Body Contouring Procedures Could Contribute to the Long-term Success of Bariatric Patients in Maintaining Weight Loss

Dear Bariatric Times Editor:
As the number of bariatric procedures being performed has increased, so has the number of patients presenting for body contouring procedures after significant weight loss. Despite the desire of many post-bariatric patients to undergo these procedures, only 21 percent of patients actually undergo them.[1] Several barriers contribute to this low number, including out-of-pocket cost, lack of insurance coverage, limited access to a qualified plastic surgeon, and general unawareness that these procedures exist.
As bariatric surgery has erroneously been labeled by some as an easy fix for weight loss, so too have body contouring procedures been stigmatized as being medically unnecessary, cosmetic, and selfish. This could not be further from the truth. These procedures help resolve recurrent skin manifestations directly related to the excess skin, improve hygiene, and improve patients’ quality of life. As a plastic surgeon whose practice focuses on treating patients following weight loss, I can attest to the fact that these surgeries can be life changing. Unfortunately, insurance companies currently do not view these procedures as being cost-effective, and they have little regard for their impact on patients’ quality of life. In many plans, these procedures are not even covered, despite documentation of medical issues secondary to excess skin.
To improve coverage for these procedures, further research is needed to demonstrate the medical benefit that body contouring procedures have on weight loss patients. To this end, in an article by Balagué et al2 published in Plastic & Reconstructive Surgery, the authors demonstrated for the first time that body contouring procedures could contribute to the long-term success of bariatric patients in maintaining their weight loss. The study evaluated two groups of patients: one group underwent Roux-en-Y gastric bypass (RYGB) only and the other group underwent RYGB and subsequent body contouring. Patients were longitudinally followed, and at seven years following RYGB, patients that underwent body contouring surgery were better able to maintain greater than 50 percent of their excess body weight loss compared to those that did not undergo body contouring procedures (75% vs 29.2%, respectively).
This is the first paper that has demonstrated that body contouring surgery may contribute to a better long-term weight reduction after bariatric surgery. As weight gain following bariatric surgery may be associated with the return of medical comorbidities, body contouring procedures may prove to be an integral component of the patient’s overall treatment plan. This research will hopefully allow insurance companies to realize the reconstructive and medical benefits of body contouring procedures and influence future coverage for these procedures. Although this study shows promising data, more cost-effective research is needed.
As only 33 percent of bariatric surgeons regularly refer their patients for body contouring procedures,[3] these results will hopefully encourage additional patient education on the options available to remove the excess skin that frequently occurs after weight loss. These findings may also motivate patients to consider body contouring surgery as part of their comprehensive weight loss plan.

Sincerely,

Joseph Michaels, MD
Private Practice, North Bethesda, MD
Assistant Professor, Department of Plastic Surgery, Johns Hopkins Medicine, Baltimore, Maryland

References
1.    Kitzinger HB, Abayev S, Pitterman A et al. After massive weight loss: Patient’s expectations of body contouring surgery. Obes Surg. 2012;22:544–548.
2.    Balagué N, Combescure C, Huber O et al. Plastic surgery improves long-term weight control after bariatric surgery. Plas Reconstr Surg. 2013;132:826–833.
3.    Warner JP, Stacey DH, Sillah NM et al. National bariatric surgery and massive weight loss body contouring survey. Plas Reconstr Surg. 2009;124:926–933.

Tags: bariatric surgery, body contouring, weight loss

Category: Letters to the Editor, Past Articles