Post Weight Loss Surgery (Thousand Oaks)
The massive weight loss patient describes a person who has lost a significant amount of weight—whether through diet and exercise or after weight loss surgery. There is no precise definition of how much weight lost constitutes a “massive” amount. For some patients this is as little as fifty pounds. For others it can be as much as two-hundred pounds. With the rapidly increasing rate that gastric bypass and other bariatric surgical procedures are being performed in the U.S., the number of massive weight loss patients is growing quickly.
Why do massive weight loss patients seek surgery?
As a person loses weight, subcutaneous fat decreases and the fat cells become smaller. For many patients, this occurs so rapidly that the overlying skin cannot contract at the same pace. In addition, this skin is very inelastic in many of these individuals due to years of very large weight fluctuations. As a consequence, the person’s ends up with pounds of sagging, extra loose skin that can occur anywhere on the body. An additional problem in women is the loss of shape and volume of the breasts that occurs after massive weight loss. The breasts become deflated and extremely saggy (ptotic).
What types of surgeries are performed for massive weight loss patients?
The collective group of surgeries performed for these patients are termed body contouring procedures. They include a number of common procedures:
- Tummy Tuck (Abdominoplasty)
- Body Lift (Belt Lipectomy)
- Breast Lift (Mastopexy) / Breast Augmentation
- Arm Lift (Brachiaplasty)
- Thigh Lift (Thighplasty)
- Neck Lift
Who is a good candidate for surgery?
It is important for a person’s weight to be stable at the time of surgery. You should have been at this weight for at least six months time. If you are still losing weight, you should wait until you are at your goal weight. Studies have shown that if your body mass index (BMI) is over 30, you are at much higher risk for developing complications from body contouring surgery (or any surgery for that matter). Smokers must quit for 6 weeks before and 6 weeks after the surgery. If they do not quit smoking, there are significantly increased risks associated with the surgery.
Does insurance cover body contouring procedures?
Some procedures for massive weight loss patients may be covered by insurance. This varies from carrier to carrier and from one patient to the next. Approval of coverage is usually contingent on one having bothersome symptoms from the extra, overhanging skin that have not responded to non-surgical measures. Even then, insurance may only cover part of the costs of surgery. It is impossible to predict if your carrier will cover the cost of the procedure, therefore pre-approval is required. Our patient care coordinator will help you with this process.
Preparing for surgery
Tell your surgeon about any medical problems you have, and any problems you may have had with surgery in the past. Inform him what medications you take-both prescription and non-prescription (including herbs and dietary supplements). You will be told which medications to stop and which to take before surgery. Aspirin and anti-inflammatory medications such ibuprofen and Alleve must be stopped for 7 days before surgery. Finally, you must strictly follow the instructions about when to start fasting before surgery (usually at midnight). If you get sick or have any health issues in the days before surgery, please notify the office at once in case we have to postpone your operation.
The surgery: trading skin for scars
Body contouring procedures for massive weight loss patients are all based on a similar principle: you are trading the extra hanging, loose skin for a much better contour and shape at the expense of scars. The more skin that is removed, the longer the scars will be. By far and away, the majority of massive weight loss patients feel that this is a very worthwhile trade. Since the scars can often be situated within the bra and panty line, and those that are not can be placed inconspicuously.
The degree of scarring is an unpredictable part of any surgery. It is impossible to cut through the full thickness of the skin and not have a scar. Our surgeons have published numerous scientific papers about the scarring process and wound healing, and will do everything possible to minimize scarring. To a large extent, however, scarring is determined by your genetics. If you are prone to hypertrophic (wide, raised) scars or keloids, make sure to inform your surgeon ahead of time. Our surgeons will use all the available techniques to minimize your scars based on their extensive research experience on hypertrophic scarring.
Your scars will be firm and pink for at least six weeks. After six weeks, scars are very strong and can withstand any activity. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. It takes 1-2 years for a scar to completely heal. Make sure to apply sunscreen containing zinc-oxide to your scars for six months so that they do not darken due to increased pigmentation.
Why are drains so important in most body contouring procedures?
The majority of procedures for the massive weight loss patient require that you have drains after surgery. These drains help drain the fluid that is produced under your skin as part of the healing process. Without drains, this fluid can accumulate, termed a seroma. Drains are especially important in massive weight loss patients because years of obesity damage the lymphatic system, and the body’s ability to reabsorb fluid is impaired. This remains true even after the weight has been lossed. The drains stay in until the drainage is less than 25 ml per drain in a twenty four hour period. This usually takes 5-7 days, but can be shorter or longer in some cases. The drains are easy to take care of, and do not hurt to take out.
How much pain is there after surgery?
Pain after body contouring procedures is highly variable, and ranges from minimal to severe. In general, when only skin and fat are removed without touching the underlying muscle, pain is minimal. Pain is usually worst in the first few days after surgery, but then it rapidly improves. It is impossible to predict a person’s expected pain. If you have done well with surgery in the past, you will likely be fine after this surgery. Our surgeons have a lot of experience treating pain, and have published scientific articles and written book chapters about anesthetics and pain control. They will do everything possible to minimize your pain, including using pain pumps after surgery and utilizing all the newest pain medication. By the end of the first week, most people’s pain is controlled with plain Tylenol or Motrin.
What about swelling and bruising?
Swelling and bruising are normal signs of the healing process. They occur after any surgery to varying degrees. Swelling peaks at about 48 hours, and then rapidly decreases. By the end of the first few weeks, 50 percent of the swelling is gone. By 6-8 weeks, a majority of the swelling has diminished. By six months, almost all the swelling is gone. Any remaining swelling is almost not perceptible. Bruising is worst the day after surgery and then rapidly gets better. It is usually gone by two weeks.