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 bariatric plastic 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 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
Indianapolis, Indiana