Bariatric surgery is a procedure indicated to reverse cases of grade 3 obesity. It became known as “stomach reduction” because it changes the organ’s original anatomy and reduces its ability to receive food.

There are some criteria for undergoing surgery. It is recommended for obese individuals with a BMI above 40, and people who have a BMI above 35 with associated diseases such as diabetes, high cholesterol, hypertension, herniated disc, hepatic steatosis, among others.

An unoperated person has space to consume approximately 1 liter to 1.5 liter of food. A post-bariatric stomach has a capacity of 25 ml to 200 ml (equivalent to an American cup).
The surgery also affects the production of the satiety hormone, GLP-1, which reduces the desire to eat, but the reduction in capacity is really the main factor responsible for weight loss.
About 10% of weight is lost in the first month, with a loss ranging from 14% to 72% throughout life.

After major weight loss, such as that which occurs with bariatric surgery, excess skin may appear in some parts of the body, such as the abdomen, arms, legs, breasts and buttocks, which can leave the body with a flaccid appearance and little defined silhouette.

What is post-bariatric reconstructive surgery?

It is plastic surgery performed after the patient has undergone bariatric and metabolic surgery, also known as stomach reduction. Bariatric includes techniques for the treatment of morbid or severe obesity and diseases associated with excess body fat.

For post-bariatric reconstructive surgery, the specialist may indicate more than one procedure, including Lifting the lower part of the body: It corrects the flaccidity of the abdomen, outer thighs, buttocks and groin.

Arm Lifting: Minimizes sagging arms;

Mastopexy with or without prosthesis: Reduces sagging and sagging breasts;

Abdominoplasty: Improves the flaccidity of the abdominal region. Depending on the degree of flaccidity, it can be traditional, anchored or 360 degrees. The plastic surgeon will evaluate the case and determine the best technique for each case.

Abdominoplasty: Improves the flaccidity of the abdominal region. Depending on the degree of flaccidity, it can be traditional, anchored or 360 degrees. The plastic surgeon will evaluate the case and determine the best technique for each case.

Rhytidectomy and eyelid surgery: improves facial flaccidity and eyelid droop, since excessive weight loss causes intense facial flaccidity and a more aged appearance of the face . In addition to the intense loss of collagen that accelerates the aging process of the post-bariatric patient and is an extremely important point to be treated.

Preoperative

Before the procedure, care must be increased due to factors inherent to the condition. These are patients who have greater atherosclerosis theca in vessels, less collagen in the skin, some vitamin deficiencies, anemia, among others:

Undergoing a thorough medical evaluation

Perform extensive laboratory tests

Adjust medications, replacements and supplements

Postoperative

Postoperative care is even more important, as they prevent:

Bleeding; Because they have thicker subcutaneous vessels, these patients are more susceptible to such situations.

Edemas; They are patients with a latent inflammatory state and are more prone to edema naturally.

Necroses; due to atherosclerosis and blockage of peripheral vessels, in addition to greater removal of skin, such patients have an increased chance of skin necrosis.

Infections. In general, the immune system is further weakened by protein deficiency in these patients.

Seroma. Due to the large detachment, the protein deficiency and the smaller amount of collagen in the skin of these patients, seroma conditions are quite frequent and the use of a drain is very necessary.

The patient needs to stay in rest for approximately 1 month, without exerting effort or lifting weight. After this period, he is released to take light walks, drive, work and exercise under supervision.

It is also essential not to expose yourself to the sun for the first few months, as this can darken the scars and form blemishes. Afterwards, the recommendation is to use a sunscreen of 50 SPF, at least, until the marks lighten – which usually occurs around the sixth month.

In which cases is post-bariatric reconstructive surgery indicated?

It is usually performed when the patient achieves the weight loss stipulated by their surgeon or when the weight stabilizes – which can take up to 1 year. In addition, the patient must have a stable weight for at least 4 consecutive months.

Inexceptional cases, when excess skin and fat is impairinglocomotion, it is possible to undergo the procedure before reaching the stipulated weight, these surgeries are called hygienic ..

Generally, the first operated site is the abdomen, followed by:

Breasts;

Arms;

Thighs

Face

This order can vary according to the patient’s need and the ideal is to wait 3 months between post-bariatric restorative surgery and another, in order to give the body time to rest.

The doctor may also recommend performing more than one surgery at a time. These are called associated surgeries, which can be, for example, breasts with abdomen or arms and thighs.

However, it is important that they be done by very experienced surgeons,in order to preserve the patient’s health.

In addition, the Body Mass Index (BMI) of the patient is assessed prior to the indication of procedures. Ideally, he has a BMI below 29. This is because some studies show that this limit is a factor that protects the person against pulmonary embolism and thrombosis.

In addition, patients in this range usually have better aesthetic results than patients operated on with a certain degree of obesity.

What results can the patient expect?

The results vary according to the procedure performed, each one has its peculiarities. However, in general, the changes are immediately visible, as most involve the removal of excess skin.

It may take up to 1 year for the final results to fully appear. This is because you have to wait for the swelling to go down and the body to adjust to the new situation.

Generally, the scars are located in barely visible regions. Depending on the operated area, however, it is possible to appear some points of hypertrophic scars (enlarged), which can be retouched later.

When performed by an experienced professional, post-bariatric reconstructive surgery scars do not represent even 10% of the problem presented (flabbiness and lipodystrophy).

The maintenance of the result, however, depends exclusively on the patient. You must follow medical recommendations with discipline and keep your weight stable and in good shape. Otherwise, there will be weight and fat gain again.

Can you perform this type of procedure?

Only a specialist can determine whether or not a patient can undergo post-bariatric restorative surgery. You need to assess your health status, as well as the way your body responded to bariatric surgery.

Anyway, it is considered a fundamental step for the recovery of self-esteem. That’s because, depending on the amount of weight lost, the person may have excess skin all over the body, impairing their locomotion and making them feel ashamed.

Through the procedures, it is possible to remove the flaccidity, restoring the body contour and firmness. It is necessary to keep in mind, however, that scars may remain more or less apparent, varying according to the operated site and the care adopted in the postoperative period.

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