What is post-bariatric surgery?
Post-bariatric surgery is a highly specialised branch of plastic surgery for the correction of severe weight loss sequelae via body contouring procedures, often following surgeries such as gastrectomies, intestinal resections, gastric bands etc.
What are the most commonly performed procedures in post-bariatric surgery?
Body contouring can involve any anatomical area because all the regions of the body may be severely damaged by the obesity and subsequent weight loss. The most commonly requested procedures are: abdominoplasty (tummy tuck), inner thigh lift, arm lift, mastopexy, mastopexy with implants, torsoplasty, flankplasty, gluteoplasty, correction of gynecomastia or pseudo-gynecomastia, face lift, neck lift and many others.
Who can undergo post-bariatric surgery
Every patient enjoying good health, who has undergone considerable weight loss thanks to a surgical procedure or diet, can undergo post-bariatric surgery. It is necessary to respect the international inclusion criteria in order to reduce the risk of complications associated with these procedures. Some of these criteria are: stability of the present weight; a body mass index (BMI) less than 30; absence of severe diseases etc. These and other criteria are carefully evaluated by the plastic surgeon during the pre-operative consult in order to estimate the risk/benefit ratio of the surgical procedure.
Are post-bariatric surgical procedures dangerous?
Every surgical procedure carries a risk. Reconstructive post-bariatric surgical procedures carry a higher risk of complications compared to other procedures, even though the vast majority are minor. In all cases, if they are performed on appropriately selected patients by a skilled plastic surgeon in the field, the risk of complication is dramatically reduced.
Are post-bariatric surgery procedures painful?
Mostly they aren’t. Often moderate pain is experienced after procedures involving lipoaspiration that can result in severe swelling and bruising. However, pain during the post-operative period is easily managed by administering pain relief orally.
How many procedures can be performed simultaneously?
Some post-bariatric plastic surgery procedures carry a high risk of bleeding. The higher the number of the procedures performed simultaneously, the greater the risk. Therefore, even though specific rules about this don’t exist, it is always advisable to perform one surgery at a time, waiting for full recovery of the patient before moving onto the next procedure.
Are surgical scars visible?
Every surgical incision results in a scar. Post-bariatric body contouring procedures often cause bigger scars due to the large areas needed to be excised. Whilst there are no hard rules, the basic principle is that the wider the defect that needs to be corrected, the wider the resulting scar. Furthermore, one must consider that there is an individual tendency for good or bad scarring. For this reason some individuals or ethnic groups develop better scars than others, regardless the surgeon’s skill. Scars will be planned in order for them to be placed in less visible areas of the body such as grooves and natural creases, or in areas usually covered by underwear or bathing wear. Considering the profound aesthetic and functional benefits that these procedures realise, concerns about the length of the scar definitely play a secondary role.
What does a post-bariatric surgery examination consist of?
Medical examination meets two fundamental objectives for the surgeon:
- To know his/her medical history, the changes in his/her body weight over a period of years, highlight any bariatric surgery procedure(s) performed, current body weight etc. More widely, it has the objective of making sure that there are the necessary conditions in order for the patient to be a good candidate for surgery.
- An opportunity to explain, in detail, if the patient is a good candidate for a body contouring procedure; what a specific surgical procedure consists of; what initial discomfort and benefits it will bring; what he/she will need to be careful about before and after the surgery.
What does the patient need to do in the post-operative period?
The patient will be guided and accompanied through his/her journey, before and after surgery. During the weeks and months following the surgery, periodic medical examinations and dressing appointments will be planned. The post-operative process will vary dependent on the type of surgery, but as a general rule we can say that disinfection of the surgical wounds will be needed and specific compressive bandages must be worn in order to accelerate the healing process and recovery.
How long does the recovery last?
This will depend on the specific surgical procedure and it is not the same for every patient. On average, it varies between 20 and 45 days.
What is dermatoscopy?
It is a non-invasive diagnostic technique that has the main goal of achieving early diagnosis of melanoma, the most serious skin tumor. Dermatoscopy also has a fundamental role in the study and diagnosis of every cutaneous melanocitic and non-melanocitic lesion.
What does dermascopy consist of?
The study of cutaneous lesions is achieved with use of an optic instrument called a dermatoscope that, thanks to polarised light, allows the observation of microscopic and deep features of skin lesions, helping to diagnose them. A picture of these lesions is taken and they are filed in order to evaluate their evolution.
Is it possible to cure melanoma?
Yes, if there is an early diagnosis there is a higher chance of survival. If melanoma is diagnosed when it’s still an “in situ melanoma”, that is at an early stage, the chances of survival are very high.
How can the patient be vigilant of melanoma?
During the medical examination, the doctor will inform the patient about the basic steps to follow in order to perform an adequate self-examination, such as evaluating the shape and the features of a suspicious pre-existing or new mole. Melanoma can in fact arise from a pre-existing mole, but in 80% of cases it arises as a new cutaneous lesion. Self-examination between two medical examinations is therefore of the utmost importance for an early melanoma diagnosis.
How much time is needed for melanoma to be not “in situ” anymore?
Unfortunately, there isn’t a rule. Some melanomas seem to be immediately invasive; others can stay in a “superficial” phase for a long time. Due to its unpredictability, medical examinations should be consistent and frequent in order to spot this aggressive tumor as soon as possible.
How can melanoma be prevented?
Melanoma can arise on anyone’s skin and the only known risk factor that can be controlled is sun exposure. Therefore, it is crucial to protect oneself appropriately from the sun by using high factor sunscreens and avoiding sun exposure when the sun is most intense. However, attention to sun exposure is not wholly sufficient; many melanomas arise in areas of the body that are never exposed to sunlight. For this reason, the only efficient weapon against melanoma is early diagnosis through constant and periodical check-ups.
What are the therapeutic steps to follow when a melanoma is diagnosed?
Treatment of melanoma is certainly surgical excision. Two options are available depending on the thickness of melanoma, determined by the histological exam.
- “In situ” melanoma or very superficial melanoma: in this case it is sufficient to perform a second surgery to widen the surgical excision margin. This procedure can be performed under local anesthesia and consists of excising an area of skin surrounding the scar resulting from the first melanoma excision. In this way, we make sure that the melanoma is completely excised.
- Moderately or highly invasive melanoma: in this case, in addition to widening the excision margin, it is necessary to perform the sentinel lymph node biopsy. This procedure is performed under loco-regional or general anesthesia and it allows us to analyse the first lymph node that drains from the locality of the melanoma. If neoplastic cells are found in the sentinel lymph node, it will be necessary to excise all the lymph nodes in that area (lymphadenectomy).
Notwithstanding the melanoma’s invasiveness, the patient will have to undergo dermatoscopy check-ups every six months for at least five years due to a higher risk factor for those who have a history of melanoma.
What kind of specialist is qualified for treating melanoma?
The plastic surgeon, because melanoma is a skin tumor requiring a surgical treatment, is best qualified to treat it. Furthermore, melanoma often arises in visible areas of the body and, since its excision inevitably results in scarring, the plastic surgeon is surely the most suitable specialist in order to achieve the best aesthetic result.