Weight loss surgery, also known as bariatric surgery, has become a very popular surgical procedure in our country where obesity is epidemic. I see patient after patient who has lost more than 100 pounds, many times even without bariatric surgery. Their complaint is the excess skin that has replaced the excess fat, and they want to remove this with body contouring procedures such as tummy tucks, arm and thigh lifts, breast lifts with or without implants, and face/neck lifts. Not only do these procedures offer a significant improvement in appearance as well as freedom from the unwanted physical effects of the excess skin, but a recent study in the October issue of Plastic and Reconstructive Surgery (PRS 2013;132:829-833) concludes that patients who undergo bariatric surgery followed by body contouring surgery maintain their weight loss much better than those patients who do not have plastic surgery.
In the study, gastric bypass surgery patients lost an average of 100 pounds in the first two years following bypass surgery. If the patient did not undergo body contouring, they regained 10.8% of their weight between 2 and 7 years after surgery. If plastic surgery was done to contour away the excess skin, however, the average weight gain at 7 years was only 3.6%. Some of the weight loss in those patients who had plastic surgery was due to the weight of the excess skin removed, but even when this is taken into account, their weight gain only averaged 10.5 pounds versus 44 pounds if no body contouring was done. Certainly those patients who undergo body contouring surgery are more pleased with their final outcome following weight loss, and this study now points out the additional benefit that plastic surgery conveys, namely that weight loss is better maintained.
Why does this happen? Some have theorized that the excess fat that still remains in the tummy area following bariatric surgery produces a hormone that increases appetite. Removing the skin and fat with plastic surgery decreases the amount of hormone and thus decreases the appetite. Many of these patients who have had plastic surgery report a decreased appetite, supporting this theory. There is also the improved bodily appearance that results from plastic surgery, something that patients wish to maintain by keeping their weight under control.
In view of this study, it would seem that those insurance companies who cover bariatric surgery may also want to consider coverage of needed body contouring procedures afterwards to try to reduce the weight gain that follows bariatric surgery. If the goal is to treat obesity, then a better final outcome can be obtained by combining the two. In this author’s opinion, optimal treatment of obesity should also include body contouring surgery.
What do you think? Please feel free to comment.
George Sanders, M.D.