New National Body Contouring Surgery Guide Launched to Promote Equality in Provision and Improved Care for Weight Loss Patients
First framework to help people denied access to life changing NHS plastic surgery treatment
Today (11 March 2014) a new body contouring commissioning guide, which aims to address variation across England in provision and quality of body contouring surgery for patients who have undergone massive weight loss, is launched by the British Association of Plastic, Re-constructive and Aesthetic Surgeons (BAPRAS) and the Royal College of Surgeons (RCS).
Body contouring surgery is re-constructive surgery following major weight loss to remove excessive skin. It is the first time a standardised guide, accredited by the National Institute for Health and Care Excellence (NICE), has been developed to inform the issue.
The guide was developed in response to research which shows inconsistency in the provision of body contouring surgery across the country. A study[1] of 67 primary care trusts[2] in England showed that 23 excluded any reference to body contouring procedures.
Even where guidance is in place, recommendations can vary dramatically. It has been revealed[3] that 38% of patients who were approved in Scotland for body contouring surgery would not have fulfilled the criteria used in Leeds.
The studies reveal that patients who have already received NHS funding for a gastric band or other form of bariatric surgery then find it very difficult to get body contouring surgery after their weight loss. In addition, access to body contouring surgery is even harder for patients who have lost the weight naturally, through diet/exercise alone (10-30%). This is because they do not have the support of bariatric multi-disciplinary teams.[4]
The new guide addresses variation in provision and quality of care – whilst also helping to make most appropriate use of resources – by providing clear criteria for commissioning body contouring surgery and best practice information for healthcare professionals. This includes a quality checklist for multidisciplinary teams to follow through every step of the procedure. The guide concludes with future recommendations, including the development of a compulsory register of operations and complications to enable the best outcomes for patients.
Research has shown that patients who undergo re-constructive body contouring plastic surgery following massive weight loss experience significant improvements in their physical function, emotional well-being, body image satisfaction, physical well-being and quality of life.[5]
Conversely, patients who are not able to access body contouring surgery following massive weight loss can suffer from a range of physical and psychological problems. In a recent study, 92% of bariatric surgeons reported that patients experience functional problems relating to excess skin.[6] Psychological problems include stress, depression and low-self esteem. Patients unable to access body contouring surgery are also significantly more likely to regain weight, which can lead to health problems, such as diabetes, heart disease and mobility issues, with a resulting burden to the NHS.
Mark Soldin, BAPRAS specialist in body contouring surgery and Consultant Plastic Surgeon said:
“I’ve seen many patients whose lives have been transformed through receiving body contouring re-constructive plastic surgery. However, there are many other people who, simply due to their postcode, are denied this procedure and are left to deal with the huge physical and psychological problems caused by excess skin.
“To qualify for this surgery patients need to demonstrate incredible weight loss and to show they have kept the weight off for a considerable period. However, the current ‘postcode lottery’ is unfair for the many patients up and down the country who have worked hard to change their lifestyles in order to meet the strict criteria. We are calling on commissioners and GPs to use this carefully researched, NICE accredited guidance to put an end to people living in limbo, and enable them to live healthy, happy lives.”
It is also hoped the guidance will be used to support GP referrals for patients requesting body contouring surgery by outlining clear criteria for patient assessment.
Paul O’ Flynn, Consultant ENT surgeon and Council Lead for commissioning at the Royal College of Surgeons, said:
“Research demonstrates significant improvements in patients’ emotional wellbeing and quality of life once they have undergone body contouring surgery, which is why it is critical that this guide is used by both commissioners and GPs to inform their referral decisions.
“We hope that this guide will help to create equality in provision of body contouring surgery for patients across England and stop unfair postcode lotteries which are denying patients desperately in need of treatment.”
[1] Mukherjee S, Adegbola S, Kamat S, Agrawal S. Bariplastic (post bariatric body-contouring) surgery in England: a ‘postcode’ lottery. Presented at: 5th Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders European Chapter; April 2012; Barcelona.
[2] PCTs no longer exist
[3] Shermak MA, Chang D, Magnuson TH, Schweitzer MA. An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Plast Reconstr Surg 2006; 118: 1,026–1,031.
[4] Panniculectomy and Redundant Skin Surgery in Massive Weight Loss Patients- Current Guidelines and Recommendations for Medical Necessity Determination Gurunluoglu R. Ann Plas Surg 2008: 61(6);654-7
[5] Gilmartin, J. Long, A,F. Soldin, M. 2013. Identity transformation and a changed lifestyle following dramatic weight loss and body-contouring surgery: An exploratory study. Journal Health Psychology 1359105313511838, first published on December 1, 2013
[6]Highton L, Ekwobi C, Rose V. Post-bariatric surgery body contouring in the NHS: a survey of UK bariatric surgeons. J Plast Reconstr Aesthet Surg. 2012 Apr; 65(4): 426-32. Epub 2011 Oct 20.
Ken Clare says
A solid step in the right direction. Declared interest I was a lay member of the working group.
Carol Ball says
Looks a good framework to build on Ken. I had hoped to discuss this on Sky News yesterday but the untimely death of Bob Crow meant it was postponed. I am sure we shall hear more in the coming months. CAROL
Nikki says
Does anybody know what the recent guidelines are to get the skin removal surgery on the NHS please? I have an appointment with my GP next week to get referred.
CAROL says
I haven’t seen anything more up to date than the rules you have seen on the post Nikki and I’m not sure if there have been any further guidelines given. It would appear that it’s still something of a postcode lottery and the chances of the NHS doing any corrective contour surgery are still slim to non-existent (although I do occasionally see one or two being mentioned in forums). The best port of call seems to be your own GP and it’s essential that you get them onside in order to progress I’m told. This is one area that is severely under-funded and causes so much heartache and distress. I wish you well with exploring further. C x