Unlike many plastic surgery procedures that are performed in outpatient centers (e.g., breast augmentation, facelifts etc), body contouring is more extensive and invasive surgery. Some bariatric surgery patients also have associated medical conditions which may lead to increased complications form surgery or anesthesia. The question then becomes as to the safety of extensive body contouring procedures in an outpatient setting.

In the April 2012 issue of Aesthetic Surgery Journal, a study was published entitled ‘Outpatient-Based Massive Weight Loss Body Contouring: A Review of 260 Consecutive Cases’. These patients came from a single plastic surgeon in private practice in the state of Washington. Over a six year period (2004 – 2011), 260 patients (93% women) who underwent a total of 544 body contouring procedures was evaluated. The average age of the patients was 42 years with an average weight loss of 130 lbs. The most common procedures performed were a lower body lift, liposuction and armlifts. Nearly 60% underwent more than one procedure with an average operating time of over 5 hours. (330 minutes) Nearly 90% of the patients went directly home after leaving the recovery room.

The most common complications were wound separation (17%) followed by seroma (5%) and urinary retention. (4%) There was one case each of the need for blood transfusion and a pulmonary embolism. No instances of infection, death or need for inpatient hospitalization occurred.

This study is impressive as 260 consecutive cases of any procedure is significant, let alone complex body contouring procedures. It demonstrates that good patient selection with an experienced plastic surgeon and anesthesiologist in an accredited surgery center can produce exceptional outcomes with a very low rate of complications. The lack of DVT and pulmonary embolism complications, albeit one patient, is noteworthy given the length of the surgeries and their extensive nature. Only one infection and such a low rate of seroma formation is also noteworthy given the hundreds of patients treated.

Wound complications are the norm in any form of body contouring whether it be the arms, breasts or lower body. I tell my patients to expect minor wound healing issues that will not be completely healed until six to eight weeks after surgery. It is never a question of if but where and how significant is the wound opening area.

This study clearly shows that many bariatric plastic surgery procedures can be safely performed as outpatient procedures. Combination procedures, which may take up to four to six hours of surgery, can be done and still send the patient home without increased risks of DVT or PE complications.

Dr. Barry Eppley
Indianapolis, Indiana

The extra skin and fat around the waistline is usually the most common concern for most extreme weight loss patients. It is the most frequently requested procedure in this patient group and is usually done first in the priority of body contouring procedures. In cases of only moderate skin excess, a more simple and traditional tummy tuck (abdominoplasty) may suffice.

Like a more typical cosmetic patient, the tummy tuck in the weight loss patient is a frontal procedure that results in a hip to hip scar. An elliptical cutout of skin and fat is done that starts low at the level of the pubic hairline and stops just above the belly button. The excision patterm looks like a horizontally shaped football. The key is that the cutout goes above the belly button, which differentiates it from a limited or mini-tummy tuck in which the cutout goes below the belly button. It is very uncommon to do a limited tummy tuck in the extreme weight loss patient. This type pf cutout pattern in a full tummy tuck results in both a low horizontal scar that extends from one hip prominence to the other but a circular scar around the newly created belly button. (umbilicus)

As part of the tummy tuck, the abdominal muscles (vertical rectus muscles) are sewn closer together to help provide further flattening of the stomach area. There is a common misconception about this part of the procedure. The actual muscles are not really sewn together but the covering of the muscles are, known as the fascia. A running vertical row of sutures, from just below the breast bone down to the pubis, is placed to create a horizontal tightening effect across the stomach . In some patients, this effect is significant while in others this muscle tightening does not make a dramatic visual flattening effect. For this reason, not every tummy tuck patient needs this part of the procedure. If not done, the amount of pain after surgery is dramatically reduced.

Every tummy tuck patient gets drain tubes placed during surgery. These drainage tubes remain for an average of 10 to 14 days after surgery. They are critical to avoid a fluid collection over the stomach area after surgery.

This relatively simple tummy tuck in the extreme weight loss or bariatric patient represents about 1/3 of the types of tummy tucks that I do for this patient population. Whether this tummy tuck version, or a more extended one is necessary, depends on the amount of extra skin and fat that the patient has.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis