Post-Bariatric Surgery (following massive weight loss)

Massive Weight Loss Correction/Thigh Lifts/Brachioplasty

This is a group of operations to deal with the excess skin, unwanted scars, stretch marks, residual fat and folds after massive weight loss. The commonest procedures include a form of abdominoplasty (tummy tuck); medial thigh lifts (removing the excess skin between your upper inner legs); mastopexy (breast uplift with or without implants); arm lifts or brachioplasty (removing the “bat-wing” flaps under your upper arms) and total body lifts (a combination of tummy tuck, outer thigh lift and bottom lift).

Who is suitable for this surgery?

People should have reached their new ideal weight, be well and happy in themselves and have no on-going medical problems. This is often a long and complex surgery. I will discuss with you the areas of excess skin and folds that most trouble you and a treatment plan will be discussed. Various areas may be operated on at the same time, but this means longer operating time, increased risk and perhaps the need for a blood transfusion. Recovery will be longer than normal for any of the individual operations and scarring will also be more extensive. These are the types of operations that may be discussed:

“Fleur-de-lys” Tummy Tuck

In patients with an even greater degree of slack/excess skin, excess fat and splaying of the muscles, a classic tummy tuck may not be sufficient. An extra incision is made from the lower breast bone to the classic tummy-tuck incision in the suprapubic area, around the bully button and a larger wedge of skin is excised from above the belly button to just above the pubic hair. This will leave an inverted “T” scar on your tummy. Although this operation leaves the biggest scar, it provides the greatest degree of improvement in shape.

Medial Thigh Lifts

This operation removes excess skin and fat from between your upper legs (where it rubs together as you walk or run). The resulting scar usually runs in the groin crease but may also include a line down your inner thigh, depending on how much tissue needs to be removed. If there is a lot of tissue here you may even end up with a T- shaped scar running down the inner leg.

Arm Lifts (Brachioplasty)

This operation removes the “bat wing” flaps of skin below the upper arms. This leaves a long thin scar running down the inner aspect of your arm as far as the elbow.

Body Lifts

This operation removes excess skin and fat, not only from the front of your tummy but also going round your back. This lifts your bottom and upper outer thighs.

What to expect at the initial consultation?

At the initial consultation, I will discuss your thoughts and needs with you and elicit a past medical history. It is important that you mention to me any previous abdominal surgery (especially what type of bariatric surgery you have had and whether or not you are still part of a support group and MDT), pregnancies, previous leg or lung blood clots and whether you smoke. Tell your surgeon if you are on any long-term medication, have any allergies, have a tendency to bleed or bruise easily, have had any previous surgery, have had any problems with local or general anaesthesia or have any medical ailments.

Where does the treatment take place?

Your operation can take place at either Parkside Hospital, Wimbledon; St Anthony’s Hospital, Cheam, or The New Victoria Hospital, Kingston upon Thames. You can expect to spend 2-3 nights in hospital recovering from the operation before going home.

What can go wrong?

No surgery is without risk and I will explain the risks and possible side effects of treatment with you at your consultation. Patients who have combined procedures, which is often the case in post-massive-weight-loss patients, are more prone to common complications such as bleeding, wound infection and breakdown, stretched scars, asymmetry, numb skin and prolonged, difficult healing.

How long does it take to recover?

Recovery can take up to 4 weeks and you are not advised to return to work during the recovery period.

How satisfied can you expect to be with the procedure?

In most people, the results are long lasting, especially if you avoid weight gain, follow a balanced diet and exercise regularly. Patients will experience improved self-confidence, better fitting clothing and a real “rounding off” of their weight loss campaign. You must remember, however, that the results will not be instantaneous and it will take anything up to 6 months before the new you emerges. Scars are inevitable with any operation, but in time these should decrease and appear much less conspicuous.

I will discuss the exact nature of your treatment, including procedure details, recovery times and any possible side effects at a consultation. This will reflect your exact circumstances and needs. The information included here is provided for general guidance only.

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