urge you to read these rules so you will have a better understanding of what may or may not be covered.
Insurance coverage is sometimes available for the removal of the large amount of overhanging tissue on the lower abdomen (pannus) that may result after significant weight loss as this may cause functional problems. In order to determine if removal of this (panniculectomy) will be a covered procedure, we will send a predetermination letter to your company detailing your symptoms, physical findings, photographs, and our surgical plan so that decisions regarding coverage can be made prior to surgery. This process usually takes 2-4 weeks.
Other than panniculectomy or abdominoplasty, other procedures are generally are not covered by insurance as they are considered cosmetic procedures with little or no functional benefit. This list of non-covered procedures includes circumferential abdominoplasty, thigh lifts, breast implants/lifts, brachioplasty (arm lift), liposuction, labiaplasty, and facial procedures. We will give you price information and financing options at the time of your consultation.
Your insurance company may cover part of the procedure, but not all the corrections you desire. In this case, we will break down the costs for you so you can see what charges will be covered by your insurance company and how much you will be expected to pay for the remainder.
Fast Fact
From 2000 to 2018 the number of lower body lift procedures performed in the U.S. increased almost 4000% (40x).
Insurance coverage is sometimes available for the removal of the large amount of overhanging tissue on the lower abdomen (pannus) that may result after significant weight loss as this may cause functional problems. In order to determine if removal of this (panniculectomy) will be a covered procedure, we will send a predetermination letter to your company detailing your symptoms, physical findings, photographs, and our surgical plan so that decisions regarding coverage can be made prior to surgery. This process usually takes 2-4 weeks.
Financing & Payment Options
Visit our financing and payment options to learn more about the cost of surgery.
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