New Orleans — Massive weight loss patients endure surgery on 40 percent of their body when they undergo a lower body lift procedure called the belt lipectomy.
The majority of the belt lipectomy patients are those who have lost 100 to 200 pounds. This is extensive surgery, says Al S. Aly, M.D., previously associate professor, plastic and reconstructive surgery at the University of Iowa Medical Center and currently in private practice in the Iowa City, Iowa area. "We tell patients that this is a major life event that will take all of their physical and mental strength to recover from," he says.
Dr. Aly and his partner, Albert Cram, M.D., pioneered the belt lipectomy at the University of Iowa. Dr. Aly estimates that he and his colleague have performed the largest series of belt lipectomy-type surgeries in the country. Irregularities among these patients that can be corrected with the belt lipectomy include removal of anterior abdominal fat and skin excess, tightening of the abdominal wall and lifting of the mons pubis. Removal of back rolls, tightening of the outer thigh, creation of a distinct point between the lower back and the buttocks and lifting of the buttocks is accomplished via this procedure, as well.The procedure
"We remove a wedge of tissue around the entire front and back of the lower trunk to treat excess from just beneath the breast bone to just above the pelvic region, and we tighten up the lax skin on the inner balloon or abdominal wall," Dr. Aly says. "Although a few of these patients will still have excellent skin elasticity and may benefit from an abdominoplasty with extensive liposuction of the trunk, the majority of them need circumferential dermatolipectomy to correct the full range of the deformities," he adds
The amount of redundant skin that is removed varies greatly from patient to patient, according to Dr. Aly, who addressed the topic recently at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) here.
"The problem is that when we talk about massive weight loss patients we tend to clump them all in one group when, in truth, they are quite variable in their presentation," Dr. Aly says.
About the only certain commonality, he points out, is that more excess skin will be removed from the front than the back in essentially all patients.
BMI and risk
Seromas are the most common risk, resulting in approximately 15 percent to 30 percent of cases universally, with Dr. Aly's cases erring toward the higher end of the risk spectrum.
"The higher the patient's body mass index (BMI), the higher the complication rate, and we perform this procedure on some of the highest risk cases out there," he says. "Patients with a BMI of 35 or above have a 100 percent chance of a seroma. Every single patient with a BMI over 35 that we've operated on has had one," he points out. Just the opposite is true in patients whose BMI is in the 25 to 27 range. "Our seroma incidence is much lower in that group," Dr. Aly adds.
Patients do not use support garments postoperatively.
"When we lift the skin up and stretch it, we reduce the blood supply anteriorly by as much as 50 percent. The additional support garments postoperatively could further compromise the blood supply and cause tissue necrosis," Dr. Aly explains.
Other patients, procedures
A significant portion of Dr. Aly's belt lipectomy patients are candidates for upper body lifts or other individual procedures such as brachioplasty and/or breast lift. His decision to perform these procedures on the same day as the belt lipectomy depends on the amount of time that the lower body lift takes.