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BAPRAS call for body contouring guidelines

Association of plastic surgeons arrange consultation to define evidence for body contouring
Lack of guidelines in UK has lead to postcode lottery

A British plastic surgery association is pushing for national guidelines for the commissioning of body contour surgery in the NHS. 

The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) are currently inviting stakeholder organisations to an initial consultation. They hope to establish the key points to be considered for the development of guidelines for body contour surgery. 

NICE currently offer no such guidelines, and BAPRAS claim that this has created a postcode lottery in body contour commissioning. Simon Kay, Professor of Hand Surgery at the University of Leeds and BAPRAS’ communications chair, said “In some parts of the country you can have this operation done on the health service, in other parts you have to go before a panel, and in other parts there’s a complete ban on it.”

While Kay described the evidence supporting the use of the surgery as “sporadic”, he said that he hoped the planned consultation would consolidate the existing evidence base. A pilot study presented at BAPRAS’ Winter Meeting by Mark Soldin, consultant plastic surgeon at Kingston and St Georges University Teaching Hospitals, indicated significant improvements in patients’ physical and emotional wellbeing following the surgery.

However, Kay was keen to emphasise that BAPRAS was not lobbying for the supply of body contouring surgery on the NHS; rather, they were seeking greater nationwide consistency in its provision. 

“We want to act as an informed adviser, rather than a lobbyist,” said Kay. “We don’t act for one group or another but we’ve realised that when the commissioning groups are making decisions about commissioning they may need authoritative advice.”

Excess skin following heavy weight loss can result in conditions including soreness, recurrent infections, functional problems, depression, difficulty with sexual function and poor body image. “Very often the weight loss will result in a patient whose diabetes is reversed, whose risk of arthritis is reduced, whose heart attack risk is reduced, but who won’t re-enter society, as it were, because of the stigmatising skin redundancy,” said Kay.

BAPRAS are hoping to attract a number of stakeholder groups to take part in the consultation, representing medical providers, patients and the Department of Health. Kay said that while he expected the patient groups to be very supportive of the commissioning, the government organisations might not consider the benefits to be worth the price of the surgery.

“The cost implications are quite considerable,” said Kay. “If you do fund the surgery, the plastic surgery after dramatic weight loss is substantially more expensive than the bariatric surgery, in terms of the length of stay, the complications, and the operating time.”

A recent study carried out by BAPRAS showed that only 45% of British GPs support the NHS offering body contouring surgery following bariatric surgery. However, Kay said he hopes that this will rise with increased awareness of the implications of the surgery. “They may not understand what’s involved – what the implications are, what the costs are, what the stress for the patient is,” said Kay. “They may not understand the utility and the benefits.”

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