You Are Not Alone
Gastric bypass surgery (bariatric surgery) or massive weight loss (MWL) leaves a spectrum of changes that most patients find disturbing. For some, a near normal appearance may be the result, but more often, excess skin and soft tissue persists throughout the body. One of the most important considerations for a plastic surgeon is how a bariatric patient must be treated differently from non-bariatric body contouring patients. Traditional techniques simply do not provide adequate shaping and contouring for the post bariatric patient.
The nature and degree of the changes are determined by the patient’s gender, age, pre-bariatric weight, the actual weight loss, and genetic predisposition of the patient. As we gain weight, the skin is all too accommodating in expanding and stretching in order to meet the body’s growing size. With cycles of weight gain and loss, expansion of the soft tissues of the body can adversely affect the skin’s dermal elasticity as well as the underlying connective tissue stability. It is this connective tissue mesh that is responsible for holding the skin tightly against the underlying muscle structures. This results in stretch marks and the skin’s inability contract with weight loss.
After the weight loss, many patients experience significant changes in the form, shape, and contour of their arms, upper chest, breasts, back, buttocks, abdomen, thighs, and calves. Many of these changes follow a predictable course.
The arms show mild, moderate, or severe overall laxity that is best appreciated over the under surface of the arm. This extends from the elbow to the upper back through a hanging and hollowed arm pit. The breasts undergo typical deflation and flattening as well as significant sagging. The upper chest laxity hangs loosely and rolls over the chest and back to obscure the breasts. The inframammary fold under each breast is pulled down by the weight of the hanging abdominal pannius (bulge). This pull deforms the shape and form of the inframammary fold, resulting in displacement of the breasts on the chest region. These changes further deform the breast/chest demarcation and result in a boxy contour.
Abdominal laxity presents as a large, hanging pannius that often extends over the pubic region. The groin region is lax and sagging. The lower back tissue forms a roll that extends from the abdominal pannius over the waist regions. The buttocks are deflated, loose and sagging. The thigh tissue becomes loose and sags at the front, back, inner, and outer surfaces. Folds of loose thigh tissue can develop on both the inner and/or outer surface.
Weight loss patients probably embody the concept of individuality more than any other group of surgical patients. The aim of body contouring surgery is a customized correction of the lost shape and form. In the weight loss patient, a thorough understanding of the deformity and the patient’s desires must be considered.