Allison Barrett, MD

At your current BMI (34), insurance won't pay for bariatric surgery. Lipsuction will not really remove that much fat -- you need something more aggressive. Options would include a gastric balloon, such as the Obalon.

We need more information... There is a small subset of patients who develop reflux symptoms after the sleeve because of the way the stomach is cut. Your doctor may need to send you for additional studies for further information. This may include an Upper GI xray study and an esophageal manometry. These studies will provide information on the anatomy of the sleeve, as well as the function of your esophagus and stomach at moving food/liquid through from top to bottom. If reflux symptoms are chronic and uncontrolled after the sleeve, you may be a candidate for a revision to a gastric bypass.

Please call your surgeon ASAP! JP drains are left inside the abdomen adjacent to the stomach when a  "split" or "leak" occurs. If the JP drain has fallen out, your surgeon need to know. Call him or her today!

Yes, you qualify! Insurance companies will approve patients for bariatric surgery if their BMI (body mass index) is above 40, and yours is 46, according to the numbers you listed. You would benefit greatly for this surgery, as you are still very young, and it would have a significant impact on your future health. Be sure to see a board-certified bariatric surgeon.

Unfortunately, with extreme weight loss, some skin sagging is inevitable. I recommend that PRIOR to surgery, you build as much muscle as possible with a high protein diet, and resistance/weight exercises. Hydration is very important for skin health as well.