Page 21 - When surgery alone won’t cut it - Valerie Maureen Monpellier

In my opinion the current system has serious drawbacks. The first problem is that the PRS was never created for reimbursement purposes and the evaluation of excess skin by means of visual interpretation of photographs has been proven to be incon- sistent and therefore unreliable 112-114. The second problem is that psychological and physical complaints are not part of the assessment, which seems unfair. Especially because these issues seem to negatively impact patient well-being. The result of the current system is a growing population of patients who have undergone bariatric sur- gery, but have no access to post-bariatric BCS. Unfortunately, no exact figures are available for the Netherlands.
Several others have described the problem of a large post-bariatric population who don’t get reimbursed and neither do have the financial means to pay for BCS them- selves 109,110,115. The British Association of Plastic, Reconstructive and Aesthetic Sur- geons (BAPRAS) has now developed a questionnaire to define which post-bariatric patients qualify for referral and reimbursement of BCS 116. Assessment of weight loss results, medical, physical and psychological complaints of excess skin, and history of the patient are part of this questionnaire.
In the second part of this thesis, I will focus on desire for BCS, body image and ex- cess skin in the post-bariatric population. It is hypothesized that patients who have overhanging skin and desire BCS will have a more negative body image compared to patients who already had BCS. It is also hypothesized that the patients who did not undergo BCS are the patients in whom body image mediates the relationship between weight loss and depressive symptoms. Therefore, patients who did not undergo BCS will be compared with patients who already had BCS and patients who do not want BCS. In each of these groups we will assess the relationship between weight loss, de- pressive symptoms and body image. Additionally, we will conduct a mediation analy- sis to assess whether body image mediates the relationship between weight loss and depressive symptoms in the post-bariatric population. In the following study we will compare patients who desire BCS, with patients who don’t desire BCS concentrating on demographics, skin surplus and Dutch qualifications for reimbursement of BCS. Perceived reasons why patients have not undergone BCS will be evaluated. In the last chapter a new tool to decide which patients qualify for referral and reimbursement of BCS will be developed and tested. This screening tool will be a modified version of the tool created by the BAPRAS, in which weight loss results, complaints of excess skin, and history of the patient are used to decide which patients qualify for reimbursement.
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