Post-bariatric reconstructive plastic surgery is a specific field of plastic surgery, which encompasses procedures for body contouring in ex-obese patients, with severe physical deformities caused by their weight loss.
In 1997 the World Health Organization (WHO) officially recognised obesity as a global epidemic (“globesity”), in consideration of the increasing incidence of this pathologic condition. Hippocrates wrote: “Corpulence is not only a disease itself, but the harbinger of others”. In fact, obesity is associated with cardio-vascular diseases, type 2 diabetes, obstructive sleep apnea-hypopnea syndrome and osteoarthrosis. In case of severe obesity (BMI > 40) life expectancy is reduced by around 10 years. Weight loss is a positive step to prevent the abovementioned conditions.
Currently, bariatric surgery is performed in selected cases to induce weight loss (sleeve gastrectomy, gastric by-pass, gastric bending, biliopancreatic diversion etc.). It is the primary treatment employed to achieve significant, long-term and stable weight loss. Unfortunately, massive and rapid weight loss may lead to severe deformities, with functional and aesthetic impairment as a consequence of extreme skin laxity. These conditions may be corrected through body contouring procedures, which are increasingly being requested, given better information and knowledge of the options.
The most popular post-bariatric surgeries are: abdominoplasty, thigh lift, arm lift and breast uplift in women. Nonetheless, it is possible to treat every area of the body, such as the face, neck, male breasts, back, flanks, buttocks and genitals.
Many of these surgeries include skin excess excision and liposuction, namely removal of localized and persistent fat deposits, which are not eliminated with the weight loss. Liposuction facilitates less invasive surgery, sparing blood and lymphatic vessels. In regards to the laxity of the deep connective tissues, which are found between the skin and muscles, it is also crucial to treat these structures, through tightening, suspension and anchoring. In this way, the underlying framework is moulded and the skin re-draped. In such surgeries as abdominoplasty, flankplasty, torsoplasty, thigh lift, arm lift, deep tissue tightening is important to achieve more aesthetically pleasing and long-lasting results.
Post-bariatric body-contouring is a long and difficult physical and psychological course of treatment – not devoid of complications – which must be faced with motivation and commitment. The incidence of post-operative complications is higher than in the non-obese population and in international series is reported to be up to 20%. Luckily, minor complications mainly occur. However they can prolong the healing time and cause discomfort.
Careful pre-operative patient restrictions are necessarily enforced for post-bariatric plastic surgery to be performed successfully and with lower complication rates. Internationally recognised criteria are applied:
- body mass index (BMI)lower than 30
- weight stability for at least six months
- stability and adequacy of the nutritional status
- haemoglobin within normal levels
- no severe comorbidities
- not a heavy smoker
Additionally, accurate surgical planning, meticulous performance and strict and consistent follow-up checks are of the utmost importance. Again to prevent complications, where possible, it is preferable to avoid concomitant multiple surgeries. It may be advisable to perform surgery to single body parts and wait for full recovery before continuing further surgery shortly after.
Downtime, after post-bariatric surgery, depending on the extent of the operation and the onset of complications, is usually around a month.
The expectations of patients seeking post-bariatric plastic surgery, must be realistic and based on an understanding of the feasible functional and aesthetic improvements, not from models of perfection or imaginary idealistic results; sometimes a pre-operative psychological assessment is necessary.
Patients must be aware that the majority of post-bariatric procedures result in long scars, which will take a long time (in some cases years) to mature and become less conspicuous. No scar is invisible and there is a personal predisposition to good or bad scarring. Nevertheless, sophisticated surgical techniques and specific post-operative treatments (i.e. silicone gel) help to achieve good scar quality. In most cases the dramatic functional, psychological and aesthetic benefits outweigh scar burden.
Post-bariatric body contouring requires fundamental principles of aesthetic surgery, which each plastic surgeon develops in their life-long learning, by vocation. On one hand standardized geometric rules are used, on the other, surgical creativity, attention to detail, sense of proportion and a desire for harmony, which stem from a surgeon’s personal sensitivity and experience, both are essential.
This artistic approach to surgery underpins successful body contouring, as every patient needs a “personalized” operation. Patients’ specific physical characteristics need to be considered, with the objective to correct the functional and aesthetic impairment, maintaining harmony and proportion. This is why procedures such as these should be performed by plastic surgeons, experts in this specialist discipline.