The location of the incision for brachioplasty (arm lift) is most commonly placed along the inner aspect of the arm, extending from the axilla (arm pit) to the elbow, so that when short sleeves are worn and the arms are by your side the incisions won’t be visible. Some surgeons place the incision along the posterior aspect of the arm, however the incision will be noticeable from behind.
After massive weight loss, the breasts change shape and breast surgery requests in these patients vary. Some patients maintain very large breasts and may benefit from a breast reduction. Others may notice that their breasts sag and do not want a reduction in volume. These patients can benefit from a breast lift (mastopexy). If the patient wants more volume, then they can have breast augmentation (implants) performed as well. Still, there are some patients that request breast augmentation and do not need a lift.
Some massive weight loss patients can achieve a good contour from an abdominoplasty (tummy tuck) alone. This is more common in a younger patient with good skin elasticity and also in a patient that did not have to lose a lot of weight to begin. On the other hand, most patients will have laxity of the abdominal tissues that will extend to their flanks as well as their buttocks. A circumferential abdominoplasty improves the contour of all these regions.
Gynecomastia surgery is individualized for each patient. Some patients do very well with liposuction alone. Some patients require an additional excision of tissue underneath the nipple. The tissue may be more fibrous and as a result is not adequately removed by liposuction. This can be accomplished with a small incision along the border of the areola and chest skin and usually heals very well. Still there are other patients who have significant skin redundancy and need a reduction with some skin removal.
Lower Body Lift
When a patient has excess skin and subcutaneous tissue of the thighs and buttocks, a lower body lift is performed to remove this excess tissue and improve the contour of the lateral thighs and buttocks. Although the patient may get some improvement of the lateral thighs as an added benefit from a circumferential abdominoplasty, the lateral thighs will be markedly improved with the lower body lift.
Upper Body Lift
e goal of the UBL is to remove the excess soft tissue and skin of the upper back, including the lateral, upper, and mid back rolls. The incision pattern is often designed for women to hide the resulting scar in the bra line as best as possible. For men it is in a similar location as for women. The incision is often extended into the lateral chest along the lower lateral chest crease or in the previously treated incision pattern used for a breast reduction or gynecomastia surgery. The procedure takes two to three hours and patients need one to two weeks to recuperate.
Massive weight loss patients often consult for treatment of multiple body areas. Some insurance companies will pay for surgery when there are significant rashes that cannot be treated successfully with conservative management or if the overhanging abdominal pannus affects personal hygiene. Proper documentation of these medical conditions is essential. Notes from your primary care doctor, dermatologist, or treating physician are helpful, and are submitted to your insurance company along with our office notes for pre-approval. You should check with your insurance company to find out their policy.
It is difficult to determine exactly how much weight each given patient will lose after surgery. In general, the abdominal, back, and flank procedures remove significant amounts of tissue and produce the greatest weight loss. In general, patients can lose 5 or more pounds. Other body contour procedures that are not as extensive such as arm lifts or breast lifts will result in less weight loss.
In general, total body lifts (i.e. performing breast work, arm work, thigh work, abdominal, hip, and buttock work) in the same surgical setting are not recommended. For instance, a circumferential abdominoplasty that treats the abdomen, hips, and buttock region often takes 4-6 hours. It also can result in significant blood loss. Performing additional procedures during one surgical setting will take too many hours, and will probably cause significant blood loss that would most likely require blood transfusions and require an extended hospitalization. That is not to say that I will not combine some procedures to be performed in the same setting. However, it is safer to stage these procedures over several months to allow for adequate recuperation. My goal is to perform an operation that will provide the patient with a satisfying result and a safe outcome.
I think it is very important for patients to see representative photos of the procedures that they are interested in. Just as important, talking to patients that have already had the surgery is very helpful. The information obtained is invaluable to educate and inform the new patient.
Hernias are common in massive weight loss patients who have undergone gastric bypass or lap banding procedures. Often, the hernia repair can be treated at the same time as an abdominoplasty or circumferential abdominoplasty. Repairing the hernia is important so that contour deformities can be improved, and complications of hernias can be avoided such as bowel obstruction (blockage). The exposure obtained while performing an abdominoplasty or circumferential abdominoplasty makes it easier for the bariatric surgeon to repair the hernia. But, fixing the hernia takes priority and sometimes the hernia repair limits the ability to tighten the abdominal musculature as well as one would like.
This is a common complaint of many massive weight loss patients. Even though they lose a lot of weight, the tissues tend to sag more. As a result, the overhanging tissue tends to chafe more and rashes can develop. Removing the overhanging chafing tissues can significantly improve this problem.