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Post-bariatric surgery - Weight loss treatments

Information in spanish

What is the post-bariatric surgery? - Medical management of patients after bariatric surgery

Significant weight loss may result in the presence of redundant skin. After weight loss, the skin often fails to tighten and then sagging and hanging skin may appear. The post-bariatric surgery considers the entire body and involves different procedures to remove the redundant skin especially in the arms, stomach, thighs, breasts, and buttocks.

Preoperative evaluation - Post-bariatric surgery

What is the preoperative evaluation of the post-bariatric patient?

The post-bariatric surgery patient must be carefully assessed. The patient who has had a significant weight loss is completely different to any other patient. The preoperative evaluation may include:

Degree of hanging skin.
Degree of skin laxity.
Evaluation of the potential incisions.
Use of liposuction.

A thorough preoperative health history and physical examination will be performed. Some laboratory tests are required. Any previous condition must be treated by the specialist, who authorizes the surgery. The following aspects are taking into account before surgery:

Anesthesia protocol for the post-bariatric surgery patient.
Procedures to be performed during the post-bariatric surgery.
Surgical equipment.
Possibility of blood transfusion.
Pain management.
Duration of the procedure.
Post-operatory protocol.

Pre and post-operative photos of the patient are taken.


Bariatric surgery

The bariatric surgery is the surgical treatment which combines restrictive and malabsorption methods to help obese patient to lose weight.

The expression bariatric comes from bariatrics which is the branch of
medicine that deals with the causes, prevention, and treatment of obesity. There are different surgical procedures aimed to achieve massive weight
loss and maintain weight.

The gastric band, the biliopancreatic diversion, and the gastric bypass surgery are methods to help the obese patient. Dr. Nieto works with an experienced team of bariatric surgeons to give the most complete
treatment to the obese patient.

Dr. Nieto does not perform the bariatric surgery as this procedure does not belong to the plastic surgery and reconstructive specialty. Dr. Nieto does perform the surgical procedures
to treat the redundant skin after the bariatric surgery.


Post - Bariatric surgery preparation


It is considered you are in surgery from the moment you arrive to the surgical area until you have sufficiently recovered from anesthesia. Before surgery, your surgeon, anesthesiologist and the nursing staff will meet you in the pre-operative area, to discuss your medical condition and answer your questions.

The anesthesia

What kind of anesthesia is used during the post-bariatric surgery? Since this is a major and complex surgery, it should be performed under general anesthesia with intravenous induction and inhalation anesthesia. You will sleep through the entire operation, feeling no pain and remaining absolutely relaxed. The section about Anesthesia provides complete information on this medical practice along with recommendations and instructions.

How long does breast reconstruction surgery take?

Post-bariatric surgery usually involves different procedures which are performed at the same time by a complete surgical team. This combination of procedures may take 5-8 hours to complete. However, this time may vary according to the patient´s needs.

Hospitalization
Will I require hospitalization?
Since post-bariatric surgery is a very complex procedure, you will need to be hospitalized. You will be carefully monitored during and after the procedure. Your stay at the hospital will depend on the complexity of the procedure and your health condition after surgery.

Surgical technique

The post-bariatric surgery involves a variety of procedures commonly performed according to the condition of the patient. Although there is no single correct operative technique in body contouring, there are certain factors about this complex procedure, you must understand before considering post-bariatric surgery. Marking should begin with the patient slightly flexed at the waist, which helps the surgeon determine the quantity of skin to be removed. The preoperative marking is critical step in the planning of the surgery, which allows surgeon to observe the position of the incisions lines, in order to prevent that one procedure may affect the other. Once the surgeon has identified the surgical area, a treatment can be established.

Most patients accept scars as an unwanted but necessary event, and usually they are pleased with a positive aesthetic outcome and less concerned about scars. The surgeon will be careful to place the incision in the most convenient situation, avoiding retraction for adequate wound healing.

Some patients with excess fat may benefit from liposuction, while in other cases liposuction should be the only treatment required to achieve the desired outcome. For some patients, besides liposuction, skin removal should be necessary.

