After gastric bypass, patients feel better—but they often don’t think they look better because their dramatic weight loss has resulted in sagging skin. A plastic surgery procedure known as belt lipectomy can complete their transformations.

This final step shapes their new bodies and affords them the full benefit of their weight loss, says Dr. Albert Cram, UI professor of surgery.

“[After gastric bypass], people often still can’t wear form-fitting clothes or exercise effectively because the flab bounces up and down,” Cram says. “When they lose 100 pounds, it’s a wonderful thing and their health is markedly improved, but the skin the fat stretched out for all those years doesn’t go away. It’s like taking some air out of a blown-up balloon. Gravity takes over and abdominal tissue [can] fall down over the groin region and legs.”

Before the belt lipectomy, plastic surgeons can spend up to an hour-and-a-half marking areas of the patient’s body that need removal. Then, in a procedure that can take up to seven hours, they remove or liposuction the tissue around the entire middle section of the body—front, sides, and back—turning the patient three times during the procedure to reach all affected areas. Recovery takes about six weeks, and as with any major surgery, certain risks exist, including bleeding, infection, and blood clots in the legs. Specific to belt lipectomy is the risk of fluid accumulation in the back.

As belt lipectomy is such a complex procedure, the UI is one of relatively few facilities to offer the operation. Some patients travel to Iowa City from the east or west coasts. UI surgeons share their expertise with their medical colleagues by teaching a course on belt lipectomy at the yearly meeting of the American Society of Plastic Surgeons.
Since the UI began offering the procedure five years ago, demand has grown considerably. “We’ve gone from doing one every couple months to one or two a week,” says Cram. “Almost every gastric bypass patient wants this. It’s usually just a matter of insurance coverage.”

Indeed, Cram says that his most satisfied plastic surgery customers are belt lipectomy patients and women who have breast reduction. Belt lipectomy puts the crowning touch on a journey toward both physical and mental self-improvement. “How you feel about yourself has a tremendous impact on overall health,” says Cram.