Patients with obesity are at risk of multiple medical problems. Through either diet modification or bariatric surgery (eg gastric bypass), a significant amount of weight can be lost. This, unfortunately, can lead to problems with loose and excess skin and fat. Problems following massive weight loss include:
- Unsightly or embarrassing appearance
- Difficulty with movement/exercise due to skin excess
- Irritation or skin infections such as boils
Body contouring surgery following massive weight loss can lead to an improved quality of life for patients. A number of procedures are available to address the different areas affected.
Eligibilty
The British Association of Plastic and Reconstructive Surgeons (BAPRAS) has developed a set of NICE (National Institute for Health and Care Excellence) accredited commissioning guidelines to aid patients and GPs in the referral pathway for body contouring surgery. These outline the eligibility criteria below:
- Age over 16
- Starting BMI >40, or >35 with other medical problems (eg diabetes) AND a current BMI of less than or equal to 28
- Weight stability for 12 months AND significant medical problems (both physical and psychological)
The only exception to the criteria listed previously is for apronectomy. This is a simpler procedure than an abdominoplasty and can be performed at higher BMIs than those mentioned. Although the risks would be higher than if the BMI was less than or equal to 28, removal of the hanging apron improves mobility and can aid further weight loss. Apronectomy is a largely functional operation with little improvement in the abdominal appearance. There are also some factors that would prevent a patient from being referred for this form of surgery. These include smoking, which dramatically increases the risks of surgery, and an active psychosocial condition. This form of surgery requires very realistic expectations of what can be achieved and all patients must be able to cope with the worst of the complications that may arise as a result of the surgery.
Preparation
The aims of any body contouring surgery are to improve the symptoms you have and to improve your quality of life. The procedures available demonstrate the range of operations that may be necessary, but not all patients will require all procedures and your surgeon will discuss with you which may be most appropriate. All operations of this kind carry a high risk of complications, whether they be minor ones or major ones. For this reason we must do everything to optimise your wound healing and recovery otential preoperatively, including stopping smoking and improving your nutritional state. Sometimes this may require blood tests to be performed and nutritional supplements to be taken.You will often undergo a pre-assessment appointment to help ensure that your health is optimised prior to any surgery.