Seven B’s of Body Contouring Surgery

As a specialist plastic surgeon for almost 20 years, a large part of my practice has been dedicated to looking after those individuals that have undergone massive weight loss.

The surgical procedures required to address the issues following massive weight loss are highly variable and need to be precisely tailored to deal with each individuals unique requirements.

Excess Skin Issues After Massive Weight Loss

People who are carrying an excessive amount of weight may choose to lose that weight, either through diet and exercise, or via medical or surgical assistance – such as lap band, gastric sleeve and gastric bypass surgery.

No matter what method of weight loss is employed, individuals who have lost a massive amount of weight experience the same issue – their bodies become smaller, but their skin does not. The skin has a limited amount of ability to contract, or ‘shrink wrap’ around a smaller body. Therefore, the skin starts to hang from the body. The greater the weight loss, the greater the amount of excess skin.

This excess skin is both a significant physical and psychological burden on the patient. Amongst many other issues, the excess skin and skin folds often poses serious skin hygiene issues, along with clothing, physical mobility and social issues.

Surgery to address these problems is essentially total body reconstruction – and in doing so tailoring the skin to fit the now smaller healthier body.

Surgical Procedures After Weight Loss

Over the years I have continued to refine, define and develop my techniques to deal with the many varied and often complex patients that require my professional expertise.

Skin and tissues are not rigid – they swell, stretch, shrink and sag. Additionally, the body beneath the skin also changes, which is especially true during the first few months after surgery. Therefore, as a surgeon, I need to reconstruct and reshape things that are 3D, and not static. I also need to ensure that he does not make things too tight because that can result in serious problems with wound healing and breaking down.

In order to manage and put together an appropriate treatment plan for these patients, I have developed a system which groups together the key surgical procedures that are frequently required after massive weight loss.

I have defined these as The Seven B’s of Body Contouring Surgery. After massive weight loss every part of the body is affected. However, if we start from the top and work our way down, the Seven B’s are:

Brachioplasty (Arm Reduction)

Brachioplasty, commonly known as an Arm Lift surgery, is designed to remove extra skin and fat from the upper arms. This is a common request following weight loss, as the arms are often the only thing patients can’t hide and want addressed.

BREASTS – Lifts, Reductions & Augmentations

The type of breast surgery required after massive weight loss is entirely dependent on the state of the breasts and what the patient desires.

Breast Lift (Mastopexy) – is designed to lift and reshape the breasts, and this can be performed with or without the use of an implant.

Breast Reduction – a breast that is too heavy (and typically too low after weight loss), can be lifted, reduced and reshaped.

Breast Augmentations – sometimes after significant weight loss the breast can reduce in size (become deflated) without any significant droop (ptosis). In this scenario the patient may simply want additional volume via the use of an implant to enhance the breasts size and shape.

Belly – Abdominoplasty (Tummy Tuck)

Abdominoplasty is perhaps the greatest area of concern following significant weight loss. The surgery in this region is effectively an abdominal wall reconstruction designed to address several issues:

• Excess skin folds
• Rectus Divarication – muscle separation and damage
• Ptotic (droopy) mons region
• Possible abdominal wall hernias

The type of abdominoplasty procedure will be determined by the degree of problems that need to be addressed.

• Standard Tummy Tuck (Abdominoplasty)
• Extended Tummy Tuck (Abdominoplasty)
• Fleur De Lis Tummy Tuck (Abdominoplasty)
• OPEN BOOK TUMMY TUCK™ (Abdominoplasty)

Bra Lipectomy (Upper Body Lift)

An Upper Body Lift or Bra Lipectomy is an operation performed to address excess skin rolls and associated fat, in the upper and middle part of the back around the bra strap area.

A Bra Lipectomy scar pattern varies depending on the severity of the excess skin. However, the scar pattern typically extends from the back, through to the front of the chest wall, under the bust area.

Belt Lipectomy (Lower Body Lift, 360 Tummy Tuck)

A Belt Lipectomy, often called a Lower Body Lift, A Belt Lipectomy is an operation designed to remove rolls of excess skin and the associated fat in the lower back, flanks, upper outer thighs and abdominal region. It also lifts the buttock and pubic regions. A Belt Lipectomy combines two operations: a Buttock Lift and a Tummy Tuck (Abdominoplasty), which results in one continuous circumferential scar contained within the belt line.

Buttock Surgery

A Buttock Lift (Lipectomy) describes a surgical procedure that involves the removal of excess skin from the lower back, lifting and tightening the buttocks. If combined with an Abdominoplasty (aka Tummy Tuck) then the operation with the resultant circumferential scar is often referred to as a Belt Lipectomy.

Below The Waistline Surgery – Genital & Thigh Surgery

After your formal consultation, and assuming you are suitable for surgery, I will put together a precise surgical plan incorporating one or more of the Seven B’s to give you the best chance of achieving your desired outcome.

Combining Surgical Procedures After Weight Loss

Depending on the patients concerns, you can sometimes combine two or more of these Seven B’s . These decisions can only be made after a formal consultation and determining an individual’s suitability for surgery.

Some common combinations include:

• Breast Surgery with Belly Surgery (Abdominoplasty/Tummy Tuck)
• Brachioplasty (Arm Reduction) with Breast Surgery
• Belly Surgery (Abdominoplasty/Tummy Tuck) with Buttock Surgery
• Bra Lipectomy with an Open Book Tummy Tuck (Abdominoplasty)

For many patients that have lost a significant amount of what, they will often have to undergo surgeries in a staged manner over a period. Ultimately, we begin with the areas that most concern the patient and then continue in stages depending on the degree of concern and other considerations, such as lifestyle, financial and health constraints. The minimum time between each surgery is three months.

Potential Risks Of Plastic Surgery After Weight Loss

No surgical procedure is risk free, and understanding the possible complications is essential so that you can consider the benefits and risks before you undergo treatment.

For massive weight loss individuals, the skin and tissue quality are often poor, which increases the potential for complications to arise, such as poor wound healing and infection. This leads to a higher risk of wounds breaking down with skin and tissue loss. Therefore, there is an increased risk of further surgery being required in the postoperative stage to address these issues.

All surgeries carry general potential risks, and surgery specific potential risks.

The general potential complications for surgery can be found here – LEARN MORE

The specific potential complications can be found on our website on the relevant page for the procedure/s you’re considering.

Importance Of Selecting A Qualified Surgeon

Choosing a qualified and experienced plastic surgeon is crucial when considering surgery after major weight loss. A specialist, familiar with procedures like tummy tucks, arm lifts, bra lipectomies and breast lifts, ensures you have the best chance of an excellent outcome. Their expertise in dealing with excess and redundant skin following massive weight loss is vital for both safety, functional and aesthetic outcomes.

Dr Dona has spent his lifetime honing his craft and a large part of his private practice is dedicated to looking after patients after massive weight loss.

He values the unique honour of being a Plastic Surgeon, recognising the privilege it brings in assisting others. This appreciation, coupled with his understanding of the potential of what Plastic Surgery can do, guides the care he provides to all his patients. As a meticulous practitioner, Dr Dona consistently refines his surgical skills, maintaining a steadfast commitment to delivering excellence in Plastic Surgery.