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Body contouring

Only six percent of bariatric patients undergo body contouring surgery

Women, patients with health insurance such as Medicare or Medicaid, those with higher incomes or who had undergone sleeve gastrectomy were more likely to have it done

Only a small percentage of obese patients who have undergone bariatric surgery undergo additional body contouring surgery to reshape their bodies and remove excess skin, according to researchers from Stony Brook University Hospital, New York. In addition, such body contouring surgery is generally only affordable to patients with adequate insurance and income.

The study, ‘Utilization of Body Contouring Procedures Following Weight Loss Surgery: A Study of 37,806 Patients’, published in the journal Obesity Surgery, stated that recent surveys have shown that up to 75 percent of women and 68 percent of men are interested in plastic surgery after losing weight, and are especially interested in undergoing body contouring procedures of the waist and abdomen. Excess skin is associated with personal hygiene problems, skin infections, ulcers as well as severe psychosocial stress.

Although the health and medical benefits of bariatric surgery leading to massive weight loss are easily noticeable, measurable and thus universally insured, the benefits of plastic surgery following bariatric surgery are less so. Most of the 127,967 surgeries performed in the US are considered cosmetic in nature. Therefore, in the current US health care system, insurance providers refuse to cover the costs for body contouring procedures, according to the authors.

Although surveys show that interest among bariatric patients is high, the true frequency of reconstruction following weight loss surgery is unknown. This research study examined the extent to which two common body contouring procedures, abdominoplasty and panniculectomy, are used following bariatric surgery in New York State. An analysis of the New York Statewide Planning and Research Cooperative System (SPARCS) database identified 37, 806 patients older than 18 years old who had undergone a bariatric procedure between 2004 and 2010 for the first time.

Procedures included sleeve gastrectomy (n=1,743), Roux-en-Y gastric bypass (n=22,428) and laparoscopic adjustable gastric banding (n=13,635). Using a unique patient identifier, the researchers tracked those patients who subsequently underwent either abdominoplasty or panniculectomy with at least a four-year follow-up (until 2014). Multivariable Cox proportional hazard model was used to evaluate predictors of follow-up BC surgery.

The researchers report that of the 37,806 patients who underwent bariatric surgery between 2004 and 2010, only 5.58% (n=2,112) of these patients subsequently had a body contouring procedure, with 143 of them (6.8%) having ≥1 plastic surgery. The average time to plastic surgery after band, bypass or sleeve was 1,134.83±671.09, 984.70±570.53 and 903.02 ± 497.31 days, respectively (p<0.0001).

In the LAGB group, 434 patients (3.18%) had one body contouring procedure and 20 (0.14%) had two or more body contouring procedures; within the bypass patients group, 1,376 (6.14%) had one body contouring procedure and 106 (0.48%) had two or more body contouring procedures: within the sleeve group, 159 (9.12%) had one body contouring procedure and 17 (0.98%) had two or more body contouring procedures. Four hundred and eight out of 2,112 (19.31%) patients who had body contouring procedures changed insurance following the index bariatric procedure.

The mean time to first plastic surgery was significantly different (p<0.05) with respect to bariatric procedure type, age, race/ethnicity, insurance, and yearly income level, but not significantly different among different gender (p=0.0542). It took longer for young patients whose age was 18–30 years old to have plastic surgery than older patients (age >30). Sleeve patients had plastic surgery sooner than band patients.

When looking at patients’ characteristics, comorbidities, and complications at the initial bariatric surgery, records between patients who ever had a plastic surgery and who did not have one up to 2014, sleeve gastrectomy patients, age group, gender, race/ethnicity, payment, yearly income level and some of the comorbidities and complications were significantly associated with having plastic surgery or not (all p<0.05). In terms of gender, more female patients (6.27%) had plastic surgery than male patients (2.92%) (p<0.0001).

“Our study shows that plastic surgery is completed by only 6% of patients following bariatric procedures,” the authors conclude. “Insurance and income make body contouring surgery affordable for these patients. Additional studies are required to examine patient attitudes toward body contouring surgery and possible barriers to utilisation.”

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