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Scott Webb (Host): I'm sure many of us have looked in the mirror at times and wondered how a surgeon could help improve our shape, removing hanging skin and more. And joining me today to explain body contouring surgery and how it can improve our self-esteem and outlook on life, is Dr. Jessica Gillespie, she's a Board Certified Plastic and Reconstructive Surgeon with the Franciscan Physician Network. This is the Franciscan Health Doc pod. I'm Scott Webb. So, Doctor, thanks so much for your time today. This is a really interesting topic. I told my wife that I was doing one on body contouring and she asked if we could maybe get a freebie. I said, probably not, but I'm going to get all the info I can from Dr. Gillespie. So, let's do that for my wife and for everybody else. Doctor, as we get rolling, what is body contouring surgery?

Jessica Gillespie, MD (Guest): I'd say body contouring surgery is a broad term for plastic surgery procedures that help reshape your different body areas. So, that could include your abdomen, your breasts, your neck, your thighs, your legs. It's pretty all inclusive.

Host: Yeah, good to know that it kind of sounds a little bit like a kind of one-stop shopping, you know, sort of looking in the mirror and we look at all these things that maybe would improve our self-esteem or mental, physical outlook and good to know that you can kind of help us with most things. So, if we assume that you're right and you are because you're an expert at this, that you can help with just about anything, then who would be a good candidate for body contouring surgery?

Dr. Gillespie: I would say a good candidate is someone who's maintaining a healthy lifestyle. Who's already excercising, eating well. And I always ask patients if they're at their happy weight and to me, a happy weight might not be your ideal body weight. We all come in different shapes and sizes. But your happy weight, the weight you're comfortable at, you're not going to try and lose another 10 or 20 pounds. You're comfortable at this weight and you just need some help with getting things corrected, removing loose skin and to keep you looking confident.

Host: Yeah, I like that. I liked the way you put that to the happy weight, cause I just saw my primary for a physical last week. And I think that her happy weight for me is different than my happy weight. Cause, cause I feel just fine. And she said, I'd feel better. I'd be happier if you will, if you were just, you know, maybe five or 10 under that. So I'll continue to negotiate with her, but I get your point.

Dr. Gillespie: Now I will say that you do need to have a happy weight and a healthy weight, so it is not uncommon for me to see a patient in consultation and have a long discussion about it. I've had patients tell me their happy weights are maybe a hundred pounds heavier than they should be. So that would not be a good candidate, so at a healthy, and happy weight, I should say.

Host: Yeah, I see what you mean that both is ideal, especially when we're thinking about who's a good candidate for this. What are the most common body parts that patients, you know, want to have reshaped?

Dr. Gillespie: The most common body area for a woman is her breasts and abdomen. I see a lot of patients, male patients for abdominal reshaping. So, I'd say most common areas, your abdomen, your breasts, arms and thighs. Patients who lose a lot of weight after bariatric surgery are some of our most common patients that seek help for body shaping surgery.

Host: Yeah. And you can see why, and that kind kinda leads right into my next question here. What's the difference between a panniculectomy versus an abdominoplasty, which may be most of us might refer to as a tummy tuck.

Dr. Gillespie: Absolutely. So, a panniculectomy is a term that's used to describe removing, hanging skin on the lower abdomen. A lot of people call it a panis, more technically it's called the panniculus . So, when people lose weight, or age, sometimes that skin just really hangs over your belts and removing that hanging skin and fat on the lower part of the abdomen beneath the belly button is called a panniculectomy.

Oftentimes that doesn't give you a great cosmetic result. A more satisfying surgery is a full abdominoplasty, which includes a panniculectomy because we're removing that hanging skin. But we also work on the upper abdomen too. I always tell people it's kind of like making the bed. We pull up the sheets, which would be your abdominal skin and fat flap.

And pull it, straighten it out, remove the excess and relocate your belly button. It also includes some muscle tightening. Oftentimes after pregnancy or after weight loss, your rectus abdominis muscles will separate or pull apart. And you can actually feel this if you're doing a sit-up, if your abdominal muscles have separated. So, during a full abdominoplasty, we will bring those muscles back together. I like to call it an internal corset. And then that will make it so when you're standing up, it looks like you're sucking it in, but you're actually not, you just have some tight abs.

Host: And who wouldn't like some tight abs, you know,

Dr. Gillespie: Exactly.

Host: So Doctor, let's talk a little bit about insurance, which I'm sure is probably the number one thing people want to know are some things covered by insurance or partially covered? How does that work?

Dr. Gillespie: Absolutely. There are body contouring procedures that insurance companies are happy to cover. Breast reductions often get covered by insurance companies. For people who have had bariatric surgery, and have lost significant weight and have excess hanging skin and fats, insurance will often cover the panniculectomy.

Sometimes they cover a full abdominoplasty and sometimes if they cover just the panniculectomy and we want to give the patients the best procedure, which is a full abdominoplasty, patients can pay out of pocket, a small cosmetic fee to have the whole procedure done with partial payment by insurance.

Host: Uh, Wondering from the patient's perspective, what can we expect if we opt for body contouring surgery, maybe just kind of take us through that process.

Dr. Gillespie: If you come in for a consultation for body contouring surgery, of course, we're going to ask you, what's bothering you. How long have you been thinking about this? Are you at a happy weight? Or do you anticipate weight changes? One thing I will add to that is how I like to describe it to patients if I do breast surgery, breast shaping surgery for you or a tummy tuck. And then you lose weight after our surgery. Your results will not be as good there. You're going to loosen up and wish I took out more or you're the one another nip or tuck. So, being at your lowest happy weight is what I would recommend.

So we'll talk about the different areas that you would like to see improvement on. We'll talk about, what makes sense to do first. If you have multiple areas that you want to work on, of course I'll describe the surgery in detail for you. Describe a typical recovery process. What this could be like. How much work are you going to need to miss? How long will you have to restrain from, um, intense physical activity and just start planning from there.

Host: Yeah. And you've talked today about how important it is to be at both a healthy and happy weight. And I can see why, because if you're going to do this, you know, sort of major or even minor body contouring surgery, you want it to hold up. You want it to last and not again, have to as you said, go back in for another nip and tuck along the way. And, I think it's probably natural folks are thinking, okay, this is maybe a bit of a major undertaking, at least from the patient's perspective.

Maybe just all in a day's work, you know, for an expert like yourself, but for us, this is kind of a big deal, right? So, can we just kinda knock a couple of things out at one time? Can we do more than one thing when we're on the table, so to speak?

Dr. Gillespie: It is absolutely a possibility. I think that the main question that you and your surgeon should talk about is does it make sense? Can it be done safely? So, my general rule of thumb is I don't want to keep a patient on an operating table for six hours or longer. So, the time it takes to do a procedure factors into it. Your different personal health factors into it, if you have other risk factors. Sometimes I like to counsel patients that combining procedures, depending on the degree of difficulty for each procedure can make sense. But sometimes it can make sense to break it up. Well, I like to say if I could focus on one thing at one time, I'll make sure I get that done to perfection. Not knowing I have to do two or three more procedures during that day. For some people also, depending on age and health status, you can recover quickly from multiple procedures at one time, but adding on procedures can make recovery a little more difficult. It's a higher demand on your body for the healing.

I think those are just individual conversations to have, depending on what procedures we're talking about. And then making an informed choice with you and your surgeon, best way to go. I wouldn't come into a consultation with a preconceived notion of, I want it all done at once. Unfortunately, some plastic surgery reality TV shows will show these extreme make-over type procedures. What they don't show is the complete recovery process and how difficult of a time that patient might have had going through that recovery process.

Host: I see what you mean, you know, you said nip tuck earlier, and that made me remember the show Nip Tuck that I used to watch. And I was always struck by how quickly people seem to recover. You know, they had these major surgeries and then they're up and walking around and they're on their way out the door. And I'm like that just can't be. So, maybe you can talk about that a little bit. What, what is the recovery period generally speaking for the most common surgeries that you do?

Dr. Gillespie: Answering patient questions about recoveries is difficult because after probably every procedure I do, I want my patient's up and walking that day. Any recovery on average is about three weeks to start feeling a lot better. But breast augmentation patients are going out to dinner that night with, my rapid recovery protocol. But still you're feeling a little lag in your energy level, for a few weeks. So it's hard to answer that question. I think for any body contouring procedure, the first couple of weeks, you're going to be sore. You're going to be swollen. You're not going to feel normal. But you are going to be functional. You're going to be excited about your results. You might have drain tubes that will be a little cumbersome for a short period of time. I say from probably any surgery that any surgeon would do, it's three months for the most complete recovery. That being said for a lot of body contouring procedures, we don't see full results for three months to up to a year.

As things have to heal in, contract in, tighten, especially if you're considering any procedures that include liposuction. I'd say final results you would see at six months to one year. So final results is slightly different from full recovery. It's hard to describe. It depends on what your definition is. Is it when you can lift 50 pounds? Is it when you're driving in your car? Is it when you have no pain? But in general, within a few weeks, you're feeling pretty good. I'm a pretty conservative surgeon and I'm pretty honest with people like, so I'll have a discussion. Okay. I want you up and walking and I actually minimally use narcotics. Most of my patients do not use narcotics. And then we talk about, hey, if you work from home, you might feel like engaging with work in a week or two weeks. If you own your own business, you're going to get back to work in 48 hours. Everyone's got different motivations, but I'd say for a full recovery, you're not really putting it behind you until about three months to a year, depending on the procedure. You know, when you forget your plastic surgeons name.

Host: I don't think they would ever forget your name, but I totally get what you're saying, which is it's maybe different for everybody. And it's one thing to be up and about or to be doing some work from home or whatever it might be. But as you say, somewhere between three months and a year.

Dr. Gillespie: Complete recovery and final results, complete recovery, final results. Recovery, I guess you can say two to three weeks would be on average.

Host: I guess it makes me think then there's things that we could do. We've talked about happy, healthy weight. So maybe to folks come in for a consultation and then they go out and spend six months or a year losing that weight to get to that happy, healthy weight and either way, what else can we do to prepare for the surgery?

Dr. Gillespie: Besides being t aa healthy and happy weight, I would make sure you're not on any nicotine products to prepare for surgery, and to make sure you're nutritionally doing well. Some people will do an extreme diet and come in for surgery. And if you're nutritionally depleted, you will not heal well. As a surgeon, I might check your blood count to make sure you're not anemic. Make sure that your protein levels are good just to make sure you're optimized for surgery. Besides that just planning a time in your life when you don't have family pictures. You don't have a family wedding within a couple of weeks of your procedure. Making sure that it, maybe it's a slow time at work for you. For some of the body contouring procedures, we'll want you to wear compression garments. And so those might be more cumbersome in July, in Indiana than in in Indiana. So think about things like that.

Host: You know, we touched earlier about people may have some changes, they may gain some weight, lose some weight after the surgery, which may require that you go back in for a little nip and tuck afterwards. But I think generally folks are gonna wonder or want to know, is generally speaking the types of surgeries that you do, the most common types of surgeries that you do, are they. permanent?

Dr. Gillespie: Yes and no. Once we remove some excess skin and tighten some muscles that's going to last, but, I can't change the forces of aging or gravity, or weight gain or weight loss. In general, yes, but life marches on and as you age, things might loosen up and gravity might take effect and severe changes in weight gain or loss will affect your results.

But in general, I tell patients for example, if we do a abdominoplasty, a tummy tuck and you lose weight, that's when you're going to wish I took more skin off, but if you gain weight, you're going to look okay. You're gonna look okay.

Host: Yeah.

Dr. Gillespie: So you have to think about these things. The other thing I should've mentioned about getting ready for surgery, patients who smoke or use nicotine products or vape with nicotine products, they are bad candidates for surgery. So, most plastic surgeons are going to have you stop those products and try to eliminate them from your system, both before surgery and after surgery.

And that's because the nicotine and smoking will increase your risk of infection, increase of your chances of how wound healing problems and even having the blood supply to the skin, not being good and having some skin loss or delayed wound healing.

Host: Yeah. And you and I, before we got rolling here, we were kind of talking through some things and just, you know, thinking about self-esteem and how there are mental, of course and physical benefits of course, if you can get folks to lose some weight, quit smoking. And feel really good about how they look in the mirror. That sounds like a big win for you and for patients. So I've really enjoyed this conversation. As we wrap up here, what would be your takeaways? Final thoughts? Generally speaking on body contouring surgery, who's a good candidate and how you think you can help folks.

Dr. Gillespie: Overall body contouring surgery is wonderful for many different types of people, of all ages and all genders. Procedures, such as, you know, breast reduction, breast lifts, breast augmentations, tummy tucks, liposuction, arm lifts that are all procedures that help improve a patient's self-esteem help people feel more confident about their bodies more confident about themselves and how they present to the world. It's a reason I went into plastic surgery is to try to help people see results, improve their self-esteem, feel good about themselves. So, it's one of my favorite parts of my day is having a consultation with a new patient to find out more about them and how I can help.

Host: That's so awesome. So gratifying. Well, Doctor, thanks so much for your time. This has been really educational and fun and you stay well.

Dr. Gillespie: Thank you, you too.

Host: For more information, go to Franciscanhealth.org and search body shaping surgery. And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.