According to a report by the Brazilian Society of Metabolic and Bariatric Surgery (SBCBM), between 2011 and 2018, the number of bariatric surgeries increased by 84.73% in Brazil, from 34,629 to 63,969. And the demand remains high , at least in the state of São Paulo. As reported by the state health department at the end of 2021, approximately 5,200 people are lining up to have the procedure through the Unified Health System (SUS).
In the wake of the increase in bariatric surgeries, the number of people seeking plastic surgery after the procedure to remove excess skin due to the severe weight loss is also increasing. Referring doctor in plastic surgery in Brazil, Dr. Wandemberg Barbosa confirms the increase in demand for surgical interventions of this type and affirms that they are not more important due to the high cost.
Dr. Wandermberg explains that when it comes to plastic surgery after bariatrics, medical plans only release patients for a few procedures, such as abdominoplasty and mastoplasty. To carry out the other acts, it is necessary that the patient bears the full costs. The use of SUS is also not easy, according to the doctor, because the demand is very high and the wait can usually reach six years.
However, for some patients this is not an acceptable time, as bariatric surgery usually entails significant weight loss (up to 80 kg) and the need to remove excess skin from almost the entire body. According to Dr. Wandemberg, in addition to anterior and posterior abdominoplasty and breast reduction, with prosthesis placement, it is customary to perform surgeries in the gluteal region, in the lower dorsal region, dermolipectomy of the posterior trunk and liposuction.
In addition, according to Dr. Wandemberg, the suppression or shortening of the stomach, makes this patient prone to problems of anemia due to lack of absorption of iron, lack of absorption of proteins, calcium, vitamins and electrolytes, among others, making them harder to heal, weaker immune response to infections. “Usually these patients are people who have little muscle mass, do little exercise, and care should be taken with early mobilization and the use of anticoagulants to prevent DVT – deep vein thrombosis or PTE – thromboembolism For these reasons, the doctor must have the necessary experience to cover and observe all these needs,” he explains.
Due to the need for several surgeries to remove the skin, which would involve a long treatment with a long period of rest, Dr. Wandemberg systematized four initial surgeries: breast correction, abdominal dermolipectomy, posterior trunk and medium liposuction.
As these are long and time-consuming surgeries, Dr. Wandemberg stresses the importance of the participation of an experienced anesthesiologist, with good integration with the plastic surgeon. In this sense, the doctor also states that good hydration of the patient throughout the surgical procedure is essential. After the surgery, the person must stay an average of three days in the hospital, so that in the most acute phase the medical team can provide the necessary support. In addition, according to the referring doctor in plastic surgery, with this waiting time, the patient goes home with much less pain.
About the time it takes to perform plastic surgery to remove excess skin and fat after bariatric surgery, the doctor who is a reference in plastic surgery says that it is about two years. Dr. Wandermberg explains that in the first months after stomach reduction, the most critical period occurs, during which there is a lot of weight loss. But the process continues for at least another year, in a reduced way, of course, because the body adapts.
Many times, however, says Dr. Wandemberg, the first surgery is performed earlier than expected. Indeed, patients with very large thighs usually have complications resulting from excess skin, such as diaper rash, which prevents them from even walking. “So sometimes we indicate that the surgical process should be started early, to perform dermolipectomy of the thigh or even the abdomen, and thus remove the itchy skin, eczema and infections, greatly improving the patient’s life. “, he says.
The need to perform multiple surgeries, resulting in the total removal of the skin after more than a year from the first surgery, must be well explained to the patient. Dr. Wandemberg therefore emphasizes the importance for the patient to carefully analyze the professional responsible for carrying out the procedures. “He needs to know if the doctor has experience with major surgeries and that only happens through a frank conversation during the consultation,” he explains. According to Dr. Wandemberg, if the patient feels that the doctor does not provide him with security or credibility, he should seek another professional.