The benefits of bariatric surgery are well known and weight losses of 100lbs or more are not uncommon. While the weight loss has tremendous medical and functional benefits, patients often do not necessarily feel better about their body. Once deflated by the weight loss the excess skin results in extensive skin excesses and rolls. It can literally affect the whole body from the neck to the knees but always the stomach and waistline areas are the biggest concerns and the first for surgical removal.
While the body contouring benefits from such large skin removals are obvious, a recent study suggested that there are other long term benefits as well. At the recent annual American Society of Plastic Surgeons meeting earlier this month, a presentation presented data that morbidly obese patients who have excess skin removed after bariatric surgery are more prone to keep the weight off than those who don’t. Out of Henry Ford Hospital in Detroit, plastic surgeons followed almost 100 patients who had bariatric surgery over a ten year period of which almost half had subsequent body recontouring plastic surgery procedures. The patients that had the plastic surgery had an average decrease in their BMI of just over 18 two and half years later. That compared to an average decrease in BMI of over 12 for those that did not have the body contouring surgery.
While bariatric surgery can have great short-term results, it is well know to have a relatively high rate of relapse with partial or full weight return in some patients. It is perhaps no surprise that those massive weight loss patients that feel the need and make the sacrifice to have body contouring have better long-term maintenance of their initial weight loss. There are numerous explanations as to why this is so but the most compelling would be their body image perception. Once you see yourself in a ‘new body’ that truly reflects what has been accomplished by weight measurements, you are more motivated to exercise and even lose more weight is some cases.
What this study shows is that many bariatric surgery patients who have excess skin should have body contouring surgery if they can. Economics is the ultimate barrier for many of these bariatric patients. While some insurance companies provide coverage for certain body contouring procedures (e.g., abdominal panniculectomy), the approval process can be arduous and often disheartening. The criteria for insurance coverage for such bariatric plastic surgeries are a large amount of weight loss (greater than 100lbs), a stable weight for six months and a documented history of chronic skin irritation or rashes. Even if approved it can be hard to find a plastic surgeon to do the procedure because of the very low insurance reimbursement rates given the amount of surgical work needed and the potential risk exposure.
But in almost any community plastic surgery care can be found to help get this reconstructive body contouring done. As this study shows, improved function and body image plays an important role in helping maintain the weight loss from bariatric surgery.
Dr. Barry Eppley
Indianapolis, Indiana