There are a tremendous number of options when it comes to choices for post-bariatric surgery. What you choose depends on where you lost most of your weight, where you have excess skin and what areas concern you the most.
Most patients are primarily concerned about their abdomen as this is where they tend to lose the majority of their excess weight and, therefore, this is usually the first surgery after massive weight loss. Options for tummy tuck surgery include a standard tuck where excess skin is removed from the lower abdomen between the belly button and the pubic area vertically and from hip to hip horizontally. At the same time the muscles of the abdomen are tightened to flatten the stomach.
For patients who have lost a tremendous amount of weight, a standard tuck may not accomplish all that they are looking for. Another option is what is known as a circumferential abdominoplasty or lower body lift. In this surgery, rather than tapering the incisions to a point on the sides, they continue completely around the waist so that excess skin is removed from the flanks, lower back and buttock as well as the abdomen. This results in tighter flanks, hips and outer thighs as well as somewhat of a buttock lift.
Another option includes removing an inverted ‘V’ of skin starting at the rib cage extending downwards in addition to a standard tummy tuck. This removes a large amount of skin side to side as well as vertically for those who have a lot of excess skin around the trunk as well as from top to bottom. This is known as a fleur-de-lis abdominoplasty and has the disadvantage of leaving a long vertical scar in the middle of the abdomen as well as the low transverse scar.
A breast lift is probably the most common surgery to combine with a tummy tuck after massive weight loss as most of these patients have a significant problem with sagging of their breasts. Excess skin is removed, the areola is usually made smaller and the nipple/areolar complex is moved to a higher position on the breast. Although implants can be placed at the same time, a breast augmentation is often performed as a subsequent procedure after the breasts have healed from the lift.
An arm lift is known as a brachioplasty. During this surgery, excess skin is removed from the upper inner arms to improve the arm contour, tighten the skin and eliminate sagging. In severe cases, the skin removal extends below the elbow and onto the sides of the chest. The extension onto the chest may preclude this procedure being done at the same time as a breast lift.
Thigh lifts are commonly done on patients who have lost a considerable amount of weight as many much of the fat loss is in the thighs leaving hanging folds of skin. The excess skin is removed from the upper front of the thigh and along the inner thighs down to and sometimes past the knees. A thigh lift can be done at the same time a other post-bariatric procedures.