Bariatric surgery — a stomach-shrinking operation performed to help overcome obesity — is becoming more popular than ever. But there’s a catch often not understood by those who undergo the procedure: Once they lose the weight the surgery helps them lose, there may be more surgery to come — surgery that is costlier and riskier and that requires a longer recovery time than the original operation.
The reason is leftover excess skin. An obese person who loses weight quickly will lose the fat but not the skin that once enveloped the fat. The arms, thighs, abdomen, breasts, all lose texture and sag. The “solution” is a new surgery to remove the extra skin, which is a set of procedures known as body contouring.
Body contouring operations are often longer and more complex than bariatric surgery, involving potentially more blood loss and shifts of fluids, and a painful healing period that can extend over weeks or months. Like all major surgery, it also carries risks of infection and problems with anesthesia.
“It’s a radical procedure,” warns Baez, who had her contouring work done last August. “It was much more invasive than my initial surgery.”
“It’s as if a very, very large person all of a sudden had all the air let out, as if [he] were a doll,” says Richard A. D’Amico, chief of the Department of Plastic Surgery at Englewood Hospital and Medical Center in Englewood, N.J.
According to an article in the Washington Post, as bariatric surgery has grown more common (some 144,000 such procedures were performed in the United States in 2004, more than double the number in 2002), D’Amico says, patients seeking body contouring have “started to show up in plastic surgeons’ offices in large numbers.” Last year more than 68,000 patients underwent body contouring after bariatric surgery, 77 percent more than five years ago, according to the American Society of Plastic Surgeons.
Barbara Baez of Fort Worth was part of that increase. Within a year of having weight loss surgery in 2003, she lost about 150 pounds; her blood pressure dropped to normal levels and the swelling in her legs decreased. She felt healthier and began exercising more. Friends told her she looked great. But, she says, “nobody saw what was underneath.”
Many patients get chronic infections from skin rubbing against skin, and develop open wounds in the folds of flesh.
From the skin rubbing together against her thighs, she developed bacterial and fungal infections. “I would have bandages on me all the time. It was very painful. Just walking was painful. I had hygiene problems.” Eventually, Baez says, “I realized that I would need to have the skin removed.”
Her doctors never warned her this might be necessary, she says. That’s not uncommon, says D’Amico. There are no guidelines requiring bariatric surgeons to warn their patients, although recently professional societies of plastic surgeons and bariatric surgeons have begun holding seminars to discuss the idea.
The cost of contouring can run into the tens of thousands of dollars, depending on how many procedures are needed. Most insurers pay for bariatric surgery, but they often consider contouring to be cosmetic, rather than medically necessary, and thus not covered under their policies.