- The Washington Times - Monday, November 14, 2005

Tammy Shaffer of Chambersburg, Pa., weighed 320 pounds before she had bariatric surgery — a gastric bypass procedure that would forever limit the amount of food she could comfortably eat and digest and thus help in controlling her intake.

Three years later, she was down to 168 pounds and wearing size 14 clothing but was bothered by the loose skin around her middle that had stretched out during her “fat” years.

So, like most patients who find exercise inadequate to rid themselves of excess fatty tissue and skin, she opted for “a tummy tuck” — plastic surgery — that removed 11 pounds of skin in a single day. The second operation took place in late September. Both procedures were done by Dr. Joseph Afram at George Washington University Hospital, a bariatric specialist. The tummy tuck is the only plastic surgery he performs, and only on patients whom he has previously treated.

It’s easy to understand why Mrs. Shaffer, the assistant dietary manager in a nursing home, would voluntarily undergo another invasive procedure even though she was unsure whether insurance would cover any or all of it.

Most people who have a gastric bypass or banding operation to reduce stomach size eventually opt for a so-called body lift or reduction of some kind, usually performed by a plastic surgeon. Each case is individual; need is determined by age and a person’s physical condition. Usually, the younger the patient, the more likely the skin has some elasticity.

Dr. Dennis Hurwitz, a plastic surgeon in Pittsburgh, has pioneered what he calls his total body lift, which can take away 20 pounds of loose skin in a single nine-hour operation. He says it is a high-risk procedure and he will do it only on people “around 40 years or less who have lost enough weight to be no longer overweight and who are not only healthy but physically fit, so we can count on that reserve because [the procedure] is an insult to the body.”

His patients have come from as far away as Hong Kong, he says, and just two of 120 patients to date had to be readmitted because of complications.

According to Dr. Steven Davison of the department of plastic surgery at Georgetown University Hospital, the most common procedure is a panniculectomy, or tummy tuck, which also may be called a lipectomy or abdominoplasty, depending on the amount of body shaping that is done.

Women are most likely to undergo plastic surgery, doctors say, but the options are open to everyone. “After healing is done — anywhere from two weeks to three months,” he asserts, “patients are uniformly delighted.”

Last year, 140,000 gastric bypass surgeries were performed in the United States, double the number in 2003, reports Dr. Hurwitz, who says that at least 90 percent of those patients are eligible for follow-up plastic surgery of some kind, but “insurance is a major inhibitor.” Many companies refuse to pay for some or all of the work.

The American Society of Plastic Surgeons (ASPS) reports 55,927 people had total body contouring after massive weight loss in 2004. Of them, 16,945 were for an “extended abdominoplasty” or lower body lift.

Mrs. Shaffer, 36, who says she remembers always being heavy, had a modified version of the latter. She was cut vertically and horizontally in a three-hour procedure and returned to work just five weeks later in spite of having to be admitted to a hospital near her home two weeks after the operation when blood clots were found in her lungs — a possibly fatal complication that she gamely describes as “a little setback.”

Before that, the only postoperative problem had been a severe rash on her abdomen where a binder belt covered drainage tubes and helped protect the many sutures that would disappear in six weeks’ time.

She is realistic about the experience, echoing the words of her supportive husband, John, who says, “It’s no quick fix.”

Her husband had known of two people who had had bypass surgery and gained back their weight, so at home with Mr. Shaffer’s 16-year-old son, Taylor, Mrs. Shaffer is careful to have small portions and chew them slowly. Her goal is to get down to 150 pounds. Future plastic surgery remains an option, with insurance the main barrier.

This particular branch of the plastic surgery specialty is “an evolving skill,” Dr. Davison notes, as evidenced by the ASPS plan to hold an annual conference on only post-bariatric surgery.

Though Mrs. Shaffer and other patients (including folk-pop performer Julie Clark, 38, of Norfolk, a patient of Dr. Davison’s who wrote about her surgery on her Web site) willingly discuss the issue, others are private to the point of obsession.

A 48-year-old Virginia man who sought out Dr. Davison to have two surgeries — one of which removed 33 pounds — will only speak anonymously on grounds that he hasn’t fully resolved his guilt at not being able to conquer a “compulsive eating disorder” in other ways.

Overall, these are patients with positive stories to tell. As Miss Clark says, “It took a lot of trust for me to allow someone to do that kind of operation.” Now, with greater confidence that comes of having a trimmer appearance, she reflects that “the old adage about ‘being comfortable in your own skin’ is literally and figuratively true.”

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