Skin Redundancy after Massive Weight Loss

A 30-year-old man presented at our plastic-surgery clinic to request body contouring after massive weight loss (Panels A and B; inset shows patient before weight loss). Two years earlier, the patient had undergone an open gastric bypass for morbid obesity, and he subsequently lost 418 lb (190 kg) (from 647 to 229 lb [294 to 104 kg]) and had a decrease in waist size from 84 to 48 in. Although the procedure cured his hypertension, he had recurrent rashes and skin breakdown of the residual abdominal pannus. In addition, he continued to have difficulty ambulating and could not urinate while standing or have sexual intercourse. These symptoms were cured by body-contouring surgery (Panels C and D), after which he weighed 204 lb (93 kg) and had a waist size of 38 in.

The rising prevalence of gastric-bypass procedures for morbid obesity has created a rapidly growing area of plastic surgery for body contouring after massive weight loss. After gastric-bypass surgery, patients commonly have rashes, skin breakdown, and psychological complications because of skin redundancy. Consequently, these patients often consult a plastic surgeon about undergoing abdominoplasty, mastopexy, brachioplasty, or thigh lifts to improve their functional problems as well as their appearance.