Body-Contouring Following Bariatric Surgery: How Much is Being Done?

BACKGROUND: As a result of the widespread obesity epidemic, over 150,000 bariatric procedures are performed in the United States annually. The massive weight loss that typically ensues can leave patients with large amounts of excess skin, poor cosmesis, and as a result, a worsened quality of life. Despite the frequency with which weight-reduction surgeries are performed, the proportion of post-bariatric surgery patients who undergo subsequent body-contouring procures is unknown. We therefore designed a study to explore demographic features and patient education regarding body-contouring procedures in the bariatric surgery population.

METHODS: A survey was designed to acquire post-bariatric patient data including age, weight-loss parameters, income and insurance coverage, the extent of preoperative counseling performed by their bariatric surgeon regarding body-contouring options, referrals to plastic surgeons, body-contouring procedures performed, and outcome satisfaction. The survey was mailed to 501 patients who underwent bariatric surgery by a single surgeon between 2004 and 2010.  Attempts were made to contact non-responders via telephone.

RESULTS: One hundred twenty-eight patients responded (25.5%).  One hundred four (82.3%) were female.  Mean respondent age was 45.7 years (range, 20-74). Fifty-seven (44.5%) completed a college education.  Over half of all respondents reported an annual household income <$50,000. Insurance covered 96.1% of bariatric procedures.  Thirty (23.4%) report discussing body-contouring surgery with their bariatric surgeon, either preoperatively or postoperatively.  Fifteen (11.7%) were referred for consultation with a plastic surgeon, while only 9 (7.0%) underwent any body-contouring procedure (2 reduction mammoplasties and 7 abdominoplasties/panniculectomies). The most frequent reasons cited for not undergoing plastic surgery were expense (33.0%) and lack of awareness regarding surgical options (35.8%).  Fifty-six (43.8%) report that although they were not given information regarding body-contouring plastic surgery, they would consider inquiring about it now.  Approximately half of all respondents report that they might have chosen to undergo body-contouring surgery had they received more information beforehand.

CONCLUSION: As a result of insufficient pre- and post-operative counseling, the majority of bariatric surgery patients are unaware of the multitude of body-contouring procedures available.  Furthermore, a large subset of these patients demonstrate an interest in further pursuing such options but are unable to afford them.  Additional efforts towards improving patient (and surgeon) education regarding post-bariatric body-contouring options are warranted.  Therefore, we as plastic surgeons must ensure that we reach this underserved demographic.