Body Lift (Belt Lipectomy / Post Bariatric Reconstruction Surgery)

The following information has been prepared to familiarize you with facts about the surgical procedure known as body lift ("belt lipectomy") or reconstruction following bariatric surgery or diet/exercise induced weight loss. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to proceed with this procedure. You are also requested to keep this form as a reference in the postoperative period.

We are in the midst of an obesity epidemic in America, but this problem is not one limited to the industrialized world. The World Health Organization has stated  that world wide, currently, over a billion adults are overweight, and that at least 300 million are grossly obese (more than a hundred pounds overweight). The degree of obesity is commonly assessed by calculating the body mass index, or BMI. A BMI over 25 kg/m2 is defined as overweight and over 30 as obese. In California, 10% of adults were considered obese in 1991, 17% in 1998, and over 23% in 2005. Obesity leads to adverse metabolic effects on blood pressure, cholesterol and insulin resistance (higher incidence of diabetes) as well as non-fatal but debilitating health problems such as musculoskeletal problems, infertility and respiratory difficulties. Over the past decade, increased awareness of this issue has prompted a number of people to loose massive quantities of weight as a result of diet/exercise programs or a variety of advanced surgical procedures (known as bariatric surgery).  

The two most popular bariatric procedures entail some type of gastric bypass, in which the GI tract is rearranged so eaten food bypasses a large portion of the absorptive portion of the stomach, or a “band” procedure in which a band is placed around the upper portion of the stomach, physically decreasing the amount of food a person can eat at one sitting, both of which usually result in weight losses from one to two hundred pounds in those who are morbidly obese.  Allergan, the maker of the Lap Band® that is used to decrease the upper portion of the stomach, has stated that over 350,000 such procedures have already been performed in the United States. Weight loss is accompanied by numerous health benefits, but leaves patients with undesirable quantities of excess skin. This skin excess varies from person to person, but generally involves an excess of facial/neck skin, upper arm and thigh skin, deflated/droopy breasts and massive degrees of excess involving the anterior and posterior trunk.    This hand out will address excess skin in the abdominal and posterior trunk/back areas.

A body lift is an operation in which excess skin and fat from the abdominal wall, particularly below the navel, and posterior trunk/back is removed. This will result in a removal of the hanging abdominal wall skin and a tightening of the skin over the sides, lower back, upper lateral thighs and upper buttocks areas. This is accomplished by first placing the patient in the face down position and resecting the excess posterior trunk/lower back skin. In patients who have been left with a very flat buttocks, some of this tissue from the lower back can be replaced, as a flap, into the buttocks area to enhance that area simultaneously. After returning the patient to a face up position, the abdominal skin is elevated from the anterior muscles, the muscles are tightened as necessary, the excess skin is pulled downward, and the excess skin excised. This procedure is particularly effective in removing vertical skin excess and stretch marks from the lower abdomen, but it must be understood that not all stretch marks can be eliminated, and that significant laxity, particularly noticeable when flexing the hips or when pinching the skin horizontally, will persist. The same navel is reinserted into the skin after the tightening procedure.

Frequently, particularly after childbirth or weight loss, patients present with a weakness of the abdominal wall muscles and fascia; in such cases, the defect between the anterior muscles is repaired (fascial repair) before trimming the excess skin and fat.

This procedure can be combined with other non-abdominal operations such as liposuction, arm lifts, breast uplifts (with or without implants), facelifts or other procedures.   It has been shown that the risks of surgery/anesthesia are infinitesimally small for any length of time up to six hours, but that thereafter, risks of infection, blood clots and other risks begin to rise.   As all of the procedures here mentioned are elective, your surgeon will discuss your desires and formulate a plan based on how much can safely be done in one sitting that does not exceed six hours –patients desiring full correction of their deformities usually return for two or three procedure until their goals are met.

The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all folds and stretch marks.  You must accept the judgment of your plastic surgeon and realize that he/she will remove as much as is safe and suitable. Particularly in patients with thicker abdominal walls or marked skin excess, it may be desirable to return for a secondary liposuction of the abdominal wall or an additional skin excision to obtain an optimal result.   Should this prove desirable, the patient will be responsible for all costs associated with all secondary surgical procedures.

The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient intends pregnancies in the near future.   Should a patient become pregnant after a body lift, a normal pregnancy will ensue but the abdominal wall skin will again get stretched.  While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.  

A common question is, "How long will the results of this procedure last?" This is impossible to state.  Factors affecting the length of the improvement include physical conditioning afterwards, type of skin, and alterations in weight.  In general, it is not necessary to repeat this procedure to maintain the optimal result.  It should be noted that this procedure removes the skin and fatty excess that a patient has at the time of the body lift but does not prevent a patient from gaining weight and stretching the abdominal wall again in the future.  Should a patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, each patient will be responsible for the cost of a subsequent procedure.