Post-bariatric surgery abdominoplasty (also known as a tummy tuck) can provide additional weight loss to overweight patients, are medically necessary in some cases, and contribute to improvements in the quality of life for patients. Warning patients of the additional costs that may come later, once the weight is lost, or recommending abdominoplasty be listed as medically necessary, are important steps when performing bariatric surgery on large patients.
Long term weight loss efforts are aided when post-bariatric patients have reached out to plastic surgery. When patients use contouring surgery after their bariatric surgery there is, on average, a BMI decrease of 18.24, as opposed to a decrease of about 12.45 for bariatric patients who do not get contouring surgery1. A BMI variation of 6.5 is the difference between borderline underweight (18.5) to the rim of overweight (25.0)2, meaning that the weight differential between shaped patients and non-shaped patients is significant enough to warrant a difference in the health of these patients. For example, a 7% weight loss in people with high risk for diabetes cut their risk by nearly 60%2.
For patients who have lost more weight, there are medical necessities beyond additional weight loss that make contouring surgery a fundamental fact to gaining their life back again. In some cases the weight loss will leave patients still unable to walk due to excessive skin, at high risk of infection, and depression. Sometimes the weight loss after bariatric surgery is so extreme that patients do not gain back their ability to walk, even after their weight allows, because of a curtain of skin hanging from their stomach and legs. One such case was Paul Mason from the UK, who after 8 feet of incisions and losing 650 lbs after his bariatric surgery, lost 50lbs of skin in a massive contouring surgery3. The ability to walk returned to Paul, means that he can walk, garden, and enjoy activities that we take for granted, it also means that he can further his weight loss and improve his lifestyle at a faster rate.
The high risk of infection associated with large amounts of skin can result in patients having new set of health problems to deal with. Infected skin ulcers and cellulitis pose serious threats if left untreated or unfound. Cellulitis is a bacterial infection spread beneath the skin4 and often accompanies ulcers or surgical wounds. It can be treated, as can infected ulcers, but they are morbid to many patients and decrease the quality of life by causing pain and discomfort.
The long-term quality of life for patients is affected by an abnormal amount of skin. Contouring surgery is not only necessary to maximise the amount of weight lost and reduce risks of infection, but it is also vital to the mental health of the post-bariatric patient. Depression is fairly common in bariatric patients due to a sudden, severe withdrawal from large quantities of food, similar to ex-smokers who used to reach for a cigarette at night to fall asleep or wake up in the morning for the same addiction, post-bariatric patients also feel that void where food used to be. The remnants of their former self, in the form of an ulcerous and obstruent acts as a constant reminder of the way they used to be, and can be a sore spot for many. By removing the excess skin, depression rates plummet, posture is improved, and hernias are reduced5.
It is vital for post-bariatric patients to get body contouring surgery after their weight loss is complete to maintain their mobility, prevent infection, and improve their quality of life. In fact 97% of people said they would recommend surgery to others6.