Post-Bariatric Surgery

When a person undergoes bariatric surgery to lose weight and loses between 40 and 60% of the excess they had, they may require plastic surgery to remove excess and sagging skin.

“After massive weight loss as is known in the post-bariatric patient, it is necessary to correct each anatomical area.” Generally, this surgery is indicated one year after the first admission to the Operating Room, when the maximum extra kilos has already been lost.

The main anatomical areas that must be corrected are:

• abdomen
• thighs
• arms
• armpit
• buttocks
• torso.

“The patient, after his cutaneous excesses, suffers a new psychological impairment that must be treated and considered as an important stage of the corrective process”, once these patients are subjected to some bariatric surgical treatment, several months pass until the aesthetic alterations caused by weight loss become evident. These sequels are presented with a wide variety and without a well-defined anatomical pattern. They mainly consist of cutaneous laxity and lipodystrophies located in various body regions, depending on the degree of previous obesity and the constitution of each individual. It is at this point that the Plastic Surgery assessment is planned, however the optimal time to start the reconstructive process is not subject to the patient’s perception, but to the consensus of an entire interdisciplinary team.

Corrective plastic surgery is indicated and assessed by a Multidisciplinary Team (Cardiologist, Psychologist or Psychiatrist, Nutritionist Physician, Physiatrist, Plastic Surgeon among others) that treats the patient. It is these specialists who must give the pass to plastic surgeons. Before the procedure, the anesthesia time is calculated and all the antecedents of the patient’s medical history and the corresponding ones are analyzed.

Evaluations with the bariatric surgeon and the nutrition team. After that stage, we proceed to reconstructive plastic surgery in steppes.

Plastic and Reconstructive Surgery

 The patient will go to Plastic Surgery only after having completed all previous assessments, with the corresponding notes recorded in the clinical file. Requirements to start the reconstructive process:

1. Have elapsed more than 18 months after the event of metabolic surgery.
2. Maintain a stable weight for more than 3 months, with a BMI between 25 and 28 kg/m2 (in cases of previous grade I-II obesity) or between 28 and 31kg / m2 (in cases of previous extreme obesity/grade III).
3. In the case of a second or third procedure, a minimum period of 3 months must be expected between the previous surgery and the projected surgery.

Surgical procedure planning:

The first of the reconstructive procedures will be decided by the treating reconstructive plastic surgeon taking into account the patient’s opinion regarding the aesthetic-functional alteration that most affects him. However, this will only serve as an orientation to be able to define the order of approach of the areas susceptible to reconstruction.

The resulting choice must be respected, since it will be taken according to the maximum benefit for the patient.

In the event that it is not at its ideal weight for surgery but requires the resection of a dermo-fat panicle in order to improve its functional performance (favor its physical activity), the procedure must be assessed by the interdisciplinary team by submitting consensus the risk-benefit that will be provided to the patient, who in turn must sign a detailed informed consent of the surgical procedure to be performed.

The total reconstruction of the patient will be divided into different surgical events addressing specific anatomical regions, all to reduce the risks related to prolonged surgeries (over 6 hours).

The division of anatomical regions is as follows:

1. Cervico-facial region.
2. Upper body contour region: dorsal, thoraco-brachial and pectoral.
3. Lower body contour region: abdominal, pubic, gluteal and crural.

The procedures to be performed according to the anatomical regions described are:

1. Surgery of the cervical region: cervical rhinoplasty.
2. Upper body contour surgery: liposuction-assisted Brachioplasty; lateral torsoplasty; posterior torsoplasty; mastopexy with or without placement of breast implants; reduction mammoplasty; torso-tummy tuck (reverse tummy tuck); and isolated regional liposuction (torso, upper dorsal region, and arms).
3. Lower body contour surgery: extended tummy tuck with or without vertical component (Fleur de Lis); circumferential tummy tuck with or without vertical component (Fleur de Lis); gluteal region lifting with or without transposition of fatty flaps; plasty of mount of Venus; treatment of isolated lipodystrophies through regional liposuction (abdomen, flanks, pelvic trochanteric and lumbosacral region); vertical medial cruroplasty  (or leg lifting) assisted by liposuction; and lateral vertical cruroplasty assisted by liposuction.

Integration of criteria for surgery programming:

The following criteria must be integrated as a result of the approval of the specialties that make up the interdisciplinary team:

1. 18-month interval between metabolic surgery and the first reconstructive procedure.
2. Stable BMI between 25 and 28kg / m2 (previous grade III obesity) or between 28 and 31kg / m2 (previous grade III obesity) for a minimum period of 3 months.
3. Minimum period of 3 months between one reconstructive procedure and another.
4.  Classification ASA I and ASA II (Except for those candidates for panniculectomy whose characteristics may exclude them from this group).
5. Negative smoking (negative urine nicotine test 72 hours before surgery).
6. Suspension of hormonal substitutes and contraceptives. II) Transoperative The post-massive weight loss patient should be treated in a hospital facility duly equipped with all necessary materials, supplies and human resources. The operating room must have adequate dimensions to house all the surgical equipment, the instruments, and the necessary materials and equipment.