Surgery after Massive Weight Loss

As gastric bypass procedures have become more common, patients who have lost a large amount of weight following gastric bypass, who now have significant laxity of their skin have also become more common in our office. As you'd expect, the areas that are commonly affected after massive weight loss (MWL) include: the abdomen and trunk, the breasts, the arms, and the inner and outer thighs.

While plastic surgeons have long had operations to fix these problem areas by removing the excess skin, we've learned through experience that the MWL patients are a little different than regular non-MWL patients when it comes to wound healing, complications and results.

For example, problems like anemia (from iron or vitamin B12 malabsorption) and certain other vitamin deficiencies are much more common in someone who has had a previous gastric bypass, compared to a non-bypass patient. Also, poor protein absorption caused by the effects of bypass surgery can result in low protein reserves and subsequent troubles with slow or impaired wound healing.

MWL patients are also more prone to have a higher rate of certain post-surgical complications. These include: wound separation, fluid accumulations under the skin known as seromas, and scars that may be more obvious in color or size compared to the non-MWL group.

Also, the MWL- patient's skin tends to stretch out more over time, due to decreased elasticity. So, even though we pull the skin as snug as we safely can, some relapse of the lifted area can occur.

Overall, this makes surgery for MWL patients more of a challenge - but the results are usually very gratifying for both surgeon and patient alike when it is completed. We'll discuss this topic in more detail in future blogs.