title: Body contouring surgery after bariatric surgery: a study of cost as a barrier and impact on psychological well-being.
abstract: BACKGROUND
  Body-contouring surgery can be a solution to excess skin folds following bariatric surgery. Many patients desire body-contouring surgery, but the cost of the procedure may be a limiting factor. This study aims to examine barriers to access and to compare socioeconomic variables and psychological variables between bariatric surgery patients who have undergone body contouring and those who have not.
  
  
  METHODS
  In this cross-sectional study, a questionnaire packet was administered to (1) patients who underwent bariatric but not body-contouring surgery and (2) patients who underwent both. The questionnaire included perceived barriers to body-contouring surgery, socioeconomic barriers, measures of anxiety (Generalized Anxiety Disorder seven-item scale), depression (Patient Health Questionnaire nine-item scale), and quality of life (Short Form-36).
  
  
  RESULTS
  Among the 58 study participants, 93.1 percent reported having excess skin folds. Of this sample, 95.4 percent desired body-contouring surgery, and the majority (87.8 percent) of this subsample identified cost as the major barrier to access. Mean scores on the Generalized Anxiety Disorder scale (6.08 ± 5.97 versus 3.50 ± 3.10; p = 0.030) and the Patient Health Questionnaire (6.40 ± 6.77 versus 2.40 ± 2.37; p = 0.002) were significantly higher for the bariatric surgery group versus bariatric surgery plus body contouring group. Patients in the latter group had significantly higher Short Form-36 physical health component scores (56.80 ± 4.88 versus 49.57 ± 8.25; p = 0.010).
  
  
  CONCLUSIONS
  Bariatric surgery patients who desire body-contouring surgery perceive cost as a major barrier. Patients undergoing body-contouring surgery may experience improved physical quality of life but not mental quality of life; however, body-contouring surgery may improve aspects of depression and anxiety.
authors.affiliation: Toronto, Ontario, Canada From the Faculty of Medicine, Division of General Surgery, University Health Network, the Departments of Surgery and Psychiatry, University of Toronto; the Department of Psychology, Ryerson University; and the Toronto Western Hospital Bariatric Surgery Psychosocial Program.
authors.forename: Arash
authors.initials: A
authors.lastname: Azin
authors.forename: Carrol
authors.initials: C
authors.lastname: Zhou
authors.forename: Timothy
authors.initials: T
authors.lastname: Jackson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cassin
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Raed
authors.initials: R
authors.lastname: Hawa
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass / Q000523:psychology; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery; D011184:Postoperative Period; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000191:economics*; D012649:Self Concept; D012867:Skin; D011795:Surveys and Questionnaires; D015431:Weight Loss