Post-Bariatric Surgery/ Body Contouring Plastic Surgeon Wollongong & Sydney

Some patients develop loose skin across the upper back, bra-line region and sides of the chest.

An upper body lift may be considered when these areas form connected folds that cannot be addressed through surgery limited to the abdomen.

A corset abdominoplasty may be considered in selected patients with loose tissue extending across the upper back, as well as vertical skin excess through the abdomen.

These procedures create extensive permanent scars and generally form part of a staged body-contouring plan.

Brachioplasty, commonly called arm lift surgery, removes selected excess skin and tissue from the upper arms.

When the loose tissue is limited to the arm, a standard brachioplasty may be considered. When it extends through the armpit and onto the side of the chest, an extended procedure may be required.

The scar may extend from the armpit towards the elbow and, in more extensive surgery, onto the lateral chest.

Body contouring may be considered when weight has stabilized, and loose skin causes physical symptoms or remains a concern despite exercise and weight maintenance. Suitability is assessed individually and may depend on:

• The amount and location of excess skin
• How long the current weight has been stable
• Overall health and fitness for a lengthy operation
• Nutrition and any deficiencies following bariatric surgery
• Smoking, vaping, or nicotine use
• Previous abdominal or bariatric operations
• The recovery time and support available at home

Further weight loss, pregnancy, or significant weight fluctuation can change the result, so surgery timing is an important part of planning.

Post-bariatric patients may have iron, vitamin B12, folate, vitamin D, protein or other nutritional deficiencies, even when they feel well. These can affect energy levels, wound healing and recovery. Recent blood tests and review by the patient’s GP, bariatric team or dietitian may be recommended before surgery.

Weight should generally be stable before body contouring. No single timeframe suits everyone; timing depends on the bariatric procedure, weight-loss pattern, current nutrition, and whether further weight loss is expected.

Weight loss can reduce breast volume and support, leaving loose skin, changes in breast shape, and a lower nipple position.

Depending on the patient’s anatomy and concerns, treatment may involve:

• Breast lift
• Breast reduction
• Breast augmentation
• Breast lift with implants
• Fat grafting in selected circumstances

The appropriate procedure depends on whether the main concern is loose skin, breast position, heaviness, reduced volume, or a combination of these features.

Breast procedures may be part of a staged post-weight-loss plan rather than performed during the same operation as extensive abdominal or body lift surgery.

Patients should generally be at or close to their goal weight and have maintained a stable weight for at least six months before post-weight-loss body-contouring surgery.

After bariatric surgery, body-contouring procedures are commonly considered 12 to 18 months later, once the main period of rapid weight loss has ended.

These timeframes are a general guide. Readiness for surgery also depends on:

• General health and fitness for surgery
• Nutritional status
• Whether further weight loss is planned
• The type of bariatric procedure performed
• Current weight-management treatment
• Smoking, vaping, or other nicotine exposure
• Mobility and other medical conditions
• The operation being considered
• Available support during recovery

Further weight loss, significant weight gain, or pregnancy can alter the surgical result. Surgery may be delayed if weight continues to change.

Loose skin may affect several body regions after significant weight loss. It is not always appropriate or safe to treat every area during one operation.

Combining multiple extensive procedures can result in:

• Longer anesthetic and operating times
• Larger surgical wounds
• Greater blood and fluid shifts
• More difficult mobility and positioning
• Increased wound-care requirements
• A more demanding recovery

Staged surgery treats the areas of greatest concern first and gives the body time to recover before another operation.

The sequence depends on the patient’s health, tissue distribution, priorities and available support.

A staged plan involves more than one operation and recovery period. Dr Barker will discuss the advantages and limitations of staging during consultation.

Removing significant amounts of loose skin requires permanent scars.

Depending on the procedure, scars may extend:

• Across the lower abdomen
• Vertically through the abdomen
• Around part or all of the torso
• Across the upper back
• Along the upper arms
• Through the armpits or lateral chest
• Within the groin crease
• Down the inner thighs
• Around or beneath the breasts

Scars are planned according to the tissue being removed and, where possible, clothing preferences. However, they cannot always be completely concealed.

Scars generally change and soften over time, but their final position, width, color, and appearance vary.

Bariatric surgery can affect the absorption and intake of important nutrients.

Patients may have low levels of:

• Iron
• Vitamin B12
• Folate
• Vitamin D
• Protein
• Other vitamins or minerals

Nutritional deficiencies can affect energy levels, immune function, wound healing and recovery, even when the patient otherwise feels well.

Dr Barker may request recent blood tests and information from the patient’s general practitioner, bariatric surgeon or dietitian.

Identified deficiencies may need to be treated before surgery proceeds. More extensive body-contouring procedures may be postponed until nutritional health is considered adequate for healing.