So, after the ins and outs of the most basic, and essential recountouring procedure for our weight loss patients, and the differences in Abdominplasty and Panniculectomy, (and the attendant insurance games to be played) now we turn to finish up this topic with a few areas of concern.
These remaining procedures / anatomical locations, are almost always purely cosmetic, and therefore NOT covered by insurance. Of the three - Breasts, Thighs, and Upper Arms- on occasion, Breast work may be covered by a patient's insurance carrier. Let's start there.
Breast recontouring is very often highly desired after massive weight loss. While the abdominal area is almost universally effected by massive weight loss, the breasts (for females) are a close second, and a close second as well in their list of potential body image issues after surgery.
Depending on the degree of weight loss, and on the degree (or lack thereof-) of breast / glandular tissue in an individual patient's breasts, very significant ptosis often occurs with massive weight loss. This often creates a cosmetic concern for a patient, but can also lead to functional issues of intertrigo, rashes, and having challenges with finding a special bra that can fit their new shape and size comfortably.
On the occasion where breast size remains large, and is associated disproportionately with the rest of the upper body habitus, and also in the setting of supportive signs and symptoms of back pain and shoulder divots, I have heard of an occiasional case here and there that may be covered. The procedure performed is usually a bilateral reductive mammoplasty or mastopexy, and/or may involve implants if needed (which may not be covered).
As far as the upper arms (Brachioplasty) and the thighs (Thigh lift), these are somewhat lesser desired, as some but not all patients have significant issues in these anatomical areas post op. Both are always cosmetic cases and not covered by insurance, but may be an individual patient's main concern and they may be willing to pay for it out of their pocket or on a payment plan set up with the Plastic Surgeon.
Both procedures involve taking a triangle of excess skin off along the long axis of the extremity, with the apex situated distally. Patients are often willing to 'trade a scar' for the benefit of "tightening up" of the skin in those areas, but the scarring can be at least moderate at times, yet is confined to the inner portion of the arms and the legs, and fairly easy to conceal. Most are very happy with their results.
Of additional note, for Plastic Surgeons that have an interest in the area of body recontouring after massive weight loss, and most these days do, patients and their surgeons can negotiate to an extent on prices and procedures that aren't covered by insurance, or mix and match procedures to fit the desired services and a patients financial status. The surgeries can be done at one time, or over a couple of procedures, sometimes in an office setting or in the hospital. It pays to have a few Plastic Surgeons in whom you trust their work and their personality / relatability to your patients, to refer your patients to.
I have attached a link to the American Society of Plastic Surgeons for a nice Before and After gallery of recontouring procedures for you to see.
Patients often feel their weight loss mission is well on their way to 'completed' once they lose their weight, keep it off for a year or two, and have some of their 'excess skin' removed to improve their self image. They often feel that by having their body recontouring done, it can put them on a fresh start to their new life mentally and physically.
I do want to say though, taking in to account this Blog post and the previous one as well, most patients do not have recontouring surgery done after weight loss.
Most are not that concerned afterward, or are willing to have some mild to moderate body / skin issues as a trade off for their substantialy improved new health, new abilities, reduced medicines, and toleration of ADL's and beyond.
Those post op patients that do not have surgery easily represents the majority of the patients I see... but for those who have skin and anatomical needs after surgery, there is hope out there, you just need to know where and how to find it!
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