Massive Weight Loss Consequences

Congratulations!  You’ve lost a lot of weight by diet & exercise, bariatric surgery, or a combination.

You look better, feel like another person, your medical problems have significantly improved. However, you look at yourself, and you see a lot of deflated skin, and it does not match how you feel.

1. What are the most common areas that plastic surgery can improve after massive weight loss?

What I see in my weight loss patients is fairly consistent. I always ask what their priorities/concerns are, and generally they are rated the same, regardless of gender or age.

  1. Abdominal pannus (apron)
  2. Breast/chest area
  3. Arms
  4. Inner thighs
  5. Face

2. Can these areas be done at the same time?

Obviously, not all at the same time. But depending on the patient’s overall health status, and amount of tissue to be removed two or three procedures could be done at the same time.

Most common, the abdomen and breast are done together. Each of these procedures are about 3 hours in length (6 hours combined), and in most patients can be done as an outpatient procedure.

Other combinations are possible, but I do feel that the abdomen and inner thighs should be done at two separate times. These are the two “biggest” surgeries as far as recovery goes.

3. Do I always have to do a breast implant w/ my breast lift?

No, but unless you still have a substantial amount of breast tissue, you will have a fairly long scar from the skin removal on a small breast. Implants also fill out the upper part of the breast that will not be done by a breast lift alone. The size of the implant does not need to be necessarily large, nut will make a substantial difference in most people.

4. Will insurance cover my surgery?

Some insurance companies are more lenient than others in covering massive weight loss issues. The abdominal pannus, if functional problems exist (i.e., recurrent infections, yeast infections, and maybe lower back pain) is sometimes covered by insurance companies. Even then, it is often unpredictable in our experience. Other areas, breast and arms especially, are not going to be covered.

5. What is the largest pannus you (Dr. Chick) have removed?

As a resident, back in the dark ages, I assisted a removal of a 70 LB pannus. . In my own practice, I have removed a 50 LB pannus. The vast majority of cases involving abdominal tissue removal weigh between six to fifteen LBS.

6. What is the difference between a panniculectomy and an abdominoplasty?

Mostly, it is a matter of semantics. They are essentially the same operation, but insurance companies prefer the word panniculectomy, as abdominoplasty suggests a cosmetic procedure. In extreme cases, and in some surgeons’ routine, a panniculectomy is a simple amputation of the pannus.

Except for an extremely large pannus, or with infection problems, I do the same operation, undermining, the skin flap to the ribs, fixing the midline muscles, and removing as much skin and fat as possible.

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