Plastic Surgery After Bariatric Surgery and Massive Weight Loss

Abstract

My colleagues and I thank Drs Knoetgen, Petty, and Johnson for their interest in our article, and we agree that patients with massive weight loss usually require further surgery to reduce excess skin. The challenge is convincing an insurance carrier that the skin presents a functional problem, unless, as discussed in our article, the patient has experienced recurrent dermatitis or cellulitis. We attempted to increase awareness of the need for additional skin reduction surgery by discussing the issue in a separate section within the article. Perhaps a better statement would be, “In a large fraction of patients after bariatric surgery, problems with excess skin and proposed surgical treatment are considered cosmetic issues by insurance carriers. However, because excess skin after bariatric surgery may introduce definite functional impairment for the patient, skin reduction surgery should instead be considered reconstructive.” This distinction is important because the goal of such surgery is to render to as close to normal as possible those body parts that have been rendered abnormal as a part of a disease process (ie, a goal of reconstructive surgery) rather than to improve normal body structure and appearance (ie, the primary goal of cosmetic surgery). Plastic Surgery After Bariatric Surgery and Massive Weight LossMayo Clinic ProceedingsVol. 80Issue 1PreviewTo the Editor: We read with great interest the article on bariatric surgery by Presutti et al1 in the September 2004 issue of Mayo Clinic Proceedings. The authors provided an excellent review of the indications, details, and outcomes of bariatric surgery. However, we believe that they understated the considerable need that most of these patients have for reconstructive surgery, as opposed to “cosmetic surgery,” after their massive weight loss. The authors stated that “in most circumstances, such excess skin is a cosmetic problem.” We argue that the opposite is true. Full-Text PDF