POST-BARIATRIC BREAST CHANGES
This is an example of a patient who has lost 170 pounds status post Roux-en-Y gastroplasty (gastric bypass surgical procedure) two years ago. She has lost more than half of entire body weight, approximately 165 pounds, weighing in at about 310 pounds preoperatively to her Roux-en-Y gastroplasty. As expected, her skin is tremendously lax and there is grade 3 ptosis. The preoperative photographs show skin laxity from the breast extending to the lateral anterior axillary line as well as skin in the lower abdominal area. She will require a panniculectomy secondary stage.
The patient’s past medical history is significant for history of iron deficiency anemia, which is associated with her Roux-en-Y gastroplasty with malabsorption of iron. She also has a history of esophageal ulceration and has been cleared by Gastroenterology with no active bleeding at this time.
The patient was brought to the operating room at which time under general anesthesia and dual plane technique, a 500 cc high profile saline implant was filled to 580 cc to regain fullness of the upper pole and to reduce visible rippling, with a style 68 high profile Natrelle saline implant.
A formal mastopexy using the inferior pedicle Wise-pattern technique was marked out and a significant amount of skin was de-epithelialized on each breast. Subsequently, the flaps were brought together and her postoperative day one photograph shows excellent symmetry with superior fullness of the upper pole, good cleavage and moderate swelling as expected.
Patients who have massive weight loss will undergo a combination augmentation and mastopexy procedure. These can safely be performed at the same time as long as the physician is a Board Certified Plastic and Reconstructive Surgeon and has experience with the vascularity of the pedicle and the nipple areolar complex.