After significant weight loss, patients often require procedures to reshape and remove excess, unsightly skin.

Many patients are affected by excessive sweating, recurrent skin infections and may even be troubled by skin breakdown in the folds of skin. Scarring from these procedures is usually well accepted by patients as the scars are hidden wherever possible.

Body contouring is a range of aesthetic procedures designed to improve the body’s appearance after major weight loss. The surgery removes sagging skin and extra fat and improves the shape and tone of underlying tissue. Areas that after often affected by loose skin following weight loss include the upper arms, breasts, abdomen, buttock and thighs. The primary objective of Body Contouring is to alter the shape and appearance by using surgical techniques which include removal of excess fat and/or skin as well as the use of surgical implants and lifts.

Things to consider before weight loss (body contouring) surgery

This procedure is complex and, in many cases, multiple operations may be required to alter a patient’s body shape. Frequently, multiple procedures are performed under a single General Anaesthetic. Often the safest method is to utilise two plastic surgeons, working at the same time to minimise anaesthetic time and complications.

Patients should be in good general health, and their weight should be stable for at least three to six months. Ideally, they should be at or close to their ideal body weight with a BMI of 30 or less. This is because patients with a high BMI have increased risks associated with these procedures. They should not smoke cigarettes for at least six to eight weeks before surgery.

Body contouring (weight loss) surgery and reshaping can help with functional and aesthetic issues associated with the skin and fat excess remaining after weight loss. However, patients should have realistic expectations about their results and be prepared to accept the potential for significant scarring.

What does a body contouring (weight loss) surgery procedure involve?

The areas of the body usually affected by skin and fat excess after weight loss are:

Abdomen, flanks and buttocks

Breasts and back

Inner thighs

Arms

Excess abdominal tissue may be removed by a procedure known as an abdominoplasty. If the excess tissue also affects the back, buttocks and outer thighs, another procedure known as a Belt lipectomy (body lift) may be required.

Before the procedure markings are made on a patient’s trunk to determine how much tissue to remove and estimate the location of the resultant scar. In the operation, excess abdominal and back skin are excised. The wounds are closed lifting the buttocks and thighs through upward traction. The stomach muscles are tightened at the same time.

With the two-surgeon approach, the procedure typically takes around four hours to complete. Surgical drains are left in the wounds to reduce the collection of fluid under the skin. A compression garment should be worn for six weeks following the operation. Patients usually need to stay in hospital for between three to five days.

Breast mastopexy (breast lift)

Loose breast tissue can be improved by lifting and reshaping the residual breast and fatty tissue and removing excess skin. After the excess breast and areolar skin have been reduced, the nipple and areola are shifted to a higher position. Skin that was formerly located above the areola is brought down and together beneath it to reshape the breast. The nipples and areolae remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and perhaps also the ability to breast-feed.

In some cases, the breast gland at the bottom of the mound is repositioned underneath the gland at the top. This provides change in the shape of the breast and the fullness in the upper part (auto-augmentation).

In most cases, drains are inserted at the time of surgery and patients are required to stay in hospital overnight. The drains are usually removed after the first night and patients are then able to go home. Post-operative pain is usually minimal and is controlled with tablets prescribed by the anaesthetist who is present for the procedure.

Brachioplasty (Arm Lift)

Brachioplasty is a procedure for removal of excess skin affecting the upper arms. During the operation, excess skin and fat is removed through a long incision extending from the elbow to the armpit. A drain is inserted before skin closure and dressings before firm bandages are applied. The procedure may be combined with liposuction or breast surgery.

Thighplasty (Thigh Lift)

Excess loose skin from the inner thighs can be removed through a medial thigh lift. The area for excision is usually first treated with liposuction before removal of excess skin. The wound is closed with a scar either running from knee to groin on the inside of the thigh or through an incision hidden in the inner groin crease depending on the pattern of skin excess determined pre-operatively. A surgical drain is inserted in each thigh and a firm bandage applied over the dressings.

What to expect after body contouring (weight loss) surgery?

Patients are encouraged to mobilise as soon as possible after surgery. The drains are usually in place for up to 7 days. Strong pain killers are rarely required after the first 24-48 hours. Patients are usually given injections to reduce the risk of clots in their legs (DVT) until they are freely mobilising.

Most patients are discharged within a few days depending on the number and type of procedures performed. They can usually return to relatively normal activities and exercise within four to six weeks. Most patients are recommended to take around two to three weeks off work after these operations depending on the physical demands of their job.

Whilst scars are not completely predictable, most are less visible and easily concealed in time. They may appear pink and slightly thickened for a few weeks to months after the surgery but will usually fade to be pale and soft by around three to six months. Their final appearance may take up to eighteen months to achieve. Rarely, scars may remain thick, red or lumpy which may warrant revision after twelve to eighteen months.

Dr Hanikeri will usually recommend topical scar therapy such as silicone gel to be used from around the fourth postoperative week, until around three months after surgery.

Risks of body contouring (weight loss) surgery

All surgical procedures carry some risks. The potential risks are discussed at the initial consultation and will be outlined via your secure patient portal (TouchMD). Some risks may include:

Potential for reactions to anaesthesia, bleeding that may require surgical drainage, significant bruising and infection.

Minor asymmetries in respect of the contour and scars is normal. There is also the possibility of residual bulges. A perfect shape cannot be restored after massive weight loss.

Wound healing problems can occur. Most wound problems are minor and can be managed with dressings. Rarely more major wound problems such as infections, skin loss, wound separation and delayed healing can occur. If so, this will delay recovery and result in worsened scarring.

Occasionally fluid will collect in the region of the operation (seroma). If this occurs, it may need to be aspirated using a syringe and needle.

Alteration in the sensation of the skin in the operation site is normal and may be permanent.

These procedures carry a risk of blood clots in the legs (DVT) and possibly the lungs (Pulmonary embolus). Precautions are taken to reduce this risk, however if a blood clot occurs, treatment with blood thinning medication may be needed for several months. If you would like to know more about body contouring, or to request a consultation, please contact us today.

Body Contouring (Weight Loss) Surgery Perth