Post-Large Weight Loss (Post-Gastroplasty)

Plastic Surgery has as its principle the anatomic and functional restoration of parts of the organism modified by congenital or acquired deformities, as well as the correction of aesthetic (Melega) disharmonies. Bariatric surgery emerged through the evolution of surgical concepts in the specialty of General Surgery, providing a true revolution in the techniques of Plastic Surgery that were adapted for the correction of several dystrophies that can arise with massive weight loss. The magnitude of the complexity and costs involved in treating this type of patient by bariatric surgery per se is not limited to initial surgery. Insofar as it provides a recovery of the health condition through weight loss and food re-education, it is necessary, in the follow-up of these patients, the social recovery of this individual by the re-adaptation of their body relation.

The repair of the body contour will require the use of varied plastic surgery techniques, depending on the type of weight loss that may occur and the locations of lipodystrophic fat that may remain. The weight loss occurs in a gradual way in most cases, being a little faster in the first months due to the immediate postoperative period that goes through the liquid and pasty diet phases, which should be closely monitored by the team so that the malnutrition generated Do not impair healing and even elemental functions. For good skin and muscle recovery, physical activity is indicated after definitive healing (around the 3rd month), which may be provided by hydrogymnastics or low-impact walking, aiming at cardiovascular and joint overload. After 1 year of bariatric surgery, weight stability should be close by, provided that all the guidelines are followed, so it is necessary to schedule the repair treatment.

The most frequent surgeries are:

1. Abdominal Plastic - is the first surgery requested in most cases due to the discomfort caused by the abdomen in the apron, as repetitive dermatoses and even the difficulty to dress and perform intimate hygiene; Classical abdominoplasty (low abdominal horizontal incision) or ankle abdominoplasty (with 2 incisions, one vertical median and one lower abdominal horizontal in inverted T) can be performed. The indication varies according to the case (Open x Closed - Videolaparoscopic surgery, presence of hernias, need for correction of epigastric lipodystrophy, etc). This surgery may be associated, according to the evaluation, with mammoplasty or brachioplasty (Arm Surgery).

2. Breast Plastics - includes reconstruction of the breasts with correction of the mammary ptosis in the most varied degrees, besides the repositioning of the complex nipple (CAM), reduction of remaining volumes with repositioning of glandular flaps and, sometimes, filling of hypotrophic breasts with implants Silicosis allowing the correction of breast volume.

3. Gynecomastia correction - in men there is the possibility of correction of gynecomastia with liposuction associated with removal of the residual gland by infra-areolar or periareolar incision in cases of mild to moderate gynecomastia. But for large gynecomastia only resection of the skin will allow adequate adaptation of the body contour.

4. Lipodystrophy of Arms - should be corrected in cases with much leftover skin ("bat wing"), where the tissue surplus in the medial region of the arm is removed. Being the apparent scar, this indication does not apply ideally for small cases. There are some variants of the technique, but they do not alter the magnitude of this, with respect to the simple execution and with little possibility of complications. Possible variants fit along the chest at the side with possible "S" to join the incision of the breast when necessary some correction of flaccidness in the thorax.Learn More.

5. Thigh lipodystrophy - preferably performed separately for large cases, depending on the position at the table - which facilitates the (gynecological) approach - and the need for tissue adaptation as symmetrical as possible regarding thigh diameter and incision positioning. It can be applied to the inside of the thigh or the lateral-external part. Know more.

6. Liposuction - Associated with other techniques or alone, it has its applicability to cases of localized fat, never as an obesity treatment or weight loss accelerator. Respecting the legal limit of 5% of body weight. Remembering that for better safety, a local vasoconstrictor (adrenaline) may be employed through the infiltration solution, aiming at reducing blood loss during passage of the cannulae.

Any other plastic surgery procedure can be performed, as long as it is appropriate for each case and has its indication, without compromising the safety of the surgical act. Associations of procedures are common in plastic surgery, but should be employed with criteria.

The most frequent associations are: 1. Abdominoplasty in anchor + Mammoplasty
2. Ankle Abdominoplasty + Brachioplasty
3. Abdominoplasty in anchor + Plastic Crural (less frequent)
4. Liposuction + any of the above.

Associations may be used according to the judgment of the surgical team, depending on the clinical conditions and needs of each case, since such associations require a good organic reserve of blood and nutrients, as well as a strict control of the Bleeding during surgery, due to the increased size of cutaneous blood vessels, which are perpetuated to the detriment of weight loss, requiring a longer surgical time for safety of hemostasis control, as well as the use of drains. The need for a perfect integration between the plastic surgeon and the anesthesiologist is imperative for any patient, but especially in these cases, with a view to scheduling repair surgeries that will occur in series with average intervals of 4 months.

The realization of this series is usually based on the success of the first repair procedure.
The complications expected for this type of patient are usually related to the late postoperative period, the appearance of seromas, scarring pain (Patients smokers) and hypertrophic scars. Regarding the immediate postoperative period, the appearance of complications is directly related to preoperative and intraoperative care, so we can expect hematomas, or transoperative blood loss requiring transfusion. It is worth remembering that the hematological profile of these patients is chronic anemia with slow recovery through the digestive tract. Therefore, experience with this group of patients is key to good clinical and surgical management.

Additional information:

• Duration of surgery: 2.5 hours each on average
• Length of stay: 1 to 2 days
• Average recovery time Abdomen: 15 to 20 days Breast: 30 days Members: 30 days
• Elastic bands are used for 2 months
• Breast prostheses may be necessary for breast volume return
• Suction drains are used (removed at the first postoperative visit)

Surgery associations are possible but depend on an individualized assessment, according to the convenience and availability of recovery time, weighing the advantages and disadvantages of such an association.