Why not cut it off?

June 14, 2007 8:16 AM

Bariatric surgery question, gastric bypasses et al. After watching some people receive surgery to clean up loose skin post gastric bypass, I started to wonder...

Since they seem to take huge chunks of tissue out to tighten up the loose skin, why can't they use surgery to remove huge chunks of fat from morbidly obese patients?

Previous AskMeFi gastric bypass coverage here.

posted by Calibandage to health (12 comments total)

You mean like liposuction?
posted by jourman2 at 8:19 AM on June 14, 2007

I think fat that can be removed by surgery (as in liposuction) is generally not the core fat around organs and stuff that really causes health problems.
posted by thirteenkiller at 8:26 AM on June 14, 2007

If you actually wanted to remove giant chunks of fat from an obese person, ou'd be cutting up and scarring an entire body. The cosmetic aftereffects would probably be horrific. For example, I know that the surgery they do to remove "arm flaps" or redundant skin from a formerly obese person's arm result in pretty unattractive scars, which is why not many people do this surgery. And, as thirteenkiller pointed out, it's the visceral fat that is key with issues of cardiovascular health risks. So it seems like it would be a disaster from both a cosmetic and a health perspective.
posted by tuff at 8:37 AM on June 14, 2007

Google "panniculectomy." It's a procedure to remove excess belly fat that's sometimes used for people with certain conditions, like chronic pain from the excess weight. If you look at pictures, it certainly isn't pretty.
posted by ferociouskitty at 8:52 AM on June 14, 2007

jourman2

No, not liposuction, I mean actual surgery with scalpels. Although I understand that there's a limit to how much is safe to suck out with lipo also. What I'm wondering is, why is there a limit? Why can't you suck/carve out 200 lbs of fat? I figured there was a non-cosmetic health related reason, but my (non-surgeon) physician spouse didn't know either.
posted by Calibandage at 8:57 AM on June 14, 2007

In addition to the above information, bariatric surgery works by reducing a person's capacity to eat. Thus it is (barring certain individuals who find ways to wreck their resized stomachs) a long-term approach to weight loss and weight maintenance. The stomach may stretch a bit, but unless the patient is really trying, they should maintain their smaller stomach and reduced calorie intake for the long term.

With just removing huge chunks of fat, this is a short-term & temporary solution. The patient would just as easily keep their old diet and regain the body fat in no time.
posted by tastybrains at 8:58 AM on June 14, 2007

Because your body is much better at removing fat in proportion than a surgeon. Obese people need that, people who get liposuction don't.
posted by smackfu at 9:05 AM on June 14, 2007

I've always understood the reason to not do such a thing is that such a surgery (and liposuction is very much a form of surgery) can flat out kill you for two reasons:

There is a limit to the amount of surgical trauma that can safely be experienced by the human body.

Body fat contains a lot of liquid. The more fat which is suctioned or aspirated, the more fluid is lost. Bodies do not operate well with fluid imbalances or dehydration.
posted by ilikecookies at 10:21 AM on June 14, 2007

I'm not a doctor but I thought that only a certain amount of fat/skin could be removed at a time was due to major trama/disruption of the circulatory system. All of the circulatory system is connected so if you cut out a large portion of it you have a rerouting nightmare, blood pooling in certain areas and other areas being deprived. I could be way off base though
posted by estronaut at 10:38 AM on June 14, 2007

ilikecookies and estronaut, that's sort of what I was thinking, but what about amputations? An above-the-knee amputation would seem to have a similar effect...
posted by Calibandage at 12:53 PM on June 14, 2007

Well, I think in leg amputations they do sew some blood vessels together, and the overall surface area of the surgery wound for an amputation is a lot smaller than the surface area of a wound caused by fat cut out.
posted by IndigoRain at 6:23 PM on June 14, 2007

Amputations are also a very, very serious operation and pretty bad for the health of the person overall (better than keeping whatever was amputated of course).

Another important aspect is that skin just isn't infinitely flexible, it needs to stay attached to whatever is underneath for blood supply, and it takes time and energy to heal - see the problems folks can have healing from even fairly minor burns and abrasions.
posted by crabintheocean at 7:17 PM on June 14, 2007