Department of Plastic and Reconstructive Surgery

During body contouring procedures, the plastic and reconstructive surgeon reshapes and contours areas of the body where excess skin remains following weight loss after bariatric surgery (gastric bypass surgery and other procedures). If you are considering weight loss surgery and or have already undergone it, you may want to consider meeting with a plastic and reconstructive surgeon to learn about changes that occur in the body following massive weight loss.

You may develop generalized or local areas of excess skin that you may want to consider having reshaped by a surgeon. Your age is probably the most important factor in determining how much excess loose skin you will have following weight loss. Younger patients tend to have less skin. The next most important factor is the amount of the weight loss. An individual who loses 250 pounds is likely to have more excess skin than one who loses 80 pounds. Other less important variables include complexion, amount of sun exposure received over a lifetime, heredity, and whether you smoke. Fair-skinned people tend to develop more loose skin than those with dark skin. Sun worshippers tend to sustain more tissue damage over the years and more loose skin following weight loss. Because smoking breaks down collagen, a major component of skin and other structural parts of the body, smokers develop more loose skin than non-smokers.

Exercise that includes increasing muscle tone can tighten connective tissue between muscles and overlying skin so a regular exercise regimen can help tighten loose skin to some degree. However, if you lose at least 80 pounds you may want to consider a surgical procedure(s) to achieve an aesthetically satisfactory outcome. Body contouring procedures after a large amount of weight loss are usually gratifying for both patient and surgeon. The results are generally dramatic and provide significant functional and aesthetic benefits for the patient.

Patients often want all their body contour concerns addressed as soon as possible. However, providing the highest quality plastic surgery often means having one procedure performed at a time, usually with a waiting time of at least three months between surgeries. While most surgeons will begin with a patient’s preference, breast surgery will need to be delayed until after abdominal wall tightening, which can lift the breasts to some degree.

Body contouring has greatly advanced in the last two decades, and you may want to consider one or more of the following options:

Abdomen, Thigh, or Buttocks Lift
The abdomen is usually of greatest concern following weight loss. In both men and women, excess fat is stored in the abdomen and beneath the skin of the abdominal wall. Following weight loss, there tends to be both excess abdominal wall skin and loose muscles. In addition to the aesthetic concerns, the abdomen often becomes a functional problem. Large amounts of hanging skin along the lower abdomen can lead to the collection of moisture between the skin folds, resulting in a condition called intertriginous dermatitis. The skin becomes irritated, red, and painful. Occasionally, the skin may break down and bleed or even become infected. Non-surgical means of treating this problem include keeping the skin folds dry, which can be frustrating and is only a temporary solution.

With proper documentation, health insurance companies may recognize this problem and provide coverage for the surgical removal of the excess skin, a procedure called panniculectomy. A panniculectomy in the abdominal region is also called an abdominoplasty or tummy tuck. The technique involves tightening the muscles of the abdomen and removing excess skin.

Excess skin after weight loss also involves the thighs and buttocks, leading some surgeons to almost exclusively perform a procedure called a body lift. A body lift includes an abdominal, thigh, and buttocks lift done at the same time. Patients are often exhilarated to learn of a body lift. Although the scar is lengthy, it is confined to the waistline and is hidden by conventional underwear or a bikini.

Breast Augmentation/Breast Lift (Mastopexy)
Breast size and shape often change significantly in both men and women following weight loss. The effects of aging and gravity cause the breasts to sag with time. Massive weight loss greatly accelerates this process. As women age past their 20s and into later years, the glandular portion of the breast is replaced with fat. Glandular tissue is more firm than fat.

Consequently, even without weight loss, women’s breasts become less firm and change shape over time. Women who sustain significant weight loss in their 40s and 50s can experience a marked change in breast size and shape. By this age, a large portion of the breast glandular tissue has been replaced with fat; weight loss will lead to a rapid decrease in the amount of breast tissue. The skin, unable to retract, completely produces sagging breasts, a condition called breast involution.
There are several treatment options for women’s breasts following weight loss:

An implant (augmentation) may help those who have little sag, but desire larger fuller breasts.
A breast lift (mastopexy) may be needed in addition to an implant. For small amounts of sagging, a cirumareolar technique may be used, which involves only an incision around the areola. For moderate sagging, a vertical mastopexy, which involves an incision around the areola and extending from the areola to the base of the breast, may be used. For severe sagging, an anchor-type incision may be necessary. During each of these procedures, a small incision at the base of the breast is also used.
A breast lift without an implant may be satisfactory for those not desiring to be larger and who have an adequate amount of breast tissue.

Men who have lost a significant amount of weight have breast problems similar to women. However, the terminology and treatment are slightly different. When men are obese they tend to have large breasts (a condition called gynecomastia). With weight loss, some fat and glandular tissue remain. Depending on the man’s age, degree of weight loss, and other factors mentioned above, he might end up with large breasts relative to his torso, large and/or sagging breasts, or breasts that appear satisfactory.

Liposuction alone may provide adequate treatment for men with large breasts, but most men will opt for a two-staged procedure that starts with liposuction to remove excess fat and some glandular tissue. Over the next several months, the breast skin will retract to some degree. Three to six months later, the patient is evaluated. The second stage of treatment, a breast lift (mastopexy), may be necessary. The incisions are similar in men as they are in women, except a skin-tightening procedure may be added in the armpit to conceal scars. Because men often have hair on their chests, scars can be well-concealed and better tolerated in the armpit.

Arm Lift (Brachioplasty)
Loose skin and excess fat at the arms can be a source of great stress for you following weight loss. You may feel as if you have to wear long-sleeved shirts at all times. There are three surgical options to improve the appearance of the arms:

Liposuction alone may be successful if you have good skin tone at the arms.
A modified brachioplasty (arm lift) may be performed if the amount of excess skin is mild. The surgeon tightens the excess skin of the arm and armpit in the armpit area, leaving a well-concealed scar. A modified brachioplasty may be combined with liposuction.
A classic brachioplasty is usually the best option if you have large amounts of excess skin at the arms. This procedure involves a scar in the armpit as well as one along the inside of the arm. Most patients will accept the arm scar in exchange for an improved arm contour. A classic brachioplasty may be combined with liposuction.

Face Lift
Massive weight loss can accelerate the appearance of facial aging. With weight loss, the fatty layer beneath the skin thins the same as if it were aging, but at a faster rate. With age and significant weight loss, the laugh lines and other wrinkles on the face become more prominent. An important difference between the effects of the normal aging process and rapid weight loss is the excess skin that develops along the neck. The neck serves as a repository for fat in most obese individuals. With weight loss, some of the neck fat is lost but not all.

Technological advances and a better understanding of the aging process will enable your plastic surgeon to rejuvenate your face and neck without you looking like you were operated upon. Scars are shorter, recovery time is less, and results are improved. Your surgeon will customize each procedure to your needs to achieve a satisfactory result. A face lift, which almost always incorporates a neck lift, treats the deep wrinkles of the face as well as the excess fat and skin of the neck. A face lift usually involves an incision beginning in the scalp above the ear, continuing immediately in front of the ear and extending around and behind the ear and just inside the hairline below the ear. The skin of the face and neck is elevated, and the excess is removed. The superficial muscle layer just under the skin is also tightened.

Before and After Care
Since the Department of Plastic and Reconstructive Surgery is located within a comprehensive medical center, all components of your treatment can take place here for your convenience and safety.

As part of the clinical pathway that directs your entire course of treatment, your surgeon may recommend pre- and/or post-surgical treatment at BEYOND,a day spa, located nearby in theHackensack University Medical Plaza. Or, you may benefit from physical, occupational, or speech therapy at the Physical Medicine and Rehabilitation Department; home care; or other services. Whatever your needs are, you can be conveniently accommodated at the medical center.