A large part of our practice deals with  the particular needs of the patient after weight loss procedures like gastric bypass or gastric banding ("lap bands"). The massive weight loss (MWL) patient presents a challenge both surgically and medically in the pre and post-operative periods.  Dr.'s Robert Oliver Jr. and Jason M. Jack have the added expertise of actually having personally performed and assisted in many different kinds of weight loss surgeries ( lap-bands, roux-en-Y bypass, vertical band gatroplasty, and others) which adds insight into unique aspects of their care.

As patients may present with dozens of stereotypical body shapes after MWL, we individualize operations accordingly. Many of the traditional body contouring techniques do not translate well in the MWL patient, and we've incorporated many of the latest procedures evolving to address particular needs. The general trend with many of these surgeries is recognizing that for better results we've had to extend or re-orient conventional cosmetic surgery approaches to remove the larger degree of excess skin. In some cases this excess tissue may in fact be used to "auto-augment" areas like the breast or buttock which are deflated.

The most common areas treated in the MWL patient are the abdomen and breasts. Often the patient presents with significant skin excess with a "deflated" appearance. On the trunk and legs there may still be significant areas of excess fat (lipodystrophy) which persist. Loose skin on the trunk/abdomen is present in varying degrees circumferentially, and the "belt" lipectomy or body lift is a specific operation which has emerged to address this issue. The deflated MWL breast appearance represents loss of the fatty component of breast tissue and often requires a breast lift (possibly including an augmentation) rather then a breast reduction in most instances to achieve an aesthetic result.


Won't my Plastic Surgery after gastric bypass be covered by insurance?

There are some instances where the body changes in the MWL patient may meet health insurance criteria for coverage for all or parts of certain surgeries. We are happy to investigate this as an option in patients we feel are appropriate candidates. Be aware however, that it is a very distinct minority of patients who will meet such criteria and we provide honest assessments to our patients in this regard. Insurance will cover reconstructive surgery, which is any surgery done primarily to restore or improve the way the body works or correct deformities that result from disease, trauma or birth defects.

At a minimum you will be asked by your insurer to demonstrate all of the following:

• Photographs with evidence of severe chronic irritation and infection or uncontrollable intertrigo. Mild or occasional (ie. summer months) rashes are not acceptable. 
• The excess skin folds hang well below the pubic bone.
• Documentation of interference of ambulation, personal hygiene, treatments and response to treatments for at least 3-6 months as documented by your primary care physician.

Blue Cross/Blue Shield of Alabama and other insurers point out that removing an excess of abdominal skin/fat is not a covered benefit under the following scenarios:

● As an adjunct to other procedures (eg. hysterectomy) unless the medical criteria is otherwise met
● For the treatment of back pain
● For the purpose of improving appearance (cosmetic)
● For improving abdominal wall laxity (tummy tuck, cosmetic) or diastasis recti
● For the treatment of psychological or psychosocial complaints


Whats's the difference between an abdominal panniculectomy and a tummy tuck (abdominoplasty)?

Panniculectomy is performed to strictly relieve a massive apron of fat, and is considered purely functional.  It implies an amputation of overhanging skin/fat without extensive dissection or skin excision, muscle tightening, liposuction, or umbilical repositioning. Insurance will only provide coverage for this type of procedure.

Abdominoplasty is a cosmetic surgical procedure that often tightens a loose abdominal wall by sewing the rectus muscles together, repositions the belly button, and removes excess fat and abdominal skin from the middle and lower abdomen. It may include varying degrees of liposuction to thin out or mobilize areas of tissue.

When a patient is approved for an insurance panniculectomy they have the ability to pay a discounted fee for the other elements of an abdominoplasty out of pocket to achieve better aesthetic results.

What can I do to ensure the best outcomes from my Plastic Surgery procedures after massive weight loss?

Be as close to your goal weight as possible. Being at your ideal weight will give you more surgical options, is safer, and will provide a better result.

Maintain a stable weight for three consecutive months. If you are still losing weight it can negatively impact your healing and recovery.

Have a surgery plan with your plastic surgeon. You may need multiple surgeries to achieve your desired result. In fact, for some, your entire body may need to undergo contouring. You should work with your plastic surgeon to decide what order to have your body contouring pr

Ensure your nutrition intake is adequate. Many patients are unable to digest well or do not enjoy eating protein after bariatric surgery. Protein is essential as it helps to reduce blood clots and promote healing. Weight-loss surgery may also alter the body’s absorption of certain fat-soluble vitamins such as vitamin K. It may be necessary for you to take certain dietary supplements to maintain proper nutrition.ocedures, which procedures you should have, and when to have them.

Have realistic expectations. It is difficult to achieve perfect symmetry during body contouring in complex cases. Your age, the extent of loss of skin elasticity, and areas of the body affected are factors that have an impact on the outcome. Be sure to get a clear explanation of what your procedure(s) will entail and be prepared for the possibility of necessary revision surgeries.

Have a good diet and exercise routine. There is no substitute for the healthy lifestyle you need to adopt to maintain your outcome after plastic surgery.