Research Article| Volume 65, ISSUE 4, P426-432, April 2012

Post-bariatric surgery body contouring in the NHS: A survey of UK bariatric surgeons

Published:October 24, 2011DOI:



      Following massive weight loss, patients are left with folds of redundant skin that may cause physical and psychological problems. These problems can be addressed through body contouring procedures such as abdominoplasty and the thigh lift. Despite an exponential rise in the number of bariatric surgery procedures performed in the United Kingdom, there are no national guidelines on the provision of body contouring procedures after massive weight loss. We conducted a survey of UK Bariatric Surgeons to determine the pre-operative counselling that patients receive on this issue, their opinions towards post-bariatric surgery body contouring and current referral patterns to Plastic Surgery. By exploring the relationship between Bariatric and Plastic Surgery, we aimed to identify how the comprehensive treatment of patients undergoing bariatric surgery could be improved.


      A questionnaire was sent to 86 surgeon members of the British Obesity and Metabolic Surgery Society. Questionnaires were analysed from the 61/86 respondents (71% response rate).


      92% of the responding surgeons feel that patients face functional problems relating to skin redundancy after massive weight loss, and a high percentage of patients complain about this problem. However, only 66% of surgeons routinely counsel patients about these problems before they undergo bariatric surgery. 96% of respondents feel that body contouring for these patients should be funded on the NHS in selected cases. However, it is difficult for patients to access consultation with a Plastic Surgeon and there are no explicit guidelines on the criteria that patients must fulfil to undergo body contouring surgery on the NHS. At present, these criteria are locally determined and represent a postcode lottery.


      The NICE guidelines on obesity recommend that patients undergoing bariatric surgery should have information on, or access to plastic surgery where appropriate, but this standard is not being achieved. National guidelines on post-bariatric body contouring surgery are needed to improve the comprehensive treatment of these patients. The clinical and cost effectiveness of bariatric surgery has been well established. Further studies focussing on the outcome of body contouring after massive weight loss could support this becoming and integral part of the bariatric surgery pathway.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Statistics on obesity, physical activity and diet: England.
        The NHS Information Centre, London2010
        • National Institute for Health and Clinical Excellence
        Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children.
        • Picot J.
        • Jones J.
        • Colquitt J.L.
        • et al.
        The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation.
        Health Technol Assess. 2009; 13: 1-214
        • Burns E.M.
        • Naseem H.
        • Bottel A.
        • et al.
        Introduction of laparoscopic bariatric surgery in England: observational population cohort study.
        BMJ. 2010; 341: c4296
        • Magdaleno Jr., R.
        • Chaim E.A.
        • Pareja J.C.
        • Turato E.R.
        The psychology of the bariatric patient: what replaces obesity? A qualitative research with Brazilian women.
        Obes Surg. 2011 Mar; 21: 336-339
        • Song A.Y.
        • Rubin J.P.
        • Thomas V.
        • Dudas J.R.
        • Marra K.G.
        • Fernstrom M.H.
        Body image and quality of life in post massive weight loss body contouring patients.
        Obesity. 2006; 14: 1626-1636
        • Gusenoff J.A.
        • Pennino R.P.
        • Messing S.
        • O’Malley W.E.
        • Boss T.J.
        • Langstein H.N.
        Post-bariatric surgery reconstruction: patient myths, perceptions, cost and attainability strategies.
        Plast Reconstr Surg. 2008 Jul; 122: 1e-9e
        • Naghshineh N.
        • O’Brien Coon D.
        • McTique K.
        • Courcoulas A.P.
        • Fernstrom M.
        • Rubin J.P.
        Nutritional assessment of bariatric surgery patients presenting for plastic surgery: a prospective analysis.
        Plast Reconstr Surg. 2010 Aug; 126: 602-610
        • Sarwer D.B.
        • Thompson J.K.
        • Mitchell J.E.
        • Rubin J.P.
        Psychological considerations of the bariatric surgery patient undergoing body contouring.
        Plast Reconstr Surg. 2008 Jun; 121: 423e-434e
        • Warner J.P.
        • Stacey D.H.
        • Sillah N.M.
        • Gould J.C.
        • Garren M.J.
        • Gutowski K.A.
        National bariatric surgery and massive weight loss body contouring survey.
        Plast Reconstr Surg. 2009 Sep; 124: 926-933