Body Contouring After Obesity Surgery — Effective, But Expensive
Costs Soar in Patients With Severe Complications, Reports Plastic and Reconstructive Surgery

After bariatric surgery, body contouring surgery to remove excess skin has important benefits for patients—but carries substantial costs for health care systems, suggests a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"[B]ody contouring surgery after massive weight loss requires attention by patients and professionals," according to the report by plastic surgeon Dr Jordi Vilà Poyatos and colleagues of Hospital Universitari Germans Trias i Pujol, Barcelona. They note that body contouring surgery is a procedure in high demand that is effective in improving quality of life (QoL), but is also very costly—especially when serious complications occur.

High Costs of Body Contouring in Public Health System

The researchers analyzed the costs of body contouring surgery in patients treated at a morbid obesity unit, covered by the Spanish public health care system. Body contouring surgery addresses the excess, sagging skin folds that develop after bariatric surgery in most patients.

The study included 100 patients—77 women and 23 men, average age 48.5 years. Bariatric surgery reduced the patient's body mass index by average of about 21 kilograms per square meter. (Morbid obesity is commonly defined as a BMI of 40 or higher.)

The average number of body contouring procedures was 1.66 per patient. This included 109 surgeries to remove excess skin and tissue on the lower part of the trunk, 43 on the thighs (cruroplasty), 28 on the arms (brachioplasty), and 10 on the upper part of the trunk.

Body contouring surgery was expensive. Overall median cost was estimated at about 8,300 euros per patient (roughly 11,000 US dollars, at current exchange rates).

Although complications occurred in up to half of patients, they were usually not serious. Only about ten percent of patients had severe complications. For this group, the costs of body contouring surgery tripled: about 24,000 euros.

Surgery Has Benefits; Patients Underestimate Costs

In follow-up surveys, patients agreed that body contouring surgery led to significant improvements in QoL. However, they estimated the cost of the surgery about 2,000 euros (18 percent) cheaper than its real cost.

Research has shown that body contouring surgery has important health benefits for patients with massive weight loss after bariatric surgery. But relatively few studies have focused on the costs of body contouring, especially in countries with public health systems. Most US studies have focused on the issue of insurance coverage, rather than actual costs.

The results lend new insights into the costs of body contouring, with sharply higher costs for patients who have severe complications. Dr Vilà and coauthors note that criteria for medical necessity differ between the United States and Spain, and may differ for insurance companies versus public health systems.

A recent study in Plastic and Reconstructive Surgery reported that costs are the main barrier to body contouring after bariatric surgery. The ASPS has suggested insurance coverage criteria for body contouring surgery after weight loss.

"Body contouring treatment after massive weight loss requires attention by the patients and professionals because is a surgery in high demand that improves the QoL, but [also] has important costs…in public health systems," Dr Vilà and colleagues conclude. They believe that plastic surgeons and other professionals who care for bariatric surgery patients should be aware of these costs and discuss them with patients.

Plastic and Reconstructive Surgery is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.