Patients rarely have excess skin removed after weight loss surgery, although it can be a bother for people who've shed a lot of pounds, a new poll suggests.
Plastic surgeons said patients either don't know about this extra surgery, called body contouring, or simply can't afford it.
Yet it's more than just a cosmetic procedure, said Dr. Jason Spector, who presented the findings at the annual meeting of the American Society of Plastic Surgeons (ASPS) in Denver this week.
"It is surgery that improves patients' quality of life," Spector, of Weill Cornell Medical College in New York City, told Reuters Health.
The excess skin that is left after severe weight loss can get in the way of exercising, interfere with patients' ability to wear clothes properly and cause rashes and serious infections.
Spector said weight loss surgery, also called bariatric surgery, is "just the first step" for patients.
"In order to complete the journey, patients really do need to undergo the appropriate post-bariatric body contouring. Even though that has a slightly cosmetic ring to it, it's certainly something that we, as plastic surgeons, would consider reconstructive," he explained.
Body contouring after weight loss surgery is akin to breast reconstruction after mastectomy, a procedure which is now mandated by law in New York State and paid for by insurance companies.
To get a sense of how many patients were actually going on to have body contouring surgery, Spector and his team mailed a survey to 1,158 patients whose operations were done by two surgeons between 2003 and 2011. They received 284 responses.
Only a quarter of the patients said they discussed body contouring with their surgeon around the time of the operation, with about 12 percent actually undergoing the procedure.
"This was strikingly low," Spector said.
The most frequent reasons for not having body contouring were expense and lack of awareness of the procedure. Nearly 40 percent of the patients said they might have chosen differently if they had received more information.
According to Healthcare Blue Book, a consumer guide to healthcare costs, body contouring comes with a price tag of about $13,000.
The flabby excess skin can pose a very real danger, Spector said. He described a patient whose overhanging skin was caught underneath the electronically controlled seat of her car as she was adjusting it.
"A large piece of skin was ripped off and caused a big open wound and subsequent infection. Up to that point, her insurance company had told her, 'Sorry, you can't have the surgery. You don't need it.' So we're not talking small bits here."
Dr. Malcolm Z. Roth, from Albany Medical Center and the newly-elected president of the ASPS, welcomed the new findings.
"It was painfully obvious to me as a plastic surgeon practicing in the community that this was an issue," he told Reuters Health. "It's good to finally have some data."
Roth added that patients need to consider that having weight loss surgery is not the end of their journey.
"Patients need to realize it's not just a slam dunk. When they lose the weight, at the end of the rainbow, there may not be a pot of gold. It may be that they have another rainbow to navigate to get to the pot of gold, and it may take several operations to take care of the excess skin on the abdomen, thighs, arms, breasts, face and neck. We would hope that bariatric surgeons would present this information to patients, but we also want patients to become educated, themselves."