Upper and Lower Abdominal Lipectomy Post Weight Loss, a Highly Selective Body Contouring Option for Uncommon Anatomical Patterns
Book Online NowAfter significant or massive weight loss, many patients experience ongoing physical concerns related to excess skin and fat in the abdominal region. While weight loss helps health outcomes, it does not reliably reverse the changes that occur to skin and underlying tissues after years of stretching. As a result, skin elasticity is often reduced, and redundant skin may remain even when a patient has reached a stable weight.
For most post-weight-loss patients, this excess skin is distributed centrally across the abdomen and often extends to the flanks and lower back. In these cases, procedures such as an abdominoplasty (tummy tuck), extended abdominoplasty, or belt lipectomy are more commonly indicated. However, a smaller group of patients presents with a different anatomical pattern, where loose skin is concentrated mainly in the lower abdomen and the upper abdomen or lower chest, with relatively preserved skin quality in the central abdominal area.
In these selected cases, a combined upper and lower abdominal lipectomy performed during a single operation may be considered.
Skin Changes After Major Weight Loss
Following major or massive weight loss, the skin does not always retract to match the reduced body size. This is influenced by several factors, including the duration of obesity, age, genetic skin quality, smoking history, and the total amount of weight lost. The abdominal region is particularly affected because it undergoes prolonged stretching over time.
Patients may notice overhanging skin in the lower abdomen, redundant skin beneath the lower chest, or skin folds that trap moisture and cause irritation. These changes can contribute to physical discomfort, hygiene difficulties, recurrent rashes, and challenges with clothing. Importantly, these issues can persist despite maintaining a healthy lifestyle and stable weight.
While most patients develop a central apron of excess skin, some retain reasonable central skin tension but develop discrete areas of excess skin above and below the umbilicus. It is this pattern that may make a combined upper and lower abdominal lipectomy a consideration.
What is an Abdominal Lipectomy?
An abdominal lipectomy is a surgical procedure that focuses on removing excess skin and fat from the abdomen. Unlike an abdominoplasty, which often involves tightening the abdominal muscles and repositioning the umbilicus, a lipectomy is primarily concerned with direct excision of redundant tissue.
Lipectomy surgery is commonly used in post-weight-loss patients when the primary concern is excess skin and fat rather than muscle laxity. The procedure typically involves less extensive undermining of underlying tissues and does not aim to change the entire abdomen. For this reason, it is best understood as a functional body contouring operation rather than a cosmetic procedure.
Book Online NowCombining Upper and Lower Abdominal Lipectomy in One Operation
A combined upper and lower abdominal lipectomy involves removing loose skin from two distinct areas: the lower abdomen and the upper abdomen or lower chest. These areas are treated through separate incisions, each placed to follow your bodies skin creases where possible.
This approach is uncommon because most post-weight-loss patients have central abdominal skin laxity that would require a more traditional abdominoplasty or belt lipectomy. However, in carefully selected patients, the central abdominal skin and umbilicus remain in an acceptable position, allowing targeted removal of excess skin above and below without disturbing the middle section.
In this approach, the umbilicus and its stalk are preserved in their native position. Some degree of undermining is still necessary around the excision sites, but this is typically more limited than in a standard abdominoplasty, as the procedure focuses on direct removal of excess skin rather than wide skin elevation and redraping.
How This Differs From a Tummy Tuck (Abdominoplasty)
A tummy tuck (abdominoplasty) is designed to treat both excess skin and abdominal muscle separation (diastasis recti). It typically involves lifting the abdominal skin, repairing the abdominal muscles, repositioning the umbilicus, and redraping the remaining skin.
In contrast, a combined upper and lower abdominal lipectomy does not aim to tighten the abdominal wall or change the entire abdomen. The abdominal muscles are usually left untouched, and the procedure focuses solely on removing redundant skin and fat in specific areas. For this reason, it is not a substitute for an abdominoplasty, and outcomes are different.
Patients considering this option must understand that the goal is reduction of excess tissue and physical discomfort rather than comprehensive abdominal change.
Why this is an uncommon procedure
This surgical approach is rarely performed because the anatomical pattern it treats is uncommon. Most patients who have experienced substantial weight loss develop loose skin centrally, which makes procedures such as extended abdominoplasty or belt lipectomy more appropriate.
A combined upper and lower abdominal lipectomy is only considered when the surgeon determines that removing central skin would offer little additional benefit and could increase surgical risk unnecessarily. Careful assessment is required to ensure that the remaining skin will sit appropriately after surgery and that the scars created are acceptable to the patient.
Potential Advantages in Selected Patients
In appropriately selected patients, there may be practical advantages to this approach. Preserving the central abdominal skin allows the umbilicus to remain in its original position. Limited undermining of tissue may also reduce the likelihood of fluid collections such as seromas or haematomas, although this cannot be guaranteed.
Because the procedure targets only areas with significant excess skin, it may avoid the need for more extensive circumferential surgery. However, these potential benefits must always be weighed against the limitations of the procedure.
Patient Selection and Suitability
Suitability for a combined upper and lower abdominal lipectomy can only be determined during a comprehensive consultation. Patients are typically post-weight-loss, have reached a stable weight, and are in good general health. Smoking status, medical history, and previous surgeries are all important considerations.
Patients with widespread excess skin affecting the flanks, back, or lower body are usually better suited to a belt lipectomy (body lift). Similarly, patients with significant abdominal muscle separation (diastasis recti) may benefit more from an abdominoplasty.
Surgical Planning and Consultation with Dr Beldholm
All patients require a GP referral prior to consultation. During your initial appointment, I will review your medical history, weight loss journey, and current concerns. I will perform a physical examination to assess your skin quality, the distribution of excess skin and fat, and the position of your umbilicus.
Clinical photographs are taken as part of the assessment, and surgical options are discussed in detail. In many cases, a second consultation is encouraged to allow patients time to consider their options and ask further questions.
The Operation at Maitland Private Hospital
Surgery is performed under general anaesthesia at Maitland Private Hospital. This facility provides 24-hour medical cover, on-site intensive care, and experienced surgical nursing staff.
The procedure involves carefully planned incisions to remove excess skin and fat from the upper and lower abdomen. Drains may be used depending on intra-operative findings.
Hospital Stay and Early Recovery
Following surgery, patients are monitored closely in hospital. Pain control, early mobilisation, and wound care are prioritised. Compression garments are applied to support the surgical areas and reduce swelling.
Dr Beldholm reviews patients daily while they are admitted, and discharge planning is tailored to individual needs.
Recovery and Follow-up Care
Recovery from a combined upper and lower abdominal lipectomy is similar in many respects to recovery after abdominoplasty. Swelling and bruising are expected in the early weeks, and activity restrictions are necessary to support healing.
Follow-up care is structured and frequent during the first two weeks, with nurse and doctor reviews, dressing changes, and monitoring for complications. Longer-term follow-up continues at regular intervals up to 12 months after surgery. All routine follow-up is included in the procedure fee.
Risks and Limitations
As with all surgical procedures, there are risks, including infection, bleeding, fluid collections, scarring, and delayed wound healing. While limited undermining may reduce certain risks, no surgical procedure is risk-free, and individual healing responses vary.
It is also important to understand that this procedure does not treat every concern related to post-weight-loss body changes and may not be suitable for all patients.
Long-term Considerations
Long-term outcomes depend on maintaining a stable weight, following post-operative instructions, and allowing adequate time for healing. Changes in weight after surgery can affect results, and ongoing commitment to a healthy lifestyle is important.
Final Considerations
A combined upper and lower abdominal lipectomy is a specialised option reserved for a small group of post-weight-loss patients with a specific anatomical pattern. When carefully selected and appropriately planned, it may reduce excess skin while avoiding more extensive surgery.
A thorough consultation with an experienced Specialist General Surgeon is essential to determine whether this approach is appropriate.