Page 143 - When surgery alone won’t cut it - Valerie Maureen Monpellier
P. 143

EXCESS SKIN
In chapter 6, we studied the characteristics of the post-bariatric population in relation to desire for BCS. As in previous literature, almost two thirds of the patients desired BCS and about one in ten patients already had a body contouring procedure 53-56. The most common locations for excess skin and severity of complaints were also similar 54, 57-59. Patients who desired BCS were usually younger, had lower income levels and a larger part was unemployed 53, 60, 61. Interestingly, patients with a desire for BCS were usually quite satisfied with their total body, but rated specific body parts very low 54, 57. These body parts are probably also the parts in which they experience overhanging skin, since the extend of overhanging skin correlates with satisfaction of these body parts 54. The fact that all our findings regarding excess skin and complaints are com- parable to the post-bariatric populations in other countries suggests that our results can be extrapolated. But also, that there is a distinct “post-bariatric population” with the same problems worldwide.
REIMBURSEMENT OF BODY CONTOURING SURGERY
Reimbursement of BCS, or the lack of it, is a worldwide problem. In most countries, there is no clear and objective system to decide which patients qualify for reimburse- ment or the system is not implemented 53, 60, 62-64. Therefore, it is essential that there are clear criteria for reimbursement of BCS that can be easily applied. Another important aspect is that these criteria are properly communicated to the bariatric patients.
The results of chapter 6 showed that patients are not well educated on the guidelines and they often wrongly assume that BCS will not be reimbursed. This results in a large population of patients who do meet the current Dutch weight criteria for reimburse- ment, but never consult a plastic surgeon. These are the patients who might regain weight on the long-term. It can be that financial status, self-esteem and having the power to stand up for themselves, also influences whether patients will consult a plas- tic surgeon. It is, therefore, essential to educate bariatric patients about the possibility of excess skin and guidelines for reimbursement. Ideally this education starts before the bariatric procedure, so that patients are aware of the problems they might face after surgery.
The current Dutch system lacks thorough evaluation of the post-bariatric patient: it does not include weight loss results, psychological complaints or physical complaints caused by the excess skin. In chapter 7 we developed a new screening tool for post-bariatric BCS in which all these parameters are included. The tool selected the patients with the highest weight loss and the most complaints of excess skin. We included the BODY-Q in this tool. The results demonstrated that patients with a desire
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