11040555_xxlA 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, has been launched by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the Royal College of Surgeons (RCS).

According to the societies, the guide was developed in response to research which shows inconsistency in the provision of body contouring surgery across the country. A study of 67 primary care trusts 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 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.

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 reconstructive body contouring plastic surgery following massive weight loss experience significant improvements in their physical function, emotional wellbeing, body image satisfaction, physical wellbeing and quality of life.

Conversely, patients who aren’t 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.

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 reconstructive 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.”

The full guides is available from www.bapras.org.uk and www.rcseng.ac.uk