You've considered the risks, which include a real risk of death, anesthesiological complications, torn staples, infections, blood clots in the legs, gall stones, bleeding ulcers, pneumonia, hernia at the incision site, vitamin deficiency, permanent intolerance to certain foods, and hair loss.

You've thought it over and long and hard. Your insurance has agreed to pay for it, as you clearly have a medical need. Which is good, because major surgery is never cheap.

But before you sign the papers, there's a risk and side effect about which you may not know, because your doctors are not required to tell you.

Many gastric bypass patients have problems with excess skin. Yup, that's right. All that extra skin of yours that had stretched to cover your plus-sized body will now be hanging in its own weighty folds.

It seems that skin has only so much elasticity. Extreme stretching damages it so that it loses the ability to shrink back. And that skin can rub together, causing rashes, skin infections, pockets of fluid called seromas, hematomas, and death of fat cells. And of course, it's unattractive, hard to maneuver with, and uncomfortable.

You may need a second, more invasive, more dangerous surgery to correct this. Your insurance company may consider it "cosmetic," voluntary surgery which they will not pay for.

Called "body contouring," these skin removal procedures may take months to complete, because multiple surgeries are often spaced out to manage the severe pain of recovery — and also to minimize blood loss. These procedures also leave behind long, permanent scars running across the entire abdomen, down each leg to the knee, and along each arm to the elbow.

Surgeons will treat your living skin like so much yardage from Jo-Ann's, ready to be cut up and sewn back together again. Compared to your easy-peasy gastric bypass, these procedures are riskier and will require a longer convalescence.

You might hope that for such an expensive, painful, and lengthy surgery you would at least get a quality body lift. Sadly, it seems that there are an ever increasing number of poorly executed procedures that need to be redone. Of course, that's not what you want to hear, when the cost of these surgeries can run into many thousands of dollars.

You should wait about a year after your bypass to consider body contouring, to be sure you're done losing weight and no new skin folds are about to be born.

Despite all the risks, many body contouring patients are happy with the finished product. But the decision to have either surgery should not be taken lightly.

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