title: Patterns of plastic surgical use after gastric bypass: who can afford it and who will return for more.
abstract: BACKGROUND
  More patients are undergoing plastic surgery after gastric bypass. Socioeconomic factors influencing the decision to have body contouring after gastric bypass have not been studied in the current literature.
  
  
  METHODS
  In this study, 2501 consecutive gastric bypass patients were surveyed. Outcome variables were assessed by univariate and multivariable analyses.
  
  
  RESULTS
  Nine hundred twenty-six patients (817 women and 109 men) responded (40.3 percent of the 2296 surveys that at least may have been received), with a mean follow-up of 2.4 years. One hundred five (11.3 percent) underwent body contouring. Thirty-four patients assumed all costs for body contouring, and of these, 47 percent had multiple operations. Sixty-eight patients had some insurance coverage; 26 percent of these patients personally paid for additional body contouring. Having multiple procedures was not explained by any variables in our model. Body contouring was related to years since gastric bypass (p < 0.0001), post-gastric bypass body mass index (p < 0.03), change in body mass index (p < 0.0001), open versus laparoscopic gastric bypass (p < 0.0001), and income category greater than $20,000 (p < 0.03). Expenditures for body contouring were greater if the patient assumed costs versus had some insurance (p < 0.03), but were not related to income. Patients who assumed all costs of body contouring had lower pre-gastric bypass and post-gastric bypass body mass indexes (p < 0.007).
  
  
  CONCLUSIONS
  A minority of patients underwent body contouring. Patients assuming the costs of body contouring were twice as likely to have additional surgery. These results suggest that socioeconomic factors play an important role in the decision to have body contouring but may not predict who will have concomitant or additional procedures.
authors.affiliation: Rochester, N.Y. From the Division of Plastic Surgery and the Department of Biostatistics and Computational Biology, University of Rochester.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.forename: Susan
authors.initials: S
authors.lastname: Messing
authors.forename: William
authors.initials: W
authors.lastname: O'Malley
authors.forename: Howard N
authors.initials: HN
authors.lastname: Langstein