Costs Are Main Barrier to Body Contouring After Bariatric Surgery
Plastic and Reconstructive Surgery Study Adds to Evidence for Physical and Mental Health Benefits of BCS for Excess Skin Folds

PHILADELPHIA — For patients who have undergone bariatric surgery, high perceived costs are the major barrier to body contouring surgery to remove excess skin folds, reports a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The study by psychiatrist Dr. Raed Hawa and colleagues of University of Toronto adds to recent evidence that body contouring surgery (BCS)—generally regarded as a cosmetic procedure—has demonstrable mental and physical health benefits.

Cost Is Main Barrier to BCS After Obesity Surgery

The study included 58 patients, average age 46 years, who had undergone bariatric surgery for severe obesity. An average of about two years after bariatric surgery, the patients had lost about 40 percent of their previous body weight. More than 90 percent of patients developed excess skin folds after bariatric surgery.

However, only ten patients underwent BCS to remove excess skin folds—a rate of 17 percent. Body contouring surgery usually consists of abdominoplasty ("tummy tuck"), often with other procedures to remove excess skin and tissue from the breasts and upper arms.

Ninety-five percent of patients who didn't undergo BCS said they would like to have the procedure. But 88 percent perceived high costs as a barrier to undergoing BCS. About ten percent of patients said they wanted to lose more weight before considering BCS.

Although cost was the major barrier, there was no difference in income, employment rate, and other socioeconomic factors for patients who didn't undergo BCS. Younger patients were somewhat more likely to have the procedure.

Improved Mental and Physical Health Outcomes After BCS

The study showed some significant mental health benefits, including lower scores for anxiety and depression, for patients who underwent BCS.

On a quality of life questionnaire, patients who underwent BCS also had more favorable scores for physical health, compared to those who didn't have BCS. Despite the reductions in anxiety and depression, scores for mental health aspects of quality of life were not significantly different for the BCS group.

"Bariatric surgery is now considered the most effective long-term treatment for severe obesity," according to Dr. Hawa and coauthors.

In addition to reducing obesity-related health risks, bariatric surgery has been shown to lead to improvements in quality of life and psychological status.

Body contouring surgery can effectively address the excess, sagging skin folds that develop after bariatric surgery in most patients. The new study shows that although most patients want to undergo BCS after bariatric surgery, most don't do so—and perceived high costs are the main reason why.

Because of its health benefits for patients, bariatric surgery is usually covered by insurance. However, BCS is still regarded as a cosmetic procedure, and thus is not typically covered by insurance.

Recent studies in Plastic and Reconstructive Surgery have reported that BCS leads to lasting improvements in quality of life and improves long-term weight control in patients with excess skin folds after bariatric surgery.

The new study also provides preliminary evidence of mental health benefits of BCS, including reduced anxiety and depression.

Dr. Hawa and colleagues call for more research to assess long-term physical and psychological adjustment in bariatric surgery patients who undergo BCS. If the findings are confirmed by long-term follow-up studies, they conclude:

"[F]unding for BCS may need to be re-evaluated if the goal of bariatric surgery is to enhance the physical and mental well-being of patients."

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