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Excess skin

Contouring can improve weight control after bypass

Insurance should cover body contouring

Body contouring surgery to remove excess skin improves long-term weight control in patients after gastric bypass surgery, claims a study in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Since maintaining weight loss to reduce long-term health problems is the key goal of bariatric surgery, the researchers believe that body contouring should be considered reconstructive rather than cosmetic surgery for patients who have achieved massive weight loss.

"We demonstrated that patients with body contouring present better long-term weight control after gastric bypass," said study author, Dr Ali Modarressi and colleagues of University of Geneva, Switzerland.

The researchers compared long-term weight outcomes for two groups of patients who underwent gastric bypass surgery. In 98 patients, gastric bypass was followed by body contouring procedures to remove excess fat and skin. A matched group of 102 patients with similar characteristics underwent gastric bypass alone, without body contouring.

Body contouring surgery usually consisted of abdominoplasty (tummy tuck), often with other procedures to remove excess skin from the breasts, legs and upper arms. Within two years after gastric bypass, the patients had lost an average of nearly 100lbs. In subsequent years, patients who underwent body contouring regained less weight: an average of just over one pound per year, compared to 4lbs per year for patients who had gastric bypass only.

Seven years after gastric bypass, patients who underwent body contouring surgery achieved an average weight of 17lbs, and those with bariatric surgery alone, 220lbs. The average weight before gastric bypass was 275lbs in both groups.

Patients who underwent body contouring had regained about four percent of their initial body weight, compared to 11 percent for those who had gastric bypass only. After accounting for the weight of excess skin removed, average weight regain was about 14lbs in patients who had gastric bypass plus body contouring, compared to nearly 50lbs with gastric bypass only.

The researchers believe their study adds to the argument that body contouring should be considered an essential part of successful bariatric surgery and, because of its favourable effects on patient health, should be covered by insurance plans.

“Therefore, body contouring must be considered as a reconstructive operation in the treatment of morbid obesity,” the researchers conclude, "Since plastic surgery after massive weight loss is mandatory for quality of life improvement and weight loss maintenance in many patients, body contouring must be considered a reconstructive surgery for those who have achieved massive weight loss.

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