Drastic weight-loss surgery only transforms people halfway

obesity surgery (courtesy he Gazette/Tyrel Featherstone)One day in September a surgeon cut Andre Corbeil from hip to hip and removed seven kilograms of skin.

It wasn’t a tummy tuck. It was a post-bariatric panniculectomy, a procedure to remove folds of excess skin and flabby tissue Corbeil was left with after he lost half his weight following bariatric, or “stomach-stapling”, surgery.

Bariatric surgery may be life transforming, but it transforms people only halfway. Once the weight comes off, people are left with drooping, deflated bellies, chests, breasts, legs, thighs, arms, faces, necks and buttocks.

“You know what blowing bubble gum is like? Well, blow a bubble and break it. You’ve got all that loose bubble gum everywhere. It’s the same thing with humans,” says Dr. Don Lalonde, president of the Canadian Society of Plastic Surgeons. “Skin is not elastic. It stays stretched.”

But if there is a bias against weight-loss surgery in Canada, there’s “almost a repugnance regarding the surgical care of patients after massive weight loss,” says Dr. Vivian McAlister, a London, Ont. surgeon.
McAlister, a transplant surgeon, is books editor for the Canadian Journal of Surgery.

In a recent review of Body Contouring After Massive Weight Loss — the first ever textbook on the issue, edited by Iowa City surgeon Dr. Al Aly, a leader in the field — McAlister says it seems “negligent” to offer surgery to help people lose weight “without following through with the surgery that restores mobility, increases comfort and allows for the full participation of patients in society.”

The most common thing Aly hears from patients is, “I’ve lost the weight. My health is better. But I still look and feel fat, because of all this hanging skin.”

In the U.S., “body contouring” after gastric bypass is the fastest growing field of plastic surgery, with 68,134 procedures performed in 2005, up 22 per cent from the previous year, according to the American Society of Plastic Surgeons.

Depending on the number of procedures performed, surgery can cost $10,000 to $70,000 US.
There are no comparable statistics in Canada, but “plastic surgeons in Canada don’t seem too keen to operate” on these patients, says Dr. Doug Davey, an Edmonton bariatric surgeon.

Aly says part of the problem is a lack of training. Before the year 2000, there weren’t that many massive weight-loss patients. A plastic surgeon could go his entire career and see one or two. Some saw none.
Today, in the U.S., “the numbers are just outrageous — in an average practice, (plastic surgeons see) one or two a week. In our practice, we see 10 or 15 a week.”

But Lalonde says it’s a matter of limited resources, and priorities.

“If you had someone who used to weigh 400 pounds and now weighs 150 pounds, in order to, quote, solve their problem, you would have to operate on them seven or eight times and you would have to tie up more than a full operating week of general anesthesia time.

“It’s expensive for these patients to have it done. Certainly Medicare does not and should not, in my view, cover it.” Lalonde operates on one or two bariatric patients a year.” For those patients, it’s a wonderful thing. But I just don’t have enough operating time and I can’t justify inserting more ahead of cancers and broken hands and broken jaws and cheekbones and faces.”

Aly argues some post-weight loss patients have difficulty functioning in society “because of the tremendous amount of excess stuff they have.

“Should we or shouldn’t we help them with that?”

source - CanWest News