Skin Removal Surgery After Losing 250 Pounds

Doctor:

Here. Okay, pretty high. That's good, and I think we'll come in right in there.

Speaker 2:

Diagnosis, treatment, staging, all of that, and all of that-

Doctor:

That's a lot of work.

Speaker 2:

Yeah, yeah.

Doctor:

It's exciting though.

Speaker 2:

And then using [inaudible], which all the experts will get together and say, "Here's what we think you should do", or "Here's how we think you should be treating them."

Doctor:

Right.

Speaker 2:

So we have the data to back up to say, "Look, here's the guidelines. Here's what should be getting done."

Doctor:

Yeah.

Speaker 2:

And it's also good, too. We identify well, gee we're seeing an awful lot... At one point we were seeing an awful lot of Stage IV breast cancers, well why are we not diagnosing them sooner so then that helps to start an outreach program at a smaller hospital because then we-

Doctor:

Yeah.

Speaker 2:

So then you have to get them to a larger city. It's challenging.

Doctor:

Postoperative canvas already, so it looks really good. Mostly excess skin. High school and medical school in Virginia.

Speaker 2:

Oh, okay.

Doctor:

Yeah, yeah, yeah, and my parents live part-time in D. C..

Speaker 2:

Okay.

Doctor:

Foot swelling. It'll take a couple of weeks to go away, but that will be gone. Very good and we're going to look at something like there. [inaudible] okay. See when I do the surgery, the anesthesia is a block of ice.

Speaker 2:

No, I haven't seen it.

Doctor:

Very good, and now face the blue for me, hands across chest. You got it. The upper-

Doctor:

So this patient started out, and she slowly started gaining weight, gaining weight, gaining weight, and at about 372 pounds, she started Weight Watchers. Okay, but unfortunately then she started climbing to a maximum of 410 pounds, and then lost a lot of weight. Came down to about 330 pounds, and then yo-yo'd back up again to about 385, and then decided, "Hey, I need a gastric bypass," and then had the [inaudible] gastric bypass. And now today, she weighs 153 pounds, so she's lost about 257 pounds, and now she's just left with a lot of excess skin and fat, so we're going to get rid of most of the excess skin on the patient. She's already previously had a tunny tuck and a thigh lift before, but this is to get rid of even more skin, which you'll se in a minute.

So, I'm trying to get through all this skin, and this loose skin and some more. So everything from this upper line here to this lower line down there. I'm going to take out this[inaudible], this wedge or this pizza pie right here.

Doctor:

So now I'm dissecting. I'm going throught the skin. I've gone through the fat here on the buttocks. I'm going down, all the way down to about here. You can see my fingers here, all of this has been dissected. This basically loosens everything up, so then when I do the pull, all this comes up without any [inaudible]. So, I think we're getting actually more than we expected. So I've dissected all the way to about here.

Speaker 3:

Started again last night. [inaudible]

Doctor:

So I'm planning to dissect everything from where my thumbs are down to these [inaudible] clamps. So, pretty big area right in there. All going to be removed.

To dissect is everything from this line to this top line. So all of this will go. When I marked her up before the surgery, I thought I could get off this much, but you can see with anesthesia and dissection, you can get out an extra 2 to 3 inches here. So, I'm going to make this incision, and open this up sort of like a book.

There's a lot of blood in this flap, and if you just leave it hanging, especially with gravity, that blood is just going to drip out and drip on the floor. So what I'm doing here is I'm squishing all the blood that is in the flap back into this patient's circulation, so she can lose minimal blood. It's a blood conservation technique here. It's like a tourniquet. It'll minimize blood going to this flap. There you go.

All right, so what I'm going to take out is this amount this side. Yeah, that's a good... This is 6 inches, so that's 6 inches right there. We're taking out a foot on her side. So, that's quite a lot of skin.

So, planning to dissect all this. Okay. From this line to this line. This is everything I want to get rid of.

So, if you look carefully, she has had a previous tummy tuck. Here' her tummy tuck scar, and it goes out. So, with a tummy tuck, you usually, reset the skin, and stitch up a muscle. So, we're going down to the muscle here, and we're going to see, indeed if the muscle was sutured. Some general surgeons, plastic surgeons, they don't always suture the muscle. I always think it's a good idea on weight loss patients because you got to tighten up the muscle. But, we'll find out in a minute here.

So, you see I've made this little diamond.

So, here's one stitch from a previous tummy tuck. You see that little green knot right there? And there's another one. And they did some muscle [inaudible], but I think we can get her even tighter, and I don't see much muscle [inaudible] down here. And look how weak this abdominal wall is. We got to certainly tighten that up. I mean, she's had a 250-pound weight loss, so this is going to be weak, and distended, loose, so we really gotta tighten this up.

You can turn my headlight off if you want.

So I just tightened the bottom portion of the erectus. This is her belly button here. Pubic region here. So, I just tightened all this with 2 layer of closure, multiple interruptives, and then a [inaudible], so this is tight, and this is still loose up here. Tight. Loose. Tight. Loose. Loose. Tight. Loose. Tight. So, I'm going to tighten those lateral borders by bringing together and really tightening up the upper abdomen. You can see the significant difference.

So now, we're tight down here, and we're tight up here. Nice, tight tummy. Nothing loose anymore, and now she'll get a nice, flat abdomen. Before it was sticking out because the muscle was all weak, but you can see we brought that in at least 6 inches, top and bottom. From her sternum right here, her belly button and down to her pubic area. All right?

When I do these body lifts, the pubic region is also very important in the male and the female. Instead of doing liposuction, which is fairly inaccurate and it can really mess up the blood supply, I basically de-bulk it. I'm going to take out a lot of the fat in this area, so this can re-drape in a nice, flat fashion. You can see it's pretty protuberant right now, but basically we're going to get rid a lot of this excess skin and fat in this region and make this a lot flatter. You don't need to liposuction; you just need to cut out the tissue in there, which is mostly fat.

Speaker 4:

Weight guess.

Doctor:

6 pounds.

Speaker 4:

Say it again?

Doctor:

[inaudible]

Speaker 4:

No. Awesome.

Doctor:

Should be from the sternum, which is right here, to the external genitalia, which is right there. Like that, we draw a line. And at the top of the hip bones, which is here. You just bring a line in between, and that's where everyone's belly button should be. So, let's see if her belly button is in there. I just like to take out a little bit of skin right here. You get an elliptical belly button for females. There we go. There's her belly button. Yay!

Going to remove all this on the inner thigh, from this line to that line. All this has got to go. This hanging extra skin.

Remember she had all those wrinkles? Now, she's wrinkle-free. All those wrinkles gone on her tummy. She's not so stout. She's nice and concave now. Her tummy goes in instead of out. She's nice and tight. All those shrinkles on the leg, all those wrinkles all gone. Nice and flat. You could bounce quarters off her legs now.

Speaker 4:

Moment of truth.

That said 9.2. 9.6. Whoa.