Only a small percentage of obese patients who have undergone bariatric surgery to help them control their weight follow up this procedure with further plastic surgery to reshape their bodies and remove excess rolls of skin. Such body contouring surgery is generally only affordable to patients with adequate insurance and income, says Maria Altieri of Stony Brook University Hospital in the US, lead author of a study in Springer’s journal Obesity Surgery.

Along with the growing obesity problem in the US, there has been an increase in the number of patients who undergo weight loss procedures in order to reduce the severity of obesity related complications. Most adult patients are, however, left with excess redundant skin. Recent surveys have shown that up to 75 percent of women and 68 percent of men are interested in plastic surgery after losing weight, and are especially interested in undergoing body contouring procedures of the waist and abdomen. Contrary to popular belief, excess skin is also an issue for younger patients, who can experience personal hygiene problems, skin infections and ulcers. Such problems can cause severe psychosocial stress.

Although the health and medical benefits of bariatric surgery leading to massive weight loss are easily noticeable, measurable and thus universally insured, the benefits of plastic surgery following bariatric surgery are less so. Most of the 127,967 surgeries performed in the US are considered cosmetic in nature. Therefore, in the current US health care system, insurance providers refuse to cover the costs for body contouring procedures.

Although surveys show that interest among bariatric patients is high, the true frequency of reconstruction following weight loss surgery is unknown. This research study examined the extent to which two common body contouring procedures, abdominoplasty and panniculectomy, are used following bariatric surgery in New York State. An analysis of the New York SPARCS database identified 37, 806 patients older than 18 years old who had undergone a bariatric procedure between 2004 and 2010 for the first time. Only 2,112 patients (5.58 percent) underwent subsequent body contouring procedures. Of these, 93.2 percent (1969 patients) underwent only one plastic surgery procedure, while 6.8 percent (143 patients) had more work done.

The findings revealed certain trends. Body contouring procedures usually occurred within two years after the initial bariatric procedure. One year normally followed between a first body contouring procedure and a second. Patients younger than 30 years and those who had undergone a sleeve gastrectomy went for plastic surgery sooner than others. Women, patients with health insurance such as Medicare or Medicaid, those with higher incomes or who had undergone sleeve gastronomy were more likely to have it done.

“Our study shows that plastic surgery is completed by only 6 percent of patients following bariatric procedures,” say Altieri and senior author Aurora Pryor. “As insurance and income are associated with pursuing surgery, improved access may increase the number of patients who are able to undergo these reconstructive procedures.”

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