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Massive Weight Loss - Information For Patients
Introduction:
Significant weight loss after dieting or bariatric surgery is subsequently associated
with significant overhang of the remaining subcutaneous fat and skin. This can be
embarrassing, uncomfortable, and interfere with daily activities
The typical areas affected:
Abdomen / Flanks / Buttocks
Breasts / back
Inner thighs
Arms
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Plastic surgery can improve these areas by removing excess tissue.
Four or more operations may be required to improve the body shape. Before proceeding
with surgery it is important that your weight has remained stable for at least 1
year and that your other medical conditions are stable. It is also IMPERATIVE that
you have stopped SMOKING and that your nutritional state is good as this may otherwise
interfere with the healing process after your operations. As extensive surgery is
undertaken, patients require psychological support and input from the bariatric
multidisciplinary team. Furthermore, special funding approval by your primary care
group (PCT) is required.
What procedures are done and how will I look at the end?
Excess abdominal tissue can be removed by a procedure
known as abdominoplasty. If the excess tissue also affects the back, a bigger procedure
known as “lower body lift" may be required. Pre-operative markings are made on your
trunk to guide the surgeon on how much tissue to remove. During surgery, the overhanging
abdominal skin, and the folds from the lower back are excised. With closure of the
wounds the buttocks and thighs are lifted. Sometimes it is possible to use the tissue
to augment the buttocks. The stomach muscles can also be tightened at the same time
by using a special suturing technique known as "rectus plication". Your own belly
button is usually retained This is an extensive procedure that typically takes 4
hours of surgery. Several surgical drains are left coming from the wounds to avoid
any fluid from collecting within. Afterwards, elasticised abdominal support is needed.
The typical length of hospital stay is 4-5 days.
Risks: As this is a long procedure there are
increased risks of infection and development of leg vein clots. The scar can open
up under tension and may take a short while to heal. Loss of tissue (necrosis) rarely
occurs as the operation interfere with the blood supply of the tissues. Other
complications include asymmetry and fluid collection under the wound (seroma).
Typical time off work: 6 weeks
The loose
breast tissue can be improved by lifting/reshaping the existing fatty tissue
and trimming the excess skin. This procedure is known as a mastopexy. On
the day of the operation, the surgeon puts several marks on the breasts as a guide
during the operation. An inverted T-shaped scar is the result. This scar
is placed around and under the nipple and within the lower breast fold. After the
operation, you may need to stay into hospital for 1-2 days and you may have surgical
drains.
Risks: Infection, bleeding, numbness, loss of the nipple,
asymmetries and scarring can occur. Typical time off work: 2-4 weeks
Arms: A procedure known as "arm lift"
or "brachioplasty" can be performed. The skin overhang is marked before the operation
to determine how much skin should be taken off. During the operation the skin and
superficial fat is then removed by a long incision extending from the elbow to the
armpit and the skin edges sutured together. An attempt is made to hide the scar
line in the same place as the bottom seam of a shirt. This procedure may be combined
with liposuction, or breast surgery.
Risks: Asymmetries, scar widening, bleeding and
infection. Occasionally, superficial nerves that supply sensation to the forearm
and arm may also get damaged/stretched but this rarely causes problems.
Typical time off work: 4 weeks
Excess loose skin from around the thighs can be
corrected by an operation known as medial thigh lift. The surgeon marks an ellipse
on the inside of your thigh before the operation. During the procedure, the marked
area is liposucted and the skin and superficial fat layers are cut out. The skin
edges are then sutured together. The scar can run from knee to the groin on the
inside of the thigh. A surgical drain may be required.
Risks: This includes infection, bleeding, collection of fluid (seroma)
within the wound and stretched scarring
Typical time off work: 3 weeks
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Photos showing the appearance and scarring of a patient before and after a medial
thigh lift procedure
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Please be realistic about what you expect as a result of this
surgery and consider all the points highlighted in this information sheet before
finally deciding on having any operation
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Typical appearance of a
patient following massive weight loss
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Photos show patient before
and after
abdominoplasty (tummy tuck)
and mastopexy/augment
(breast lift)
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Photos before and after brachioplasty.( Arm lift )
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