Belt Lipectomy Surgery by Jan Stanek at Surgical Aesthetics

Belt lipectomy (also known as lower body lift or 360° abdominoplasty) is an operation to deal with the excess abdominal back and flank skin resulting from major weight loss. People significantly overweight may lose the excess fat, either by diet and exercise or gastric surgery (either banding or bypass), but often find the skin fails to shrink back satisfactorily. Loose, hanging skin folds cause problems with clothing and often hygiene not to mention the discomfort.

Previous abdominal surgery, especially with scars below the tummy button may also be an indication. 

Belt lipectomy is major surgery. In fact, it is of the most challenging and physiologically demanding surgery, so patients scheduled for this operation have to be as fit and well as possible.  In particular they should not be anaemic and have no previous history of deep vein thrombosis or embolism. It goes without saying that smoking is completely banned, both before and after surgery. Because of advances in operative techniques it not usual for patients to require transfusion after surgery, but blood cross-matching is done for safety reasons. Because of the weight loss, patients are often deficient in protein and minerals therefore a comprehensive blood screening is done, and any deficiencies require correction before proceeding to surgery.

Expectations are a fundamental part of all Cosmetic Surgery, but particularly so in post-weight loss body contouring. Remember that the tissues have been stretched way beyond their natural elastic limit so are permanently damaged. The outcome will not be normal looking skin with minimal scars.

The operation is carried out under general anaesthesia and will take several hours.  The surgeon injects quantities of fluid under the skin to reduce bleeding. Then an incision is made firstly in the back, therefore you will be lying prone (face down). After the excess has been removed and the wound stitched up, you will be turned either on each side or flat on your back depending on the distribution of skin excess.  Finally, the abdominal (tummy) skin will be removed, the wound closed, and the navel left attached to the abdominal muscles.  Where abdominal muscles are weak, or if there is a true hernia, a repair is carried out to produce a stronger and flatter abdomen.

Drains are usually left inside the wound to drain any excess blood and fluid and are removed 24 to 48 hours later.  Bed rest is required for the first two days and then the patient is gradually mobilised.  Sutures are removed 7 to 10 days after surgery.  Return to full activity will take six weeks.  Swelling will last for between weeks and months to settle.  Scars take at least one year to mature and fade.

 

Belt Lipectomy: The Risks and Possible Complications

Belt lipectomy is subject to complications like any other surgery and these will be discussed by the surgeon:

  1. Bleeding: this usually occurs shortly after surgery and is one of the reasons why patients are kept in hospital for a minimum of 24 hours. It may necessitate removal of blood collection from under the skin.

  2. Infection: although uncommon, this complication may need treatment with antibiotics and drainage if there is a collection of pus.

  3. Fluid collection: in some cases, fluid can accumulate under the abdominal skin, and will need to be drained on one or several occasions until no further fluid forms. This problem is usually of a self-limiting nature, but with such large areas it is more common in body lift surgery

  4. Poor wound healing: blood supply to the skin may sometimes be compromised because of tightness of wound closure, or because of persistent smoking. This may lead to prolonged healing and an unfavourable scar which may, at a later stage, have to be revised. Concurrent infection may further compromise healing, leading to loss of skin.

  5. Scar: some patients may have a tendency to form thick or even keloid scars and these will require treatment with steroid injections and may even have to be revised at a later stage.

  6. Revision surgery: due to the nature of such extensive surgery, recovery is slower, complications more likely and the need for revision surgery (i.e. surgery to enhance the overall result) significantly higher than simple abdominoplasty.

  7. Expectations: body contouring surgery is often pursued by those what have an idealised view of what it can achieve after the great success of major weight loss. For the reasons mentioned above, belt lipectomy should not be undertaken lightly, but approached with realism and reasonable expectations.

  8. Deep vein thrombosis/embolism: This complication can occur after any surgical procedure but has a higher incidence after procedures such as belt lipectomy. Compression stockings and early mobilization are applied to reduce the likelihood of this complication.

  9. Relapse of laxity: Because skin and tissues had been stretched before weight loss they have poor elasticity. It is not uncommon after belt lipectomy, despite initial tightness, for some laxity to return. It may require some further tightening in the future.

  10. Asymmetry: Asymmetry is normal prior to surgery and every attempt is made to make the result as symmetrical as possible. If asymmetry is significant further surgery may be required to improve it.

  11. Numbness/loss of sensation: Numbness, above and below scars is normal after this surgery and, in time, it will recede. However, some numbness will be permanent.

It is important to consult with a surgeon if you are contemplating belt lipectomy.  Only he or she can advise you whether this operation is going to achieve the result you expect from it and will discuss the pros and cons of surgery.  Only then you are in a position to decide whether you want to go ahead with the surgery.

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