Introduction

A new surgical field has been created. There is nothing really new under the sun, though in post–massive weight loss surgery, patients’ physiology and blood supply have been so radically altered that we need to consider this group of surgical patients as a new class of patients. Although the fundamental surgical procedures are based on previous iterations of surgery to correct body shape, there is enough of a significant difference to devote an entire textbook on surgery to correct the deformities of the previously massively obese patient. The surgeons performing weight loss surgery are successfully correcting patients’ obesity and its associated comorbid conditions, including hypertension and diabetes, but in doing so they are leaving patients with a new set of problems. Severe problems with hygiene, including cleansing and eradication of body odor, caused by overhanging folds of empty sacs of skin, are reason enough to warrant the plastic surgical intervention aimed at eliminating these offending folds. Additionally, the untoward appearance produced by the massive weight loss may be just as disheartening and depressing to the patient as the previously distorted body image due to obesity. The two major problems the surgeon needs to consider are the state of nutrition of the patient resulting from either a decrease in intake or a lack of absorption, or both, and a significant increase in blood supply that was created to nourish the formerly massive obese patient. The increased size of the vessels is both good news and bad news. The bad news is that blood loss may be significant if hemostasis is not meticulous. The good news is that the increased macro- and microcirculation allows the reconstructive surgeon to create flap lengths that are unheard of or impossible in the normal-sized patient.