Post Bariatric Body Contouring - What is covered?


Multipart question...
With regard to inelastic skin, please refer to an earlier article on my RealSelf page.

Gastric bypass has become a very popular option for weight loss in morbidly obese people, increasing in popularity exponentially. Some studies have reported that the procedure is 700% more popular than 10 years ago.
As the popularity of gastric bypass increased, so too did plastic surgery after weight loss. 7 years ago, 1 in 4 people sought out plastic surgery after weight loss. Now that number is closer to 3 in 4.
The "dirty little secret" of weight loss surgery, is that while you will lose a tremendous amount of weight, you will not lose skin. The skin is worn out. Inelastic. It won't snap back to its original shape. It must be removed.

Taking into account the increase in people getting gastric bypass, and with that the increase in people seeking plastic surgery after weight loss, insurance companies began placing tighter restrictions on what it took to qualify for a covered procedure.
These days, most insurance companies will only pay for a panniculectomy (