Post-bariatric abdominoplasty: surgery to restore the abdominal wall after major weight loss

The skin’s response to the rapid weight loss typical of bariatric surgery is highly variable and depends on several factors, including skin quality and elasticity, genetic predisposition, and the skin’s ability to adapt to the body’s new shape.

“Some patients show minimal skin laxity even after major weight loss, while others, despite losing less weight, develop prominent folds,” explains Dr. Marino.

When the skin fails to retract adequately, especially in the abdominal area, excess tissue can lead to several issues, including:

• Psychological distress
• Recurrent skin infections
• Intertriginous fungal infections in the abdominal fold
• Difficulty maintaining personal hygiene
• In some cases, impaired mobility

“In particular, patients with a large, overhanging abdominal pannus (‘apron abdomen’) may experience severe limitations in daily activities, making post-bariatric abdominoplasty a necessary solution,” the surgeon specifies.

“Post-bariatric abdominoplasty is a surgical procedure performed after significant weight loss following bariatric surgery. Its primary goal is to correct the morphological alterations of the skin and soft tissues caused by massive weight reduction. Specifically, it aims to remove excess skin and redundant subcutaneous fat in the abdominal area while restoring the abdominal wall’s structural and functional integrity,” says Dr. Marino.

As with any surgery, the benefits are significant, but there are considerations, such as the postoperative scar.

“While the intervention greatly improves quality of life, patients must accept a scar, usually placed in the suprapubic region, sometimes extending laterally toward the iliac crests (flanks). However, with proper surgical planning and experienced hands, scars are generally discreet and often well concealed,” adds the surgeon.

“Post-bariatric abdominoplasty can be performed under the Italian National Health Service (SSN) only if specific criteria are met:

• The bariatric pathway has been successfully completed.
• The patient’s weight has been stable for at least one year.
• The Body Mass Index (BMI) is within the normal range or only slightly above.

Additionally, there must be a clinically significant abdominal tissue deformity, assessed using a standardized tool known as the Pittsburgh Rating Scale, which quantifies post-weight-loss soft tissue deformities,” explains Dr. Marino.

Before surgery, the patient’s overall health status must be carefully assessed through blood tests and an electrocardiogram, ensuring they are fit for surgery.

Candidates are typically followed by a multidisciplinary team, as done at INCO, National Institute for the Treatment of Obesity, which includes a bariatric surgeon, nutritionist, and psychologist, allowing for comprehensive planning and safety. Once eligibility is confirmed, surgery can proceed. The procedure typically lasts about one hour.

“During surgery, excess skin and fat are excised from the suprapubic area, while preserving and repositioning the umbilicus (navel). If necessary, diastasis recti (separation of the rectus abdominis muscles) or abdominal wall hernias (laparoceles), common among post-obese patients, are repaired simultaneously,” Dr. Marino explains.

In more complex cases, the surgery may extend laterally to the flanks or become a 360° torsoplasty, addressing the entire trunk. Hospitalization usually does not exceed two days.

“As with any surgical procedure, post-bariatric abdominoplasty carries certain risks, including:

• Surgical site infection
• Bleeding
• Pathological (hypertrophic or keloid) scarring

With appropriate postoperative management, the use of drains, and prophylactic antibiotic therapy, these risks can be minimized, leading to faster healing and optimal aesthetic and functional results,” explains Dr. Marino.

Recovery is generally progressive and relatively quick:

• First 2–3 days: strict rest
• First week: reduced activity
• From second week: gradual return to light activities
• After 1 month: resumption of normal social and physical activities under medical supervision

Long-term success depends heavily on the patient’s commitment to a healthy lifestyle, including stable weight maintenance through proper nutrition and regular physical activity.

“Post-bariatric abdominoplasty is more than just a surgical procedure, it is part of a broader journey. It should be approached with awareness, entrusting oneself to qualified centers, following professional guidance, and investing in personal perseverance and long-term self-care,” concludes Dr. Marino.