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      Funding for Postbariatric Body-Contouring (Bariplastic) Surgery in England: A Postcode Lottery

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          Abstract

          Background. With the increase in bariatric surgery in the UK, there has been a substantial increase in patients undergoing massive weight loss (MWL) seeking postbariatric body-contouring (bariplastic) surgery. However, there is a wide variation of availability on the National Health Service (NHS). Aims. To (1) review the funding policies of Primary Care Trusts (PCTs) in England for bariplastic surgery and (2) analyse the number of procedures funded in two consecutive financial years. Methods. We sent out questionnaires to all PCTs in England regarding their funding policies for bariplastic surgery and requested the number of procedures funded in 2008-09 and 2009-10. Findings. 121/147 (82%) PCTs replied to our questionnaires. 73 (60%) excluded all bariplastic procedures. 106/121 (87.6%) PCTs had referral guidelines for plastic surgery. 46/121 (38%) PCTs provided the total number of funded abdominoplasty-apronectomy (A-A) in the two financial years: total number of A-A applicants rose from 393 to 531, but approval for funding fell from 24.2% to 19.6%. Only 3 (2%) PCTs indicated increase in their future spending on bariplastic procedures in the next 5 years, with 67% planning to decrease or unsure about future funding. Conclusion. There exists a postcode lottery for bariplastic surgery in England and we feel the need for guidelines on provision of bariplastic procedures following MWL.

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          Body image and quality of life in post massive weight loss body contouring patients.

          Angela Y Song, J Peter Rubin, Veena Thomas … (2006)
          Because post-bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including body image. Presently, few data are available documenting body image and weight-related quality of life in this population. Eighteen patients who underwent both bariatric surgery and body contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess body perception and ideals, quality of life, and mood. Patients were surveyed at the following time-points: pre-body contouring (after massive weight loss) and both 3 and 6 month post-body contouring. Statistical testing was performed using Student's t test and ANOVA. The mean age of the patients was 46 +/- 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after body contouring. Three months after body contouring, subjects ascribed thinner silhouettes to both current appearance and ideal body image. Body image also improved with body contouring surgery. Mood remained stable over 6 months. Body contouring after surgical weight loss improved both quality-of-life measurements and body image. Initial body dissatisfaction did not correlate with mood. Body contouring improved body image but produced dissatisfaction with other parts of the body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post-surgical weight loss patients.
          Article 0 comments Cited 56 times – based on 0 reviews     Review now
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            Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital.

            Keith C Neaman, Karen E. Hansen (2007)
            The number of abdominoplasties performed in the United States has been steadily increasing over the past decade. A large proportion of these patients are bariatric patients who remain obese despite prior weight-reduction surgery. This study was done to review the experience of patients undergoing abdominoplasty at a university hospital. A retrospective chart review of 206 consecutive patients was performed. The overall complication rate was 37.4%. Major complications [hematoma requiring surgical intervention, seroma requiring aspiration or surgical drainage, cellulitis or abscess requiring hospitalization and intravenous (IV) antibiotics, deep vein thrombosis (DVT), and pulmonary embolism (PE)] occurred in 16% of patients. The rate of minor complications (hematoma or seroma requiring no intervention, epidermolysis, small-wound dehiscence, neuropathic pain, and minor cellulitis) was 26.7%. Obese patients had a significantly increased risk of developing major complications as compared with nonobese patients (53.4% versus 28.8%, P = 0.001). An in-depth analysis of all complications and risk factors was done.
            Article 0 comments Cited 51 times – based on 0 reviews     Review now
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              The desire for body contouring surgery after bariatric surgery.

              James E Mitchell, Ross D Crosby, Troy W Ertelt … (2008)
              Obesity has become far more prevalent over the last few decades. In parallel, bariatric surgery has been increasingly utilized as a method of treatment. This appears to be having an impact on the rate of body contouring surgery for hanging redundant skin after the massive weight loss that usually results from bariatric surgery. Little literature is available addressing how frequently patients who have undergone bariatric surgery receive or desire body contouring surgery or regarding how satisfied these patients are with the hanging skin in certain body areas. Seventy individuals (out of 250 who were mailed the questionnaire) who had undergone Roux-en-Y gastric bypass surgery 6-10 years previously completed a questionnaire, which obtained information regarding their experiences with as well as their desire for body contouring surgery and more general body area satisfaction. Thirty three of the seventy patients reported having undergone a total of 38 body contouring procedures. The most common were abdominoplasties (24.3%), breast lifts (8.6%), and thigh lifts (7.1%). However, subjects were not uniformly satisfied with body areas that had undergone body contouring surgery; some found the areas unattractive. The majority of patients, at least to some extent, desired body contouring surgery, often in several areas, most notably the waist/abdomen, rear/buttock, upper arms, and chest/breast. Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.
              Article 0 comments Cited 35 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Plast Surg Int
                Journal ID (iso-abbrev): Plast Surg Int
                Journal ID (publisher-id): PSI
                Title: Plastic Surgery International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-1461
                ISSN (Electronic): 2090-147X
                Publication date (Print): 2014
                Publication date (Electronic): 20 March 2014
                Volume: 2014
                Electronic Location Identifier: 153194
                Affiliations
                1Bariatric Surgery Unit, Homerton University Hospital, Homerton Row, Homerton, London E9 6SR, UK
                2Centre for Digestive Diseases, Blizard Institute, Queen Mary University of London, London E1 2AT, UK
                Author notes

                Academic Editor: Bishara S. Atiyeh

                Author information
                http://orcid.org/0000-0002-8596-7960
                Article
                DOI: 10.1155/2014/153194
                PMC ID: 3980931
                PubMed ID: 24778870
                SO-VID: 81f3c40b-4bdf-493e-b953-b44871dea415
                Copyright © Copyright © 2014 Samrat Mukherjee et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 September 2013
                Date accepted : 6 February 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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