Post-bariatric surgery is aimed to achieve the following goals:

Flattening the abdomen.
Recreating the umbilicus.
Elevating the mons.
Creating a waist in female patients or reducing laxity in male patients.
Liposucción en espalda.
Excision of redundant skin.
Liposuction on the back.
Defining the buttocks.
Defining the thighs.

Post-bariatric surgery involves the following procedures:


1.Belt Lipectomy
It is called belt lipectomy because the incisions encircle the body like a belt. This procedure involves abdomen, hips (flanks), and lower back. The surgery is aimed to remove the redundant skin and fat tissue, and to reposition the tissues to create a more pleasing body contour.
2.Upper body lift
This is a surgical procedure design to remove excess skin and fat, as well as reposition the tissues of the thoracic area. The procedure includes inframammary folds, lateral area of the breasts and back.
3.Arm lift surgery
Also called brachioplasty is a surgical technique which improves the skin appearance of the upper arm. Excess skin is removed and the surrounding tissue repositioned.
4.Thigh lift surgery
This procedure is usually performed to treat the sagging skin in thighs, in those massive weight loss patients.
5.Mastopexy
Mastopexy, also called breast lift surgery, is the procedure design to raise and firm the saggy breasts. Breast lift may involve the use of breast implants or autologous tissue.
6.Abdominal lipectomy
The abdominal lipectomy seeks to reduce the excess skin and fatty tissue in the abdomen.


Postoperative Care - What can I expect after surgery?

1. Your surgeon may prescribe steroid and diuretic medications. Steroid medication may diminish some postoperative side-effects such as swelling, pain, nausea and vomit. However, in those patients with complications related to the bypass treatment, stomach ulcer, the use of these medications should be considered according to their health condition.

2. Your surgeon will recommend the use of compressive bandages which will help you to reduce swelling, (liposuction) and to promote wound healing. Your physician will indicate the adequate compressive garment according to your treatment.

Postoperative care

Part of the success of surgery depends on the postoperative care. It is very important to follow the surgeon´s recommendations to achieve the desired outcome. Dr. Nieto closely observes her patient´s convalescence and healing. Please do not hesitate to contact her if you have questions or concerns. Written instructions will be given for your postoperative care to you and your family.

What care should be taken after the post-bariatric surgery?


  • You will receive very precise instructions. Make sure both you and the person who is taking care of you have understood all the medical indications.

  • Drainage tubes will be removed usually within the following 3-4 days.

  • Dr. Nieto will give you specific instructions regarding bath and wound care.

  • Do not smoke or drink alcoholic beverages, as these activities interfere with healing process.

  • Your surgeon may recommend massage or ultrasound therapy.

  • Patient must return to the office for general check up as indicated by the physician.

  • Every patient´s healing process is different and the time and way tissues may respond to injury may vary. Usually our patients need 1-3 weeks to recover before resuming their normal activities.

  • You may experience a sensation of tension around the area but this will gradually decrease after surgery.

  • Antibiotics are prescribed to reduce the risk of infection. Also, you will receive pain medication to minimize any discomfort

  • Inform immediately to your physician if you develop an unexpected reaction to the prescribed medication.

  • Prior to surgery, you must make arrangements for a responsible adult friend or family member to take you home and take care of you during your convalescence.

  • Avoid taking any medication that has not been prescribed by your doctor, especially aspirin (acetyl salicylic acid) or aspirin-like products (Ibuprofen, Advil, Motrin or Aleve).

  • These medicines have anticoagulant adverse effects and may increase the risk of bleeding or scarring complications.

  • You should expect some bruising and swelling as a natural effect of surgery.

  • You should avoid any strenuous movement or exercise.

  • Lifting heavy things, animals or children may affect the area of surgery. You must avoid any activity that increases risk of hitting.

  • Exercise can be resumed 3 months after surgery.

  • Please inform Dr. Nieto if you present heavy bleeding from the wound, severe pain or chest pressure, high fever (more than 38 degrees), significant redness or severe discomfort.



Risks and potential complications

What kind of risks and complication may occur in the post-bariatric surgery?

A serious and skilled surgeon will take meticulous measurements before surgery to avoid all possible complications. However, every surgery involves a certain amount of risk. It is important that you understand the risks involved in your particular procedure. See our section about RISK FACTORS IN PLASTIC SURGERY for complete information.

Some preoperative measurements may help reduce risks:

* The preoperative surgical planning allows the medical team to establish the corresponding action of every member of the team for each surgical procedure, reducing the intraoperative time.

As many as 50% of massive weight loss patients can be anemic. Anemia should be identified and treated preoperatively. Excision of large sections of skin may lead to massive blood loss. For this reason, blood transfusion can be required.

The obese patient faces more complications during surgery. For this reason, Dra. Nieto usually develops a series of measurements to prevent venous thromboembolism. Each patient receives the appropriate method of prophylaxis before, during and after the procedure, and also adequate position and early deambulation. Dr. Nieto routinely uses elastic and pneumatic compression devices for her patients, as well as anticoagulant medications to prevent venous thromboembolism.

Dra. Nieto´s antiembolic prophylaxis includes:

  • Use of compression stockings during and after surgery.

  • Clexane 20 mg the night of the surgery.

  • Clexane 20 mg first day after surgery.

  • Use of a pneumatic compression device during and right after surgery.

  • 1.Patient early deambulation.


As a consequence of the procedures, the post-bariatric patient may present different wounds. Wound dehiscence, or the spontaneous opening of the wound, may occur as a consequence of inappropriate movements or fluid accumulation. Usually, drainage tubes are placed to allow fluids to release. As this is a major and complex surgery, you will need careful medical observation during the first days after the procedure.

Faqs post-bariatric surgery

What is the post-bariatric surgery?

Significant weight loss may result in the presence of redundant skin. After weight loss, the skin often fails to tighten and then sagging and hanging skin may appear. The post-bariatric surgery considers the entire body and involves different procedures to remove the redundant skin especially in the arms, stomach, thighs, breasts, and buttocks.

What is the preoperative evaluation of the post-bariatric patient?

The post-bariatric surgery patient must be carefully assessed. The patient who has had a significant weight loss is completely different to any other patient. The preoperative evaluation may include... More

What kind of anesthesia is used during the post-bariatric surgery?

Since this is a major and complex surgery, it should be performed under general anesthesia with intravenous induction and inhalation anesthesia. You will sleep through the entire operation, feeling no pain and remaining absolutely relaxed.

The section about Anesthesia provides complete information on this medical practice along with recommendations and instructions.

How long does breast reconstruction surgery take?

Post-bariatric surgery usually involves different procedures which are performed at the same time by a complete surgical team. This combination of procedures may take 5-8 hours to complete. However, this time may vary according to the patient´s needs.


Will I require hospitalization?

Since post-bariatric surgery is a very complex procedure, you will need to be hospitalized. You will be carefully monitored during and after the procedure. Your stay at the hospital will depend on the complexity of the procedure and your health condition after surgery.

What kind of risks and complication may occur in the post-bariatric surgery?

A serious and skilled surgeon will take meticulous measurements before surgery to avoid all possible complications. However, every surgery involves a certain amount of risk. It is important that you understand the risks involved in your particular procedure. See our section about RISK FACTORS IN PLASTIC SURGERY for complete information.


What can I expect after surgery?

1. Your surgeon may prescribe steroid and diuretic medications. Steroid medication may diminish some postoperative side-effects such as swelling, pain, nausea and vomit. However, in those patients with complications related to the bypass treatment, stomach ulcer, the use of these medications should be considered according to their health condition.

2. Your surgeon will recommend the use of compressive bandages which will help you to reduce swelling, (liposuction) and to promote wound healing. Your physician will indicate the adequate compressive garment according to your treatment.


What care should be taken after the post-bariatric surgery?


  • You will receive very precise instructions. Make sure both you and the person who is taking care of you have understood all the medical indications.

  • Drainage tubes will be removed usually within the following 3-4 days.

  • Dr. Nieto will give you specific instructions regarding bath and wound care.

  • Do not smoke or drink alcoholic beverages, as these activities interfere with healing process.