Body contouring plastic surgery after extreme amounts of weight loss must take into consideration the nutritional condition of the patient. Unlike traditional cosmetic surgery where one can assume that the patient can heal satisfactorily, such an assumption can not be safely made in patients who have lost a lot of weight.

This is particularly true in the patient who has lost weight through bariatric surgery. Bariatric surgery alters the way that foods are digested and processed. In the gastric bypass patient in particular, foods that are taken by mouth are not fully absorbed in the intestinal tract, a process known as malabsorption. This malabsorptive process is a major reason that this weight loss operation works. Nutritional deficiencies following this type of bariatric surgery are common from a combination of this malabsorptive process and an intolerance  to certain types of foods that have valuable nutritional ingredients.  The most common nutritional deficiencies from a gastric bypass procedure include vitamin B12, folate, calcium, and iron.

Gastric tightening or a restrictive surgical approach to weight loss include the Lap-Band and vertical banded gastroplasty. These procedures can also have nutritional deficiencies, even though the absorption of nutrients is normal, due to persistent vomiting or a low amount of food intake. Common nutritional deficiencies include folate, thiamine, and potassium. Such nutritional deficiencies may also develop in non-surgical weight loss diets which are very restrictive, especially if the weight loss is quite rapid.

These nutritional deficiencies can usually be prevented through proper supplementation after bariatric surgery. But it usually requires working with a dietitian in a structured program. Even in a bariatric patient who may be years after their surgery, I am still not comfortable with extensive body contouring surgery unless I know the patient is part of a structured nutritional program and is monitored. Periodic laboratory tests and follow-up evaluations are important and a necessary requirement prior to large plastic surgery procedures.

 Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

The treatment of obesity with bariatric surgery is a commonly done and highly effective procedure for generating large amounts of weight loss. (> 100 pounds) This has led to a large population of such weight loss patients seeking body contouring surgery to deal with their hanging skin issues. Many of the body contouring surgery options (e.g., circumferential body lift, breast lifts, arm lifts, thigh lifts) involve large amounts of skin removal with resultant long incisions and a lot of wound surface area to heal.

Such wound healing needs require a patient to have good nutrition to provide all the necessary nutrients to make new tissue and mend the wound edges. Unfortunately, many bariatric patients have chronic nutritional deficiences secondary to their gastric bypass procedure with altered absorptive capabilities. Such poorly nourished patients can be hard to detect prior to surgery unless they are part of an ongoing program of management from their original bariatric center or family physician. Body contouring surgery has a significant incidence of wound problems including minor to more significant wound separations, seromas (fluid collections), and incisional problems secondary to suture reactions. These problems are undoubtably magnified and more severe when the patient’s nutritional status is not ideal.

Because of the nutritional issues during the period of weight loss, bariatric patients should not consider body contouring surgery for at least 12 to 18 months after their gastric bypass procedure. Even when maximal weight loss is achieved, many bariatric patients will have nutritional issues. Most prevalent among them are protein-calorie, vitamin (A, B, C and folate), and mineral (iron and zinc) deficiencies. Ideal daily requirements for good healing after body contouring surgery include protein (70 - 75 grams), vitamin A (25,000 units), vitamin B12 (500 ug), folate (400ug), vitamin C (2 grams), iron (100mg), and zinc. (20mg) A wonderful article on the nutritional needs of the postbariatric patient undergoing body contouring surgery is available in the December 2008 issue of the Journal of Plastic and Reconstructivhe Surgery by Drs. Agha-Mohammadi and Hurwitz which provides in-depth nutritional information.

To achieve this level of supplentation, multivitamins and protein drinks and bars may be adequate in some cases. For many patients, however, this oral approach may not be sufficient. Fot this reason, there are available formulated supplements unique to the needs of the bariatric patient including ProMend (Bariatric Advantage, Irvine, CA) and ProCare Surgical Formula (NutrEssential, Wilmington, CA) These formulas bring to the table the necessary vitamins as well as protein, free amino acids, arginine, and glutamine which are essential building blocks for new tissue formation. ProCare is preferred as it comes in a powder form which is better absorbed in the gastric bypass patient as opposed to pills.

The postbariatric patient is a unique surgical patient because of the magnitude of the procedures and their often compromised nutritional situation. Oral vitamin and protein supplementation should be started one month before most body contouring surgeries and continue for one month after. While this will not eliminate all wound complications, it will decrease the number that occur and the length of time that any wound complications will take to heal.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Elective plastic surgery procedures, such as tummy tucks (abdominoplasty), extensive liposuction, breast reductions, and full facelifts, place great stress on the body in an effort to heal the extensively traumatized tissues. Such operations are prone to ‘wound complications’ such as small open areas and delayed healing as the body is stressed to meet the nutritional needs of the recovering tissues. Many patients are not optimally prepared from a nutritional standpoint for such procedures and may be more prone to such postoperative problems.

 
I like to think of preparing for surgery as an athletic event. Being at a good weight, if possible, in reasonable physical shape, and in good nutritional balance will help improve the surgical outcome, lessen the risks of certain complications, and have a faster physical recovery. Any edge that a patient can gain is fair game when it comes to your own surgical experience. For this reason, I advise my ‘big surgery’ patients to begin nutritional supplements 3 weeks before surgery including high doses of Vitamin C (2 grams per day) and Maxitropin supplements.

 
Maxitropin is targeted nutrition therapy that contains a patented blend of amino acids that function as ‘secretagogues’, which are designed to stimulate growth hormone release and support wound healing through collagen and protein synthesis. Such targeted nutrition therapy can help improve surgical outcomes through enhanced wound healing. One packet (two scoops per day) provides the following:

Glutamine 6g. : Its most important function is to strengthen the immune system and prevent muscle loss.

 
Arginine 1g. : Helps build muscle, enhances fat metabolism and mobility and fights off infection.

 
Lysine 1g. :The human body cannot produce it on its own, and it is critical for the growth and production of hormones, enzymes and antibodies.

 
Glycine 1g.: Essential for the formation of DNA, collagen, phospholipids and the release of energy.

 
Ornithine 1g. : Reduces fat and increases muscle mass, stimulates the immune system and enhances wound healing.

Suggested Use: Dissolve 2 scoops in your favorite juice or beverage 1-2 times daily on an empty stomach for optimal absorption. (half hour before a meal or 1-2 hours after a meal)

Nutritional intervention that increases collagen and protein synthesis, supports immune function, and rebuilds lean body mass is a fundamental part of promoting wound healing.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis