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Body Contouring Procedures After Bariatric Surgery and How They Work

July 12, 2021

Pictured above, from left: Dr. Brett Garber, plastic surgeon, and Dr. Marc A. Neff, medical director of the Jefferson Health Bariatric Surgery Program in New Jersey 

Bariatric surgery yields incredible health benefits, from diabetes reversal, to improved blood pressure, increased stamina, boosted confidence, and much more. But, while most post-bariatric changes are positive, complications can arise that might call for body contouring, or plastic surgery.

With any significant amount of weight loss, stretch marks and skin folds can develop. Genetically, everyone has different levels of skin elasticity, explains Brett Garber, DO, plastic surgeon with Jefferson Health – New Jersey, so some peoples’ skin will “shrink” easier than others. People who lose dramatic amounts of weight in a short timeframe are less likely to see skin retraction, because it doesn’t have time to “catch up.”

Excess skin can result in chronic rashes, particularly under the belly and breasts. Not only are these frustrating to manage, but they are dangerous, as they increase the risk for wounds and infection, says Dr. Garber.

Even without rashes, excess skin can cause aches and pains, limit the ability to move and exercise, and make it more challenging to dress the way you want. It makes it hard to re-build confidence and get the most out of bariatric surgery, says Marc A. Neff, MD, FACS, Medical Director of the Jefferson Health Bariatric Surgery Program in New Jersey.

Body contouring, like bariatric surgery, has been stigmatized by society, but patients should not feel ashamed for pursuing these procedures, continues Dr. Neff. “When someone is sick and needs surgery, it’s not shameful. Obesity is a disease, linked to 65 other disease processes, and procedures such as these are life-saving.”

It’s recommended that people wait at least one and a half to two years after bariatric surgery to have a body contouring procedure, so they’ve plateaued in their weight loss and they’re comfortable with their new routine, explains Dr. Neff. “Being involved in a regular exercise program is particularly important, as it’ll help to tone and tighten things.”

Unfortunately, getting body contouring covered by insurance can be an uphill battle; but, if you can prove that it’s medically necessary for your well-being, most insurers will accept it, says Dr. Garber. You should start to document any health problems that occur due to the excess skin with your doctors as soon as possible – the more documentation (including pictures), the better, adds Dr. Neff.

Below are the most common body contouring procedures done after bariatric surgery and how they work:

Panniculectomy – most common

Insurance coverage: likely
Duration: 1.5-3 hours
How it works: Panniculectomies work similarly to tummy tucks, ridding the excess skin that hangs down over the pelvic region and thighs. A long incision is made from hip to hip, in the line of where your underwear lies. The excess skin is trimmed, and the remaining skin is pulled together and sutured. The belly button is typically re-positioned on the abdomen.

Breast Reduction – 2nd most common 

Insurance coverage: likely
Duration: 2.5-3 hours
How it works: post-bariatric surgery, breast reductions are commonly done for both men and women. An anchor-shaped scar is made from a circular incision around the nipple and areola; a vertical line connecting this circle to the bottom of the breast; and a semi-circular shaped incision along the crease where the breast meets the chest, and then extra skin and/or fat tissue is removed. (Learn more, here.)

Arm Lift/Brachioplasty – less common

Insurance coverage: rare
Duration: 2 hours
How it works: An incision is made roughly from the elbow to the armpit, down the inside or back of the arms. Excess skin is trimmed, underlying supportive tissue is tightened, and excess fat may be removed.

Thigh Lift/Thighplasty – least common

Insurance coverage: rare
Duration: 2 hours
How it works: Incisions may be made in different areas, depending on whether the inner or outer thigh need to be toned. For the inner thigh, a small incision may be made from the groin, wrapping around the back of the thigh, or a larger incision may be made stretching from the groin to the knee. For the outer thigh, a curved incision from the groin, wrapping around the hip, may be made. Excess skin – and sometimes fat – are removed.

Recovery & Scar Healing:

Most body contouring procedures are done the same day at our outpatient surgery centers, says Dr. Garber, unless unique health complications necessitate a hospital stay. 

Special dressings and compression garments will need to be worn to minimize swelling and aid in healing, explains Dr. Garber. Recovery periods are relatively short but vary for everyone. After a panniculectomy and/or breast reduction, most feel back to “normal” within a couple weeks; however, activity restrictions and other precautions are recommended for about 4-6 weeks.

Proper scar care is key after any surgery, says Dr. Garber, and it’s not just about topical treatments. “We encourage all patients to stop smoking and stay well-rested.”

Keeping up with your vitamins is especially vital, even more so as a bariatric surgery patient, as you eat less and have more difficulty absorbing these nutrients from your food, reminds Dr. Neff.

Risks:

As with any surgery, there are risks after these procedures, such as hematomas, infections, and blood clots (deep vein thrombosis or pulmonary embolisms); however, they’re all rare, and precautionary actions are taken to reduce the overall risk, continues Dr. Garber.

The Biggest Benefit:

“It’s about getting your life back,” said Dr. Neff.

Patients who are brave enough to undergo bariatric surgery and body contouring are making a significant change in their lives in a remarkable way, adds Dr. Garber.

“Losing weight and improving your health is huge, but you need to like the body you’re in,” continued Dr. Neff. “Some people need body contouring as the final step in their treatment – it’s the last step of surviving.”

For more information on Bariatric Surgery at Jefferson Health - New Jersey, click HERE