Page 111 - When surgery alone won’t cut it - Valerie Maureen Monpellier

BCS was described as a lottery 30. The British Association of Plastic, Reconstruc-o tive and Aesthetic Surgeons (BAPRAS) has therefore developed a guideline to define which post-bariatric patients qualify for referral and reimbursement of BCS 32. In this guideline, a questionnaire is used to decide if the patient qualifies for reimbursement using questions regarding weight loss, complaints of excess skin, and history of the patients. In Mexico, Iglesias et al set up a classification system using only the amount of overhanging skin 31.
Considering all above, there seem to be two main problems. First, the problem we see in daily practice: the current criteria are not interpreted in a uniform way. As a result, some patients get reimbursement and some patients do not; even though the amount of excess skin is the same. Second, the problem that is masked: only a mi- nority of patients consult the plastic surgeon because they assume that they will not get reimbursed. This is, at least partially, caused by the fact that patients are unaware of the current guidelines. Patients with a poor financial status might be too afraid or unequipped to stand up for themselves and try to get a reimbursement. Psychological factors like self-esteem and self-worth could also influence whether a patient will ask for a referral and/or react against the insurance companies. A more extensive analysis of these patients should therefore be a part of future research.
Thus, there is a worldwide need for an objective and reproducible guideline to decide which patients should qualify for referral and reimbursement of BCS. This guideline has to be broadly spread and properly communicated to the bariatric population. Such a guideline will also be helpful for the plastic surgeons, as it reduces the amount of consultations with patients who do not qualify for BCS. It should not only include a questionnaire, but also an objective measurement of the amount of excess skin. Different countries can then decide their own qualification norms for reimbursement, depending on the system in the country and available funding for BCS.
For now, in our clinic, we have started informing patients about the current qualifica- tions for BCS reimbursement before bariatric surgery. At the follow-up after bariatric surgery, excess skin is a standard part of assessment, urging people to visit a plastic surgeon when they qualify according to current guidelines. Patients respond very pos- itive to the fact that so much attention is paid to these complaints.
A limitation is that we did not use a validated questionnaire and patients were not examined. Therefore, we do not know the exact extent of overhanging skin and can’t conclude which patients should be reimbursed per the current Dutch guidelines. Our goal was to show how post-bariatric patients perceive their overhanging skin and which patients meet the weight criteria. The study was set up based on the com- plaints of post-bariatric patients we encounter in the clinic. We specifically choose to set up a questionnaire with open questions to assess how the patients really feel and
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