Some are able to lose weight on their own. Others chose weight loss surgery. Bariatric Surgery and Gastric Bypass Surgery are surging in popularity. With massive weight loss in a short time, skin often does not shrink well. Body contouring plastic surgery can help deal with this extra skin and give such individuals a new image after losing weight.

The American Society for Bariatric Surgeons estimates that there were 140,000 bariatric surgery procedures performed in 2005. Here in East Contra Costa County, we have one of the finest bariatric surgery centers located at Mt. Diablo Medical Center in Concord. Even here locally, we have seen a tremendous surge in the number of weight loss surgeries performed. In turn, patients who have lost massive amounts of weight, are turning to plastic surgeons in increasing numbers to help them improve their quality of life and self-esteem. Dr. Mariotti has responded to the demand for body contouring with well-designed, staged procedures resulting in excellent, consistent results while maximizing patient safety. Dr. Mariotti has performed major contouring procedures on many of the bariatric surgery patients not only from Mt. Diablo hospital, but also from Stanford, San Francisco, San Diego and several from out of state.

The Role of Plastic Surgery in Post-Bariatric Surgery
Massive weight loss is defined as the loss of greater than 100 pounds or 100 percent above the person’s ideal body weight. Most of the weight loss is in fat. However, the patient is usually left with a large amount of excess skin. The need to remove this excess skin is not only for aesthetic benefit, but in some cases may present medical conditions which may make insurance coverage possible.

To address these problems, patients are first evaluated, preferably, when they have reached their plateau of weight loss. This is usually a year after their gastric bypass operations. Body contouring surgery is planned with patients who are psychologically stable and willing to accept staged operations to achieve the expected goals.

The exact sequence is customized to the needs and desires of each patient. It typically includes a belt lipectomy for the abdomen followed by a thigh lift and an arm lift. Many women who have lost a large amount of weight have extremely droopy breasts and need a breast lift. Liposuction can also be performed in conjunction with any of the lift procedures and is especially effective for the upper abdomen flanks and thighs. Below is a brief description of each procedure common after massive weight loss.

Brachioplasty(Arm Lift)
The inner arm excess is treated with brachioplasty through direct elliptical excision of the redundant tissue and placement of the incision medially along a line connecting the armpit to the elbow. The scars are well hidden in the brachial groove and allow for three-dimensional contouring of the arm.

Abdominoplasty or Lower body lift
This is indicated for patients with generalized loose skin encircling the torso. This procedure takes a tummy tuck and continues it around the back to not only tighten the abdomen, but also droopy thighs and buttocks.

Mastopexy(Brest lift/reduction)
The excess skin is excised and the nipple is elevated to create a more youthful appearance to match the remaining body profile. Sometimes excess skin tissue from the lateral chest wall can be used to augment the breast volume.

Thigh Lift
Usually one of the last procedures to be performed, this can involve either a removal of only the upper inner thigh skin or in cases where the skin is loose over the entire leg, the incision may be placed down the inner thigh to remove a greater amount of skin.

Insurance coverage
Many insurance companies have tightened the requirements for coverage of plastic surgery following massive weight loss. No insurance company is in the business of covering procedures which have the main goal to make a body part look better. However, if there are medical problems associated with the excess skin, such as chronic rashes previously treated with conservative measures, coverage may be possible. The most common coverage is for a panniculectomy, which is the removal of only the skin which hangs below the pubic area. Although no insurance company will pay for a cosmetic tummy tuck which removes ALL of the loose skin nor the tightening of the stretched abdominal muscles or the recreation of a more youthful, sexy belly button, many patients choose to combine an insurance covered panniculectomy with a tummy tuck to help offset the costs of the more complete cosmetic procedure. Insurance coverage always requires the submission of a letter from Dr. Mariotti along with supporting documentation and photographs.