Post

Bariatric
Surgery
dr. Irena Sakura Rini, MARS, SpBP-RE(K)

ICTEC Webinar
18 June 2019
Arya Permana
obesity

BODY MASS INDEX

obesity >30

1 in 5 adults in Indonesia severe obesity >35 + significant comorbid

is obese • DM • OSA
• Hyperlipidemia • GERD
• Hypertension • OA
morbid obesity >40
> candidates for bariatric surgery
 bariatric surgery
Surgical procedures performed on the stomach/intestines
to induce weight loss → Massive Weight Loss (MWL)

GASTRIC BYPASS GASTRIC SLEEVE GASTRIC BAND DUODENAL SWITCH

https://www.levdittliv.se/om-gastric-bypass/gastric-bypass-fragor/
https://drmariocamelo.com/gastric-banding/
https://www.dssurgery.com/weight-loss-surgery/laparoscopic-duodenal-switch/
bariatric surgery

massive skin further post bariatric

weight loss deflation complications surgery
(body contouring)

• arm • intertriginous rashes

• breast • chronic fungal infection
• abdominal • skin breakdown
• buttocks • soft tissue sepsis
• groin • social embarrassment
• thigh
perioperative evaluation

1. Timing of body contouring <12 months

relative to bariatric surgery patient still actively lose weight & in catabolic state
(disturbed wound healing)

2. BMI at presentation <30kg/m2

(multiple procedure considered)

3. Nutritional state Iron deficiency anemia

Low protein intake

4. Medical comorbidities Cardiac disease

5. Psychosocial issues Low self esteem

Body dysmorphic disorder

6. Physical deformities Objective, not subjective based on patient’s concern

planning operative procedure
A. COUNSELING

Important points:

• Body contouring is much more invasive than bariatric surgery & not simple skin tucks

• Accepting scar

• Long recovery

• Wound healing complication (including wound dehiscence & seroma)

planning operative procedure
B. COMBINING & STAGING PROCEDURE

Combining Procedure: operative setting

patient’s medical condition
surgeon’s comfort
choice of procedure

Staging Procedure: minimum 3 months between stages

procedure examples
A. BRACHIOPLASTY (ARM LIFT)

BEFORE

AFTER
procedure examples
B. MASTOPEXY (BREAST LIFT)

BEFORE AFTER
procedure examples
C. ABDOMINOPLASTY (TUMMY TUCK)

BEFORE AFTER
procedure examples
D. THIGH LIFT

BEFORE AFTER
generally favourable combinations

Circumferential Circumferential
Abdominoplasty Abdominoplasty
Lower Body Lift Lower Body Lift
& &
& &
Mastopexy Brachioplasty
Brachioplasty Mastopexy

Transverse
Mastopexy Mastopexy Brachioplasty
Upper Body Lift
& & &
&
Brachioplasty Vertical Thigh Lift Vertical Thigh Lift
Mastopexy
combinations with caution

Circumferential
Circumferential Lower Body Lift Transverse
Lower Body Lift Upper Body Lift
&
& &
Transverse
Vertical Thigh Lift Brachioplasty
Upper Body Lift
post operative management

magnitude wound healing

of recovery problem
references
1. Harbuwono DS, Pramono LA, Yunir E, Subekti I. Obesity and Central Obesity in Indonesia: Evidence from
A National Health Survey. Medical Journal of Indonesia. 2018; 27(2). [Available from:
http://mji.ui.ac.id/journal/index.php/mji/article/view/1512]

2. Rubin JP. Principles of Plastic Surgery after Massive Weight Loss. In: Grabb and Smith’s Plastic Surgery.
7th Ed. Philadelphia: Lippincott Willliams & Wilkins; 2015.

3. Sacks BC and Mattar SG. What Plastic Surgeons Should Know about Bariatric Surgery. Semin Plast Surg.
2006 Feb; 20(1): 9–14. [Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884758/]

4. University of California San Fransisco. Post-Bariatric Body Contouring. 2018. [Available from:
https://plastic.surgery.ucsf.edu/conditions--procedures/post-bariatric-body-contouring.aspx]