Casco Bay Surgery

Bariatric Surgery Program
Plastic Surgery After Successful Bariatric Surgery

The information provided is intended to give a general overview of the types of plastic surgery some people might consider after bariatric surgery. It is not a complete reference, so detailed questions should be directed to your plastic surgeon.

Significant weight loss can leave excess skin, which can hang and cause cosmetic and/or medical problems. In the vast majority of cases, the problems are more ‘cosmetic’ in nature than a health problem, that is the skin hangs and either prevents people from wearing the clothes they would like, prevents them from doing some of the activities they would like, or is just felt to be unsightly.  The types of surgery that are available depend on the location of the excess tissue, the type of problem it presents, and the amount of excess skin that is present. The most common location for excess skin, however, is the abdomen.

Abdominoplasty vs. Panniculectomy:  These terms mean different things and are often confused by patients, doctors, insurance companies, and web sites. It is important to know the differences between them and understand that the people you talk to might be using different definitions. In general, excess skin that hangs from the abdominal area is called a pannus or panniculus. 

Panniculectomy  refers to removal of the excess skin associated with a pannus. It does not usually include any reconstruction of the abdominal wall or tightening of the abdominal muscles. It is usually performed for medical necessity, which is when the pannus is causing a medical problem such as an infection. In these circumstances, it is usually covered by insurance. It should not be thought of as cosmetic surgery even though much of the excess skin is removed. It generally takes 1-2 hours and can often be done on an outpatient basis.

Abdominoplasty refers to removal of excess skin in the abdominal area with tightening of muscular structures with the intention of producing a flatter, more cosmetically appealing abdomen. An abdominoplasty is a tummy tuck. There are several varieties of abdominoplasty, and the choice of procedure is made between the patient and his/her plastic surgeon. Abdominoplasties are cosmetic operations and are not covered by most insurance companies. Many people who have had gastric bypass surgery and want excess skin removed are candidates for abdominoplasty but will have to pay the full cost of the operation. Unfortunately, insurance regulations prevent you from receiving insurance payment for a panniculectomy and then paying the difference in order to get an abdominoplasty. An abdominoplasty can take from 2-5 hours or longer, depending on the amount of work that needs to be done. It should be thought of as major surgery, and carries with it the risks and complications of major surgery.

There are other types of plastic surgery that you may want to consider after you have lost weight. Surgery to remove loose skin from arms and thighs, for example, is possible but can be big operations and will almost always be considered cosmetic surgery by insurance companies.

There are other types of plastic surgery that you may want to consider after you have lost weight. The following general principles are useful to remember:

1. Most plastic surgeons perform these operations after you have lost most or all of your excess weight and have reached your new, thinner plateau (usually 12-18 months after your gastric bypass).
2. Most of the operations are not covered by insurance. It is very important to know what kind of surgery is appropriate for you and then find out if it is covered or not.  The plastic surgeon’s office is a good resource and can help you decide what type of procedure is best for you and how to pay for it. Make sure you don’t submit a claim to the insurance company for a procedure that is not covered or is a lesser procedure than you have decided on. This is important because doing so results in many paperwork headaches for you and the plastic surgeon, and can jeopardize the willingness of the plastic surgeons to perform these operations for other Bariatric Program patients in the future.
3. Plastic surgery of this nature often involves a recovery time and will result in permanent scars. Make sure you talk to your plastic surgeon so that you have reasonable expectations.

The Bariatric Surgery Center
12 Andover Road
Portland, Maine 04102
(207)-761-5612
Toll-Free: (866)-268-9274
Fax: (207)-253-6073