Body Contouring Surgery (including post weight loss) thigh & arm reduction and body lifts

As we age, or due to specific events like pregnancy or when a patient has undergone massive weight loss, the skin sags. It occurs in the face, chest, abdomen,upper arms and inner thighs. Topics to address the first 3 are dealt with in facelift, breast reduction and abdominoplasty respectively. This section deals with inner upper arm and thigh reductions. A body lift is a variation of the abdominoplasty and you should see the section on abdominoplasty also but also read this section.

Body contouring removes the excess skin from the thighs and arms and tightens . It results in a flatter, firm and better shaped limbs. It is considered both a cosmetic procedure and a reconstructive procedure so a medicare rebate is available for these procedures.

The surgery may be combined with liposuction or other procedures and Dr Mahajani will help advise you.

When to have the surgery It is best that your weight is stable and there are no other significant other abdominal problem. After pregnancy, you should wait 12 months from the delivery and with massive weight loss, have achived your ideal body weight ( but discuss this with Dr Mahajani) The patient usually feels loose skin under the arms that flap about, or hang down. In the legs the patient feels chaffing and rubbing with clothes and is uncomfortable.There are also hygiene issues

Before the operation

Discuss any queries regarding the operation and post operation procedures with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Do not smoke 2 weeks before the operation to 3 months after the operation. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. The day before operation you will come for a mark up where the incisions are marked and the operation is discussed. Please bring the completed consent form with you. You will also need to purchase support garments.

The operation

The operation is done under general anaesthetic. In the arms, we make an incision along the front and back of the skin flaps and this extends into the armpits with an L shaped type extension. In the thighs, we make and incision along the groin crease and a variable way down the inner thigh. The excess skin in these areas are removed and the skin is sutured. We apply dressings and support garments.

In a body lift, this practice does a 2 stage body lift where the first operation involves removal of the abdominal part and then after this settles down, the flanks and the backs are done. The process takes several weeks between operations.

After the surgery

You are admitted to the ward for 1-2 days. You have calf stimulators on the legs during the operation to prevent deep vein thrombosis or clots in the legs and these are removed. The drains are removed during your inpatient stay. You are discharged from hospital after 1-2 days with antibiotics and pain relief. Go home and rest, but you will come to the clinic for dressings and stitch removal at 1-2 weeks ( most stitches are dissolving) . We will ask you to wear garments for 6 weeks and come back for dressings. You can start driving after 1 week. Walking as an exercise is possible after 1 week and we would really encourage this. At 6 weeks you can commence exercise but build this slowly. At about 3 months, final post operative photos are taken.

Time off work

Most people take 2 weeks on average off work. It can be 1 week with a mostly sit down job.

Surgery Expectations, Risks and Complications

For most people body contouring surgery is a safe and straightforward procedure. We would however like you inform you of what to expect along with risks and complications.

Scar

The operation does produces large scars in the arms or legs. This scar is red up to 12 months but then settles down. In some people the scar may thicken or stretch. Some form of scar treatment or surgery may be needed ( see scar managment) . This can be seen in both the belly button and the lower abdominal scar. Whislt we attempt to make scars as fine as possible, scars in these areas can thicken and we cannot predict how scars will manifest.

Wounds

Generally heal over 1-2 weeks but can take longer. These can get infected and usually only requires antibiotics to treat. Occasionally stitches that infect need removal. We will help manage your dressings. Rarely some wounds break down and the patient needs a revision of this. Infections that require more than antibiotics like severe necrotic infections requiring surgery are very rare. In the thighs it is the upper thigh that tends to break down and the same in the upper inner arm. These may require dressings for several weeks.

Asymmetry

There may be some asymmetry between side to side. Mostly this is not significant or noticeable and it rarely needs any correction.

Dog ears

At the end of the scars especially if you have a lot of skin to remove, the sides have a bulge that need a minor revision. This is called removal of dog ears. We would wait about 3-12 months to do this to allow the abdomen to settle down. It may cause the scars to extend.

Bleeding seroma and swelling

It is unusual to have significant bleeding but if you do bleed, we may be required to stop the bleeding and or give a transfusion. There are drains which help indicate this. After the operation, more commonly people get a seroma (wound fluid) or small lymphatic collection that collects and doesnt absorb. This may require draining in the rooms. The wounds takes usually 6 weeks to 3 months to completely settle.

Injury to deeper structures of lymphatics

In the event these structures are injured, although so far in this practice it has not been seen, lymphoedema may occur. This is a fluid swelling in the arms or legs and may need garments to control. This in theory should resolve but it could be permanent. More commonly but less serious is small lymphatic collection that has been explained in the previous paragraph.

Numbness and pain

In the scars, numbness may occur. This usually resolves over weeks or months. Occasionally it is permanent but doesnt interfere with function. In the arms it can go beyond the scars in the inner arm and in the legs in the skin under the incisions. Pain lasts 1-2 weeks and settles down after this over a 6 week period in most people but can take longer. In some patients, nerves can be irritated and cause pain that is very severe or longer to resolve. This is unexpected but occasionally occurs. If this happens, our practice will help you to manage this where we can.

Other complications

General complications from any anaesthetic include, sore throat, chest infection, deep vein thrombosis, irritation from dressings, rare complications from anaesthetic ( your anaesthetist will discuss ) .

Realistic expectations from a body contouring operations

It is important for your expectations to be realistic. It is not infrequent that a minor adjustment may be needed. Complications are uncommon but if they occur, we will do our best to help you. We will try as far as possible , within the constraints of your physical health and the state of the ears and your wishes to help you achieve your goals. The surgeon cannot guarantee all expectations and nor can guarantee the longlasting effect as the ageing process continues and there may be other variations. Also for a longlasting effect your weight should be stable and weight gains or losses will affect the outcome. Sometimes other procedures are required, and infrequently sometimes severe complications are encountered. We will endeavour to the best of our ability to help you where possible. Rarely, it may be required to seek the help of other specialists. If you however have any concerns at any time please feel free to contact the practice. You are always entitled to second opinions at any stage and we are happy to help facilitate this for you if you so desired.