After massive weight loss, the physical sequelae can be significant, especially in the stomach, breasts, inner thighs, arms, but also knees, relaxed calves or even the face. Some people therefore decide to have cosmetic surgery to repair these problems. But these interventions are not trivial and must be carefully considered. On Europe 1 Friday, Professor Barbara Hersant, plastic and aesthetic surgeon at Henri Mondor hospital, in Créteil, explains in detail what there is to know before, during and after this type of intervention.
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Who is concerned ?
It is not only patients who have lost several tens of pounds who can resort to this type of surgery. "A relaxation can be observed after a loss of ten kilos", notes Barbara Hersant. But of course, "the more you lose, the more serious the consequences", she adds.
It all really depends on the elasticity of the skin. "This is why when you lose weight, you have to perform tonic massages for five minutes, twice a day", insists the surgeon. Sport also helps tone the skin and muscles and reduce sagging skin.
The extent of the physical sequelae after significant weight loss depends mainly on genetics, the speed of weight loss and the age of the patient. "For very young patients, there are not necessarily sequelae. But there are skin sequelae such as stretch marks", explains Barbara Hersant. And after the age of 30, the sequelae are frequent.
Barbara Hersant operates more women than men. This is because for women, in the event of weight loss, "there is often sagging in the stomach and breasts" but also because of pregnancies. "There is an inequality, women are more affected," she says.
When to do it
Depending on the case, the time between losing weight and having plastic surgery varies. "We like the patient to be referred by his nutritionist or digestive surgeon, who will address him" when he is sure that the patient can be operated, explains Barbara Hersant.
"For patients who have had bariatric surgery [which consists of restricting the absorption of food, note], normally they should not gain weight if they have had bypass surgery or a reduction in the stomach . So normally, weight loss is stable. We always wait a minimum of two years before operating patients after bariatric surgery, "says the surgeon.
For people who have lost weight on their own, "there may be weight regain so they commit to not regaining weight after cosmetic surgery," she adds and the time frame is then one year minimum. After pregnancy, you also have to wait a year, especially because, because of breastfeeding, "you have to wait until the breast is no longer inflammatory and stable".
And for those who do not yet know if they want to lose weight again or not, the surgeon asks them "their healthy weight, the weight in which they feel good". In any case, "it is better to lose all the weight before the surgery so as to have the best possible result," she emphasizes. And it always takes two consultations and "a reflection period of 15 days before surgery".
What is an abdominoplasty?
Among the most common procedures, is the abdominoplasty, a tummy tuck. "There may be an abdominal apron, meaning that the skin hangs down and may even cover the genitals or the pubis," explains Barbara Hersant. "It can also be the bed of mycoses. There is a sagging skin which can be important." And the rectus abdominis muscles can also be relaxed and pulled apart. So you can also have a very bloated stomach, ”she says.
For patients who retain a little fat in the hips and poorly localized fat in the navel, the surgeon will remove it "by a liposuction technique". Then then, make "an incision from one hip to the other" and remove the excess skin. “Be careful, a belly lift is aesthetics but there is a permanent scar. It is not trivial,” she warns. Then the excess skin is removed.
In general, it takes two to three days of hospitalization. For a tummy tuck, "it takes a minimum of four hours of operation," says the surgeon. And breast surgery can be done at the same time as tummy surgery.
What are the risks and contraindications?
The intervention is done once the patient's weight is stable and he has stopped smoking. "Tobacco is a risk factor for thrombosis and poor healing, with the risk of skin necrosis," explains Barbara Hersant. The main complication, which is not common but can be serious, is thrombophlebitis, which is a small clot that gets in the veins and can travel to the lungs and cause pulmonary embolism. A greater risk during tummy tuck surgery or thigh surgery.
The patients are therefore "operated with compressive stockings which massage the calves during the operation and there are compulsory injections of anti-coagulants for 15 days", indicates the surgeon. During the operation of the lower limbs, another complication is possible: lymphorrhea. "The lymph can flow because it is an area where there are a lot of lymph nodes and lymph so there can be some discharge which can last a long time."
How much does it cost ?
Some interventions are covered by social security but this is not the case for all. For the tummy tuck, if the abdominal apron covers the pubis or the genitals, there is social security coverage. "The surgeon must then make a prior agreement and the patient is summoned by the medical insurance consultant. It is the latter who decides", explains Barbara Hersant.
Regarding that of the arms or legs, "if we notice that there is a very significant relaxation and that the patient can justify a large loss of weight, we make a prior agreement". Breast surgery is never covered. Parisian prices for these types of surgery are “between 4,000 and 6,000 euros”.