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Body Contouring Following Bariatric Surgery: How Much is Being Done?
Alyssa J. Reiffel, MD, Natalia Jimenez, BS, Whitney A. Burrell, MD, Yoann H. Millett, BA, Briar L. Dent, BA, Gregory F. Dakin, MD, Alfons Pomp, MD, FACS, Jason A. Spector, MD, FACS.
Weill Cornell Medical College, New York, NY, USA.
BACKGROUND: As a result of the widespread obesity epidemic, approximately 220,000 bariatric procedures are performed in the US annually. The massive weight loss that ensues can leave patients with large amounts of excess skin, poor cosmesis, and as studies have shown, a worsened quality of life. Despite this, 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 in the bariatric surgery population.
METHODS: A survey was designed to acquire data regarding patient demographics, the amount of pre-operative counseling given by their bariatric surgeon regarding body-contouring options, referrals to plastic surgeons, income and insurance coverage, body-contouring procedures performed, and outcome satisfaction. The survey was mailed to 1,158 patients who underwent bariatric surgery by 2 surgeons at a metropolitan tertiary care center between 2003 and 2011. Attempts were made to contact patients via telephone if they did not initially respond.
RESULTS: Forty-three surveys were returned as “unable to forward.” Of the remaining 1,115, two hundred seventy-six patients responded (24.8%). Two hundred twelve (76.8%) were female. Mean respondent age was 47.7y (range, 20-74y). One hundred fifty-one (54.7%) completed a college education. Over one-third of all respondents reported an annual household income <$50,000. Minorities represented 44.9% of the respondent population. Insurance covered 97.5% of bariatric procedures. Seventy respondents (25.4%) reported discussing body contouring surgery with their bariatric surgeon, either preoperatively or postoperatively. Of these patients, 59 (84.3%, or 21.4% overall) found the time spent discussing such options sufficient. The Internet was the most commonly used resource for obtaining supplemental information regarding body contouring procedures. Thirty-nine respondents (14.4%) were referred by their bariatric surgeon for consultation with a plastic surgeon, thirty-three (84.6%, or 12.2% overall) of whom actually saw a plastic surgeon. Thirty-two (11.6%) respondents (including 14 who self-referred for plastic surgery consultation) underwent 54 body contouring procedures including 22 abdominoplasties/panniculectomies, 11 mastopexies/breast reductions, and 9 belt lipectomies. The most frequent reasons cited for not undergoing plastic surgery were expense (28.6%) and lack of awareness regarding surgical options (23.2%). Ninety-eight (35.5%) report that although they were not given information regarding body contouring plastic surgery, they would consider inquiring about it in the future. One hundred eight (39.1%) respondents report that they might have chosen to undergo body contouring surgery had they received more information beforehand.
CONCLUSION: These data represent the largest known study to examine the frequency of body-contouring procedures in the post-bariatric surgery population as well as patient education regarding its availability. In addition, our study demonstrates that as a result of insufficient perioperative counseling, the majority of bariatric surgery patients are unaware of the multitude of body-contouring procedures available to them. Furthermore, a large subset demonstrate an interest in further pursuing such options but feel they are unable to afford them. Additional efforts towards improving patient (and surgeon) education regarding post-bariatric body-contouring options are warranted.
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