What is the role of plastic surgery in the health of post-bariatric patients?

Dear Editor,

The benefits of bariatric surgery in the treatment of morbid obesity have been widely presented and include significant weight loss, remission of obesity-related comorbidities, and improved quality of life. Nevertheless, treatment for obesity should be multidisciplinary, and the benefits of post-bariatric plastic surgery are important and have been well documented.

The common sequelae of successful weight loss remain stigmatized in the form of excess skin and soft tissue. Post-bariatric plastic surgery helps to promote the social and psychological reintegration of these patients, who have already endured the long-standing effects of obesity. In addition, after gastroplasty, these plastic surgery procedures are aimed at optimizing the functional results obtained from bariatric surgery by removing excess skin¹.

Bariatric patients’ quality of life stabilizes or even declines after the second year of gastric bypass surgery. This can be attributed to the changes in their physical appearance and the decline linked to their dissatisfaction of their own body image. Reconstructive plastic surgery plays an important role in the long-term stabilization of the quality of life of patients with massive weight loss after bariatric surgery².

Like generalized dermatochalasis resulting from expressive weight loss, bariatric surgery also leads to other medical implications such as intertrigo, fungal infections, and functional limitations to locomotion, urination, and sexual activity.

Post-bariatric plastic surgery may also improve functional results and increase physical activity, as observed in patients who had undergone reduction mammoplasty. In connection to this benefit, significant evidence suggests that post-bariatric plastic surgery helps maintain the weight loss achieved with bariatric surgery³. Inadequate weight control or regain is associated with the recurrence of comorbidities and negative impact on patient health; therefore, maintaining weight loss is of utmost importance.

The American Society of Plastic Surgeons reports that post-bariatric body contouring procedures correspond to the fastest growing sector in plastic surgery. Similarly, studies show that 75% to 84.5% of post-bariatric patients wish to undergo plastic surgery procedures. However, the percentage of patients who actually undergo a reconstructive surgical procedure is <21%, even in developed countries such as Austria, where the public health system funds the procedure. In this country, 14.9% of 622 post-bariatric patients underwent reconstructive plastic surgery. Therefore, only 1 (14.9%) in 6 post-bariatric patients underwent plastic surgery procedures⁴.

In the United States, Altieri et al.⁵ demonstrated that only 6% of patients who had undergone bariatric procedures (gastric bypass or band, or sleeve) subsequently underwent reconstructive plastic surgery within the first 4 years after the bariatric procedure. Of these post-bariatric patients who underwent plastic surgery, 93% underwent only one reconstructive procedure.

The reasons why many post-bariatric patients do not undergo plastic surgery procedures include the lack of disclosure of the benefits of post-bariatric plastic surgery, the lack of coverage by health insurance plans for body contouring procedures, the patients’ inability to pay for such procedures, and fear of complications from such surgeries. In Brazil, we can add to these reasons the inability of the Unified Health System to meet the huge and growing demand for these procedures.

The benefits of plastic surgery procedures for post-bariatric patients are significant and need to be documented and presented so that patients, health professionals, health insurance plan managers, and the public health system are made aware of the importance of plastic surgery in the multidisciplinary treatment of morbid obesity.

• Institution: Hospital Regional da Asa Norte, Brasília, DF, Brazil.

COLLABORATIONS
• JLSM  Analysis and/or data interpretation, Final manuscript approval, Writing - Original Draft Preparation, Writing - Review & Editing
• SCR  Analysis and/or data interpretation, Conception and design study, Methodology, Writing - Review & Editing

REFERÊNCIAS

• ¹
  Rosa SC, Macedo JLS, Canedo LR, Casulari LA. Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: a retrospective cohort. Surg Obes Relat Dis. 2019;15(3):447-55.
• ²
  Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B. Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg. 2013;23(1):24-30.
• ³
  Vries CEE, Kalff MC, Praag EM, Florisson JMG, Ritt MJPF, Van Veen RN, et al. The influence of body contouring surgery on weight control and comorbidities in patients after bariatric surgery. Obes Surg. 2020;30(3):924-30.
• ⁴
  Felberbauer FX, Shakeri-Leidenmuhler S, Langer FB, Kitzinger H, Bohdjalian A, Kefurt R, et al. Post-bariatric body-contouring surgery: fewer procedures, less demand, and lower costs. Obes Surg. 2015;25(7):1198-202.
• ⁵
  Altieri MS, Yang J, Park J, Novikov D, Kang L, Spaniolas K, et al. Utilization of body contouring procedures following weight loss surgery: a study of 37,806 patients. Obes Surg. 2017;27:2981-7.

Publication Dates

• Publication in this collection
  19 May 2023
• Date of issue
  Jan-Mar 2020

History

• Received
  24 Feb 2020
• Accepted
  02 Mar 2020