title: Post-Bariatric Body-Contouring Surgery: Fewer Procedures, Less Demand, and Lower Costs.
abstract: BACKGROUND
  Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing and placing additional burdens on already strained health care systems. In Austria, medically necessary body contouring is covered by public health care. In a sample of 622 women, we assessed the proportion of patients that underwent post-bariatric surgery at least 2 years after gastric bypass.
  
  
  METHODS
  Former bariatric patients were asked whether they had undergone post-bariatric surgery or were planning to do so by structured telephone interviews. For patients who had undergone body contouring, the degree of satisfaction with the results was inquired. Costs for bariatric and post-bariatric procedures were assessed.
  
  
  RESULTS
  Of 622 patients, 93 (14.9 %) had undergone body contouring and 68 (10.9 %) considered a procedure, while 454 (73 %) definitely stated that they did not want plastic surgery. Cost coverage was declined in 7 patients (1.1 %). Plastic procedures (n = 101) included 65 abdominoplasties, 25 lower body lifts without thigh lifts, 7 brachioplasties, and 4 minor procedures. Forty-nine patients were very satisfied with the results, 28 were fairly satisfied, and 16 were not satisfied. Body contouring added about 6 % to the costs of surgical treatment for morbid obesity.
  
  
  CONCLUSIONS
  Fewer patients than in other studies expressed a desire for post-bariatric surgery, 15 % actually proceeded to this step. The low demand was neither due to denied coverage nor to unfavourable results of plastic surgery. Additional costs for body contouring were less than expected.
authors.affiliation: Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria, franz.felberbauer@meduniwien.ac.at.
authors.forename: Franz X
authors.initials: FX
authors.lastname: Felberbauer
authors.forename: Soheila
authors.initials: S
authors.lastname: Shakeri-Leidenmühler
authors.forename: Felix B
authors.initials: FB
authors.lastname: Langer
authors.forename: Hugo
authors.initials: H
authors.lastname: Kitzinger
authors.forename: Arthur
authors.initials: A
authors.lastname: Bohdjalian
authors.forename: Ronald
authors.initials: R
authors.lastname: Kefurt
authors.forename: Gerhard
authors.initials: G
authors.lastname: Prager
mesh_terms: D061645:Abdominoplasty / Q000191:economics / Q000379:methods; D000328:Adult; D001317:Austria; D050110:Bariatric Surgery / Q000191:economics* / Q000379:methods; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D015431:Weight Loss