The Informed Patient: Curbing Surgical Risks

Many patients who experience massive weight loss after bariatric surgery will need additional surgery to remove excess skin. The most common body contouring procedures are: tummy tuck, lower circumferential body lift, thigh and buttock lift, back roll removal, breast lift, upper arm lift.

These procedures may require several hours under general anesthesia, and involve a long and painful recovery time. As with any surgery, the healthier you are before surgery, the better the outcome is likely to be.

To reduce risks from body contouring surgery , medical experts recommend the following:

· Ask you bariatric surgeon to refer you to a plastic surgeon or general surgeon before your bariatric procedure so you'll know better what to anticipate.

· Wait until your weight has stabilized to schedule body contouring surgery; this may take up to a year after a gastric bypass. Having surgery too soon may necessitate later surgical revisions if you lose more weight.

· Document (in your medical chart, with photos and a doctor's notes) any medical complications your excess skin has caused you, to increase your odds of insurance coverage.

· Expect to have the procedures done in stages, several weeks to months apart, to permit time for healing.

Questions for your plastic surgeon:

· How many such procedures have you done? (Sarah Holland, a plastic surgery instructor at Columbia University Medical Center in New York, says 20 per year is the minimum considered necessary to establish expertise.) Training counts; the skills involved in operating on patients who've undergone massive weight loss are highly specialized.

· Will you be the only one operating? (A team approach can reduce surgery time -- and related risks.)

· Discuss potential complications -- wound opening, slow healing, wound infections, seromas.

· Discuss the number and location of scars.

-- Ranit Mishori