Thursday, September 29, 2011

Body Contouring Not Common After Bariatric Surgery

Updated 3/2017-- all links removed (except to my own posts) removed as many no longer active. 

A study on this topic was presented at the recent American Society of Plastic Surgeons (ASPS) annual conference in Denver.   The article is also in the October issue of the Plastic and Reconstructive Surgery journal (reference #2 below).
The article notes that more than 220,000 bariatric procedures are done annually in the United States.  This number (IMHO) is likely to increase as these procedures have become an major tool in the treatment of obesity which now affects a third of adults in this country.
Massive weight loss, regardless of whether by bariatric procedure or by diet/exercise, will often leave the individual with excess skin.  This excess skin can be both a cosmetic and functional issue for the individual.
Jason Spector, MD and colleagues designed their study to “explore demographic features and patient education regarding body contouring procedures in the bariatric surgery population.”
Their study consisted of a survey mailed to 1,158 patients who underwent bariatric surgery between 2003 and 2011. Two hundred eighty-four patients responded (24.5%). 
Of the responders, 97.2% had their bariatric procedure covered by insurance.  Only 72 of the responders (25.4%) reported having discussed body contouring surgery with their bariatric surgeon.  Only 40 (14.1%) were referred for a plastic surgery consultation.
Only 33 (11.6%) actually had body contouring procedures done at the time of the survey.  The article does not mention what percentage of these procedures were covered by insurance verse considered self-pay.  I have found it infrequent that insurance will actually pay for removal of excess skin resulting from massive weight loss after a bariatric procedure.  It is a battle to prove the health issues (rashes, skin infections, mobility/comfort issues depending on where the excess skin is located, etc).
The article does note that the most frequent reasons cited for not undergoing body contouring surgery were expense (29.2%) and lack of awareness (23.6%). 
Body contouring after massive weight loss is a mixture of cosmetic and non-cosmetic.  Sometimes it is clearly one or the other, more often it is a combination. 
Spector states (in the press release), "Many massive weight loss patients suffer large amounts of loose, sagging skin as a result of their rapid weight loss that, if not removed, can cause rashes, wounds, infection, and limit comfortable mobility.  It is apparent that insufficient counseling at the time of bariatric surgery is obscuring viable body contouring options for these patients."
Yes, counseling is important, but if the individual can not afford it and insurance doesn’t cover it then the percentage of patients having the body contouring procedures isn’t likely to change.

Many Would Remove Loose Skin if Informed of Options, Insurance Covered Procedures, Study Reveals; ASPRS press release, 09/21/2011
Body-Contouring Following Bariatric Surgery: How Much Is Being Done?; Reiffel, Alyssa J.; Jimenez, Natalia; Millet, Yoann H.; Dent, Briar L.; Lekic, Nikola; Burrell, Whitney A.; Pomp, Alfons L.; Dakin, Gregory F.; Spector, Jason A.; Plastic & Reconstructive Surgery. 128():12-13, October 2011; doi: 10.1097/01.prs.0000406221.46933.5a

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