Improving Your Body Image With Post-Bariatric Surgery

There is no question that obesity is the largest epidemic of the 21st century. Obesity and its challenges affect the lives of Americans daily. The CDC (Center for Disease Control and Prevention) estimates that more than one-third (35.7%) of the U.S. population's adults are obese. Obesity does not only affect an individual's weight but their entire well-being with obesity-related conditions such as heart disease, stroke, type-2 diabetes and certain types of cancer. This epidemic certainly explains the explosion of the different methods of weight loss support; chief among them, the utilization of bariatric surgery. There are around 220,000 bariatric procedures performed annually in the United States alone. This number has been steady for quite some time with a very high likelihood of increasing in upcoming years as obesity increases as well.The healthcare system has been very successful in implementing psychological support for these patients both pre- and postoperatively. In fact, the success of these programs is not only based on weight loss but also on maintenance of the target weight post-surgery. Maintenance of target weight cannot be achieved without the bariatric team, mainly dietitians, psychologists and supportive paramedical personnel. Unfortunately, little emphasis has been placed on the mental and physical impact of redundant skin due to massive weight loss and bariatric surgery. This fact is not taken into account for the success of any program and, therefore, it is not given its due importance on the follow up of bariatric patients.Bariatric surgery provides advanced weight-loss for patients, reducing the chance of contracting obesity-related diseases though many patients continue to suffer from a poor body image. The massive weight loss creates unsightly deformities in the form of extra skin that can cause impairment on physical mobilization, sexual health and personal hygiene. This should not be underestimated. Some patients have tried to improve those deformities by "filling up" the redundant skin in the form of weight gain, a conduct that defies the original idea of submitting to bariatric surgery. The patients need to know that there is hope for the situation and that plastic surgery can alleviate or substantially improve the undesirable effects after bariatric surgery. We strongly believe in bariatric surgery on morbidly obese patients and also believe that we as plastic surgeons can deliver an important improvement on an individual's ultimate well-being.The most common areas subject to plastic surgery procedures are the abdomen, thighs and buttocks. These areas are very susceptible to treatment with a combination of liposuction and body lifting procedures. When the face and the neck are involved, the surgical corrections follow the same principle of lifting/tightening the skin and subdermal tissues. Mastopexy, or breast lift, is also a very common procedure as patients almost universally complain of ptosis and atrophy of the mammary tissue.We must remember that plastic surgery is defined by achieving harmony between the physical and mental aspects of the patients. After bariatric procedures, in a way, that harmony is lost. There are two ways to correct this: going back to their old self, or adjusting the skin volume to the new body habitus. Plastic Surgery does just that, reshaping the outside to reflect the new inside, additionally, reaffirming the new body image which is, in fact, the new self of the patient. Like in life, "we must achieve the balance... "Of course, expectations need to be defined before embarking on this new journey. At times skin tone is lost and standards change. Both the patient and the surgeon need to believe that a defined procedure will bring the best cosmetic and functional result for the patient. Unrealistic expectations create the perfect recipe for failure but this is not news to the patient. When bariatric surgeons were surveyed about the interaction with patients, 64% declared that patients had many questions about reconstructive procedures even before the actual bariatric surgery. Unfortunately only 7% were referred to a plastic surgeon. This mission has been taken by the bariatric team and we can happily report that they are willing to consider such referral based on the same beliefs that they can improve their patients' lives even further. In the end, most bariatric surgeons also believe that patients submitted to body contouring procedures are more satisfied to have undertaken bariatric surgery in the first place. Some patients blame the lack of interest in plastic surgery due to unawareness of its benefits and how this discipline can improve body deformities.We think that both physicians and the nursing team should be open to discuss issues of self-image and expectations. Shyness and/or unawareness are not healthy emotions to experience after massive weight loss and we have a very good opportunity to modify such behavior. Plastic surgery is the last step in the complete recovery for some patients. Every individual involved, from the patient to the physician, nurses to the plastic surgeon, must be engaged from start to finish leading the patient to the ultimate goal; being happy with their new body image.Each patient is treated on an individualized basis; some require one set of procedures while some require multiple. We can combine liposuction with breast/abdominal procedures and then if the patient desires arms, thigh and face lifts can be discussed for a second stage. The goal of each patient is unique, each has different conditions and they also have their own priorities for their improvement. It is for the plastic surgeon to discover with the patient what those priorities are and to accompany the patient on their journey with the utmost compassion and outstanding medical care.