A Tailored Approach to the Bariatric Patient

Bariatric surgery has become an increasingly popular means for managing obesity in the United States, and recent statistics conclude that its role is continuing to expand. The massive weight loss which has been achieved by the means of bariatric surgical approaches has created a population of patients who desire body contouring with very special needs.

The massive weight loss (MWL) patient often has a number of body contouring issues which are amenable to surgical intervention.  The questions typically are which operations and when.  This leads to the issue of body mass index and weight loss plateau.

There are simplistically two different types of bariatric surgical approaches.  These surgeries restrict dietary intake (lap band) or bypass digestion (roux-y gastric bypass).  Some surgeries combine the approaches; however, the end result is nutrition deprivation which precipitates the weight loss. Skilled bariatric surgeons communicate the ramifications of this nutritional change clearly to their patients, and guide them carefully through the post-operative course to avoid the worrisome negative impacts of rapid weight loss.

Any discussion of bariatric surgery must include an understanding of body mass index.  These calculations, which are present on virtually all bariatric websites, integrate height and weight to develop a number used in stratifying patients in terms of presentation and weight loss.  To help understand these numbers – a normal BMI ranges from 25-30 while many MWL patients may present with a BMI greater than 50.

These BMI numbers are important with relation to surgical reconstruction of the MWL patient.  The best results in body contouring are achieved in the 25-30 BMI group. Many post bariatric body contouring surgeons limit intervention to the BMI less than 35 group.  There are exceptions, but we do know that the risks of surgery increase and the patient satisfaction rates decrease as higher BMI groups are incorporated as body contouring candidates.  If a weight loss “plateau” has been reached body contouring may be considered especially with respect to the abdomen.  There is experience to suggest that removal of a large pannus and duplicated metabolically active abdominal fatty tissue may reinvigorate sluggish weight loss.  Nutrition is of paramount consideration for surgical candidates.  Protein malnutrition is not unusual in the bariatric surgery patient, and a general review of nutritional lab work and general health status is a crucial aspect of any body contouring consultation.

With these caveats the plastic surgical approaches to body contouring have become dizzying.  The best advice is to find a surgeon who is familiar with the specific body contouring issues of the MWL patient.  My personal approach is staged management, and is dependent on the patient’s primary concerns, and the safe reproducibility of the surgical intervention. Suffice it to say that MWL patients can have concerns regarding the abdomen, arms, breasts, legs, buttocks, and face.  A sensible safe surgical plan should be developed and mutually understood prior to its initiation.

Finally, educate yourself.  The internet is filled with scores of bariatric surgery websites.  Some are great, and some are not so great. If you think that you are a surgical candidate, be safe and check out the ASAPS website for a board certified aesthetic plastic surgeon.