by Nikki Johnson

After major weight loss, many people end up feeling as if the person they are on the inside—healthy and youthful—is drowning in excess skin. Joan Sundance of Pittsburgh, Pennsylvania, is no exception. She lost 208 pounds, or “two people” as she likes to say, after a Roux-en-Y gastric bypass on April 1, 2003. About a year and a half later, Joan’s weight had stabilized, but she still hid her body under clothes: “My legs were like elephant legs. I couldn’t wear shorts. My breasts had no shape; they were just two flaps of skin hanging down to my belly button. I would get rashes under my stomach and breasts: any place where the skin would sweat. I was embarrassed to be naked in front of my husband.”

Joan made an appointment with Dr. Peter Rubin of the Life after Weight Loss program at the University of Pittsburgh. “Joan was only 38 years old,” says Dr. Rubin. “Her health evaluation was favorable for undergoing major body contouring surgery, with no significant active medical problems. It was 19 months following her gastric bypass, and her weight had been stable for more than three months. She was taking her recommended vitamin supplements and had a hearty amount of protein in her diet. Importantly, she was not a smoker. She also understood that she would have to accept scars as a trade-off for removing the excess skin and reshaping her body.”

Together, Dr. Rubin and Joan worked out an individualized plan that would help her achieve the results she sought. They decided to perform her operations in two stages. Dr. Rubin explains that one of the reasons for breaking up the procedures is that “the procedures in the second stage tighten skin and put tension in opposite directions than the procedures done in the first stage, which compensates for any skin loosening that occurs.”

Joan and her husband then had to decide how to finance the operations. Joan’s insurance company determined that her abdominoplasty portion of the first stage would be covered, which meant that the other costs normally associated with the procedure (anesthesia, hospital fees, etc.) would also be paid for. They only needed to find money for the surgical cost of the additional procedures, so they took out a specialized surgical loan offered by Capital One. The second stage was not covered by insurance at all, making it much more expensive, so they got a zero-interest credit card and charged all of the expenses.

Not everyone in her life understood why Joan made the choices she made to have weight loss surgery and then plastic surgery. Some of her family members even said the decision was “stupid.” But for her, the reason was clear: she had a son who needed a mom who could be active and involved in his life. When she shared her choice with her own mother, her mom was initially dismissive, telling her she didn’t need to do it. Joan says, “I dropped my pants right there, and I lifted my shirt and I said, ‘look at me.’” Shocked by what she saw, her mother’s mind was changed.

In October 2004, Joan underwent the first stage procedures, which meant a full day of surgery. “The first stage,” Dr. Rubin explains, “involved an abdominoplasty with a vertical scar (as well as a low horizontal scar), a lower body lift and the arm lift (brachioplasty). A lift of the genital area was performed along with the abdominoplasty so that there was a smooth blending of the lower abdominal contour. With the lower body lift, fat tissue was preserved and repositioned over the buttocks to improve the shape.” According to Dr. Rubin, the average hospital stay after this sort of surgery is two nights, and the complications that are sometimes seen with these types of procedures are mostly related to wound healing problems and fluid collection. Patients may miss up to four weeks of work during recovery, or more if their jobs require heavy lifting.

Recovery from this first stage was not difficult for Joan. “The first surgery wasn’t as painful as I thought it would be,” she says, “so by the time the second stage arrived five months later, I wasn’t scared. I was absolutely excited—I couldn’t imagine how great I was going to look.”

Her second stage was accomplished in April of 2005. It included an upper body lift to correct the back rolls, a breast lift utilizing a technique Dr. Rubin developed that creates an “internal brassiere”, and an inner thigh lift. The breast lift did not involve any implants, instead using only Joan’s natural tissues.

Recovery from the second stage was more painful and more challenging: “My recovery time was almost double. I started to feel myself become depressed. I had drains for six weeks, because I didn’t want to go out with those little hand-grenade looking things hanging off of my body. I wasn’t able to go to work, so I was stuck in my house.”

The difficulties she experienced during recovery reinforce the fact that the kind of surgery Joan chose involved a major commitment. When asked how she managed it, she says, “My husband helped me get through it all—he was my caretaker, friend, support mechanism, everything. There’s no way you can get through this yourself. You need help, and it has to be someone stronger than you and who understands why you are doing it. You must have someone that loves you very much.”

The whole process was costly, painful and challenging, but Joan couldn’t be more pleased with the way it has transformed her life. To those who may be in the situation she faced a few years ago, she says, “If there is any way you can manage to afford it, do it. It is completely worth it.” Now, Joan is confident enough to wear a bikini, and her outsides match the person she is on the inside.

“The first time I got to see my breasts,” Joan says, “I can remember being so excited—my husband standing in front of me while Dr. Rubin was cutting the bandages off of me. For the first time in my life I felt sexy, pretty. I thought to myself, ‘Wow, I am an attractive woman!’ That is something no one can take away from me.”

For more information about Dr. Rubin, please visit http://lifeafterweightloss.upmc.com.

January 2008