Special Concerns with Post-Bariatric Surgery Patients

Patients who have undergone bariatric surgery pose a number of concerns for plastic surgeons and not all of them are physical.  There are a number of physical, psychological and nutritional issues that must be addressed prior to proceeding with elective plastic surgery to treat the extra skin in patients who have lost a considerable amount of weight.

Psychological Issues

Although post-bariatric surgery patients are generally pleased with their weight loss, they are generally not happy with their appearance because of the resultant sagging skin and breasts.  Unfortunately, the skin can only contract so much when fat is removed either through liposuction or weight loss.  Some patients may experience anger and depression due to their appearance following massive weight loss, which should be resolved prior to considering elective cosmetic surgery to treat the excess skin.  Sometimes, just the knowledge obtained at the time of consultation that a lot can be done to improve their appearance with plastic surgery can make a significant difference in their psyche.

Nutritional Concerns

Nutritional insufficiencies are common in patients who have undergone surgery for weight loss. These include anemia (low red blood count), malnutrition, protein malnutrition, fat malabsorption and deficiencies of folate, thiamine, iron and various vitamins including B12, A, D, E and K. Many of these are more common following certain types of bariatric procedures such as biliopancreatic diversion and are least common after gastric banding procedures.  It is important to strictly follow nutritional guidelines and supplement recommendations provided by your internist or bariatric surgeon.  These also can exist in patients who have lost a tremendous amount of weight through diet and exercise.

Complications

Post-bariatric procedures tend to be combination procedures that last for several hours. These prolonged surgeries have a higher risk of complications such as bleeding, infection, healing problems and blood clots in the legs which can migrate to the heart and lungs (pulmonary embolism).  A list of medications will be provided which should be avoided before surgery to reduce the risk of bleeding.  Antibiotics will generally be taken around the time of surgery and should be taken as directed to reduce the risk of infection.  Any vitamin or nutritional deficiencies should be corrected before surgery to prevent or reduce problems with healing. 

Deep Vein Thromboses

The risk of blood clots forming in the legs after surgery can be reduced with the use of  sequential stockings during surgery and in the recovery room and specific prescribed blood-thinners before and sometimes after surgery.  The most important thing to do to prevent blood clots is to move your feet and legs frequently after surgery and to ambulate early and often.  Getting up and walking around the room frequently during the day is very important, even the day of surgery.  It is important to inform your surgeon if you have had a blood clot (DVT) previously or have a family member who has had blood clots as these increase your risk with the surgery and increase the need to be on blood-thinners at home for a week or so after surgery. 

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