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Body contouring

Costs barrier to body contouring after surgery

Bariatric surgery plus body-contouring surgery group had a significantly lower mean age (p=0.011) and reported longer time since surgery (p=0.022)
Cost was the most commonly reported barrier (87.8 percent, n=36)

High perceived costs are the major barrier to body contouring surgery for patients who have undergone bariatric surgery to remove excess skin folds, according to a study ‘Body contouring surgery after bariatric surgery: a study of cost as a barrier and impact on psychological well-being’, published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons.

The study, by psychiatrist Dr Raed Hawa and colleagues of University of Toronto, adds to recent evidence that body contouring surgery (BCS) has demonstrable mental and physical health benefits.

The investigators sought to examine barriers to access and to compare socioeconomic variables and psychological variables between bariatric surgery patients who have undergone body contouring and those who have not. Their cross-sectional study included a questionnaire packet that was administered to (1) patients who underwent bariatric but not body-contouring surgery and (2) patients who underwent both. The questionnaire included perceived barriers to body-contouring surgery, socioeconomic barriers, measures of anxiety (Generalized Anxiety Disorder seven-item scale), depression (Patient Health Questionnaire nine-item scale), and quality of life (Short Form-36).

Patients were recruited from the Toronto Western Hospital Bariatric Surgery Program, a Level 1A bariatric center accredited by the American College of Surgeons, during follow-up appointments between February 1, 2013, and August 1, 2013. All patients underwent a Roux-en-Y gastric bypass unless a sleeve gastrectomy was surgically indicated. Consent was obtained from patients for the study if they were between the ages of 18 and 65 years and had undergone bariatric surgery at least 1 year previously. Of the 71 patients who were approached for consent, 64 provided consent, and 58 completed the entire questionnaire, resulting in a response rate of 82 percent. This study was approved by the Institutional Research Ethics Board at the University Health Network in Toronto, Ontario, Canada.

The study included 58 patients from the Toronto Western Hospital Bariatric Surgery Program, a Level 1A bariatric centre during follow-up appointments between February 2013 and August 2013. Their average age was 46 years and they lost about 40 percent of their previous body weight.


Among the 58 study participants (48 underwent bariatric surgery alone and ten patients underwent both bariatric surgery and body-contouring surgery), 93.1 percent reported having excess skin folds.

Mean scores on the Generalized Anxiety Disorder scale (6.08±5.97 versus 3.50±3.10; p=0.030) and the Patient Health Questionnaire (6.40+6.77 versus 2.40±2.37; p=0.002) were significantly higher for the bariatric surgery group versus bariatric surgery plus body contouring group. Patients in the latter group had significantly higher Short Form-36 physical health component scores (56.80 ± 4.88 versus 49.57 ± 8.25; p=0.010). 

Compared with the bariatric surgery–alone group, the bariatric surgery plus body-contouring surgery group had a significantly lower mean age (p=0.011) and reported longer time since surgery (p=0.022). No significant differences between groups were reported in any other demographic variable collected.

For the 41 patients desiring body-contouring surgery, cost was the most commonly reported barrier (87.8 percent, n=36), followed by a desire for more weight loss before considering body-contouring surgery (9.8 percent, n=4) and a fear of the operation (2.8 percent, n=1). Despite cost being reported as a major barrier to undergoing body-contouring surgery, the bariatric surgery–alone group and the bariatric surgery plus body-contouring surgery group did not significantly differ from each other with respect to any of the measured socioeconomic variables (income, education, and employment).

“Our exploration of potential barriers to accessing body-contouring surgery suggests that, as hypothesized, cost was reported as the most common barrier in accessing body-contouring surgery for this patient population,” the authors write. “However, participants who pursued body-contouring surgery did not report higher income or education, and were not more likely to be employed…our study identified a relationship between lower age and body-contouring surgery in univariate analysis and a trend toward significance in multivariate analysis. Although this has not been previously identified in the literature, it is possible that patients who are younger are more invested in their appearance and may pursue unconventional methods of paying for body-contouring surgery (e.g., loans, borrowing from family). Additional research is needed to further explore this study finding.” 

Although this study confirms that cost remains a major barrier to accessing body-contouring surgery, other socioeconomic factors, including income, may not significantly differ in patients who undergo body-contouring surgery relative to those who do not undergo the procedure.

Moreover, this research also suggests that patients who undergo body-contouring surgery report less anxiety and depression relative to bariatric surgery patients experiencing excess skin folds. 

“Longitudinal studies are needed to compare the long-term physical and psychological adjustment in bariatric surgery patients who undergo body-contouring surgery following surgery and those who do not,” they conclude. “If our findings are replicated in longitudinal studies, funding for body-contouring surgery may need to be revaluated if the goal of bariatric surgery is to enhance the physical and mental well-being of patients.”

To access this paper, please click here

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