Cut a fine figure

IRENE RITCHIE was so proud of herself. The 46-year-old from Broxburn had achieved the monumental task of losing 9st – halving her body weight to become Scottish Slimmers' Slimmer of the Year in 2005.

Yet, even after all that effort, she couldn't wear the bikinis and skimpy tops she had dreamed of because of the loose skin left behind that no amount of dieting or exercise would shift. "I had to tuck it all inside my clothes and wear hold-me-in pants. I looked slim on the outside but underneath I had all this wrinkly skin," she says. "It was awful."

In desperation, Irene sought help from her GP, who recommended her for NHS surgery – private treatment would have cost a prohibitive £6,000.

Last year, after 16 months on the waiting list, she had an operation that saw 5lb of excess skin removed from her abdomen. Now the nursing auxiliary, one of a growing number of people opting for body-contour surgery (body lifts and abdominoplasty) after losing weight, can wear whatever she likes. "I can wear a bikini on holiday – I'm transformed."

With one in four Scottish adults now classified as obese, it's reckoned that by 2050 Britain's fat crisis will be costing us the equivalent of £50 billion a year to treat. But those who do manage to fight the flab, either through diet and exercise or liposuction, are increasingly opting for surgery or body-contouring to remove loose skin and give a more shapely figure.

One problem with weight loss is that there's no controlling where the fat will go from, and slimmers can be left with sagging, deflated skin that they have to fold into their skinny jeans and keep covered. This means they still can't wear the kind of clothes they've spent their fat years dreaming of. Not only does the loose skin look unsightly, but excess flesh can also be prone to rashes and infections.

One solution is a body lift – a combination of a tummy tuck, inner-thigh lift and outer-thigh/buttock lift, while body-contouring also covers arm lifts (brachioplasty) and breast lifts (mastopexy).

Stomach surgery involves cutting and stretching the skin tight and being given a new navel, while the breast lift involves cutting and lifting the skin and repositioning the nipple. It requires a general anaesthetic, takes four to six hours, a few nights in hospital and will cause swelling for up to six weeks afterwards. The surgery will also leave scars, depending on the amount of skin removed.

Irene urges caution to those who think the operation is the kind of procedure you have one day and are out shopping for bikinis the next. Complications after surgery left her life hanging in the balance. "It was disastrous at the beginning. I went to the Golden Jubilee Clydebank for surgery, and after they sent me home blood clots formed in the wounds and I ended up in St John's hospital, in Livingston, having a lumbar puncture and more surgery. I'd say the staff at St John's saved my life.

"I honestly hadn't realised what the operation entailed. I had 39 staples in my stomach because they cut from the breast bone down, and across the way too. People talk about tummy tucks, but it's not as easy as they think. It's major surgery. And while the difference in me is amazing, I really didn't expect to go through what I went through. You have to think long and hard about it."

Despite such problems, Awf Quaba, plastic surgery consultant at Spire Hospital, Murrayfield, and honorary consultant surgeon for Lothian University Hospitals, says there is no doubt that there has been an increase in body-contour surgery. "There have been more requests, particularly because gastric-band treatments (an adjustable band tightened around the stomach to limit eating] are more common."

People who benefit from the surgery are those whose skin hasn't shrunk back after dieting or pregnancy, although it is advisable to wait until no more pregnancies are planned, as this will undo any remedial work. Side-effects include anaesthetic nausea, pain, swelling, infection and bleeding, as well as scarring taking time to settle and the patient being left with residual skin and fat deposits.

"The skin will bounce back after weight-loss if you have good skin tone, or haven't been overweight for long, but some people have poor-quality skin with stretch marks and will have had ongoing weight issues and require more work," says Quaba. "Also, when you lose weight, you don't lose it in a uniform area. There are some bits that don't go away –plus, if you lose breast volume, you might need to augment that to tighten the skin.

"These patients are typically highly motivated and are unlikely to put the weight back on. It's a question of comfort. Some are left with the most awful aprons, their legs rub together, they sweat and their breast skin hangs down. Having won the battle against obesity, they are left with all this extra skin, and it can lead to depression. They have worked very hard losing the weight and deserve a great deal of help."

Irene Ritchie certainly feels she was helped by surgery. "My GP said, 'You've done all the work, it's the least we can do,'" she says. Her achievements – slimming down from a size 30 weighing 20st to a size 12 in the space of a year, and nowadays tipping the scales at just over 9st – certainly deserved recognition.

Overweight since childhood, she decided to change her life after a 25th wedding anniversary trip to London, when walking around sightseeing with her husband Arthur left her breathless and aching. "That was the turning point," she says. "The first week, I lost 10lbs and became addicted to the slimmers' class. I was really strict about what I ate, and still am. I don't have a secret. Every day is hard, but I'm not going back there."

Now that Irene is back to full health following the operation and its aftermath, her husband and 25-year-old son Ewan can breathe a sigh of relief while she gets used to her new figure and enjoys shopping for the first time. "From the neck down, I'm a different person, and friends walk past me in the street," she says. "I can't get over going into a clothes shop and picking something up and thinking, 'That'll fit me' – pinks, reds, no more blacks. Now I'm making up for lost time. "