What is Gastric Bypass?

The term gastric bypass is a term for several surgeries performed to induce weight loss. These surgeries have become very popular in recent years. Patients often experience massive and rapid weight loss. Depending on the patient's initial weight, it is not uncommon to see weight loss of 100-200 lbs.

As patients lose this weight they often see that many of their previous health problems become less severe or disappear all together. This includes diabetes, hypertension and osteoarthritis among others. However, as the weight their weight decreases, patients also develop lax and sagging skin. As the fat melts away the skin is often not able to contract sufficiently. This process affects the entire body.

As patients lose their excess weight and feel healthier they often begin to think about addressing the excess and sagging skin. This area of plastic surgery has seen many innovations in the past several years. There are now many highly successful cosmetic procedures available to rejuvenate these areas. I find gastric bypass patients to be highly motivated, excellent patients. The results of these surgeries are often dramatic and can make an enormous difference in patient's appearance and self-confidence.

How long after gastric bypass should patients wait before considering plastic surgery?

I'm asked this question frequently. Some surgeons recommend a certain length of time, such as 18 months. However, I think the answer is different for every patient. Each patient loses weight at a different pace. And, patients have differing amounts of excess weight to begin with. I feel that once a patient has reached a plateau with weight loss and maintained a stable weight for a few months, it's time to consider plastic surgery. For some patients this will come after nine months and for others it may be up to two years.

What are the most common procedures?

The most common is abdominoplasty (tummy tuck) or panniculectomy. Other very common procedures are: belt lipectomy (body lift), breast lift (mastopexy) often with implants, and face or neck lift. Less common procedures include brachioplasty (arm lift) and thigh lift. (Please see individual procedures for specific information.)

Does insurance cover these procedures?

The only procedure that is sometimes covered is panniculectomy (tummy tuck). Patients must have loose skin that hangs over the pubis. Another helpful symptom is intertrigo which is recurrent yeast or bacterial infections in the skin folds of the abdomen. Even patients with these findings are often refused insurance coverage. All other procedures in gastric bypass patients are considered cosmetic and are not covered by insurance.

Many patients are upset and angry when they discover that there is no coverage for these procedures. Unfortunately, plastic surgeons play no role in determining which procedures are covered as these policies are set up by the insurance companies.

How can I find out if insurance will cover my procedure?

First contact your carrier and find out if it's a "covered procedure". If so, you'll need to come in for an appointment. At that time a letter will be submitted asking for a precertification on your surgery. Only if a precertification is obtained will your surgery be done under insurance coverage.

What about other, non-covered, procedures?

At the time of your consultation you will be given a price quote for any procedures that you're interested in.

What is a belt Lipectomy (body lift)?

In this procedure I make a 360 degree incision which extends around the lower back and abdomen. Skin and subcutaneous tissues are removed, muscles are tightened and the skin is closed leaving a circumferential scar. In many ways this is an extended tummy tuck with the posterior incision being used to remove lax skin of the lower back and buttocks.

Why do a body lift?

Patients often have extensive loose skin that extends all the way around the abdomen and trunk. And, they often have significant sagging and flattening of the buttocks. The posterior incision addresses these issues very well. Lax skin is removed, and the buttocks are lifted, tightened and filled out. In many ways a body lift is the ideal operation for addressing the abdomen and buttocks in the gastric bypass patient. A tummy tuck really only treats the front side and neglects the back.

What's an "inverted T" incision?

This describes the incision used for the tummy tuck on many gastric bypass patients. They often have loose skin across not only the lower abdomen, but also the mid and upper abdomen. An additional, vertical incision is used to address this skin excess. It results in a vertical scar which extends from the pubis upward, often to the breastbone. The final scar pattern resembles and upside down letter "T".

How can I know if I need the "inverted T" incision?

The decision is made by the surgeon at the time of the office exam. In my experience, most gastric bypass patients have so much loose skin that they would benefit from the additional incision. The drawback, of course, is the up and down scar which results.

What is the recovery time for a body lift?

It's really very similar to a tummy tuck. The additional incision requires two extra drains. The posterior incision adds about one hour to the surgical time.

How many procedures can I do at one time?

Several factors are considered when deciding how much is too much. These include: your overall health and length and type of procedures. Having said that, it's not uncommon, for example, to combine a body lift with a breast lift and implants. If a patient wants several procedures I often recommend two separate surgeries to avoid an overly long procedure.

Can gastric bypass patients have breast implants and avoid a breast lift?

Almost never. It's the rare patient who does not develop significant breast sagging as she loses weight. If there is significant sagging, a breast lift is mandatory. This can involve an implant as well if the patient desires a size increase.

How do I decide which procedures to do first?

Again, this is an individual decision. I usually recommend that patients first address the thing that bothers them most. For some patients it's their abdomen and for others their breasts or face.

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