MEDICA.de talked with Doctor Jürgen Hermann Reus, the founder of the obesity centre Karlsruhe about this surgical procedure. Reus is specialist for plastic and aesthetic surgery and member at the German Association for Plastic, Re-constructive and Aesthetic Surgeons (DGPRÄC).
MEDICA.de: Dr. Reus, how bad is the psychological strain of your patients?
Dr. Reus: Very bad, because most of the patients feel the large skin flaps after they lost a lot of weight just as distracting as being overweight. Problems in the areas such as relationships, sexuality or sports are preprogrammed. And since you cannot get rid of the pendulous abdomen with sports after you lost 50 to 70 kilos, a lot of patients see a light at the end of the tunnel through a plastic surgery.
MEDICA.de: How does such a surgery proceed?
Dr. Reus: The procedure itself takes place as in-patient and under general anaesthetic. First the patient is posed on the operating table in supine position and covered abacterialy. At the abdominal plastic, the tummy tuck, the procedure is as follows: The pendulous abdomen is raised with a crane for example in order to let the blood flow back into the body. After that the skin fat lappets are removed. Regularly the abdominal muscles are affected by the weight gain. During pregnancy this happens similarly. The abdominal wall is built like a bee-sting cake: The skin is on the top, below it there lays fat and under this muscles. In order to lift these, first the stomach has to be opened between the two pelvic bones. After that the overhang is removed and the navel is placed. Parts of the connective and muscular tissue are lifted on demand. When necessary other parts of the body like arms, legs, the breast or the bottom can be lifted, too. After the surgery the patient has to stay in hospital about four to ten days. A compression corsage needs to be worn for six to eight weeks. During that time physical strain and sports should be avoided.
MEDICA.de:How many hours does such a surgery last?
Dr. Reus:This varies. Lifting parts of the body can take from two to four hours. The bodylift for example is a method where many lifts of the body are realized through one surgery. This can take up to six hours. But this is very stressful for the patient. Usually, two procedures are needed. In order to let the wounds heal sufficiently, the following procedure should not be undertaken before six months have passed.
MEDICA.de: What are the risks for patients during and after such a surgery?
Dr. Reus: Obese patients often have concomitant diseases like high blood pressure or diabetes. As a result of this you have an increased risk of complications in advance. Due to a loss of blood which can be connected which such an operation a blood transfusion may be necessary. After the surgery wound healing deficits may occur. The risk of infection of such large wound surfaces is connected to the concomitant diseases.
MEDICA.de: Do you ever advice patients against such a surgery?
Dr. Reus: Yes, I have done this several times. Some people come here with wrong expectations. Such an operation improves the quality of life indeed but the patient has to realize that the procedure leaves behind scars. After the surgery the patient will not have a figure like a model. In other cases, I have advised the people to loose more weight. A surgery should not be undertaken until the desired weight is reached.
MEDICA.de: Since when do such reconstruction surgeries exist?
Dr. Reus: They exist since the sixties in the same way they are practised today.
MEDICA.de: Which aspects should patients consider when choosing a physician in Germany?
Dr. Reus: They should pay attention to the doctor's title being a “plastic surgeon”. Only this title guarantees that the physician has passed a professional training for six years. A doctor can get himself other titles only by educating himself.
MEDICA.de: Do health insurance funds accept the costs?
Dr. Reus: Health insurance funds do not see consequences of obesity after reducing the weight as a disease. After an analysis of the individual case the insurance companies decide whether to accept the costs or not. In the case of refusal, patients have to pay themselves. The costs vary between 3000 and 5000 Euros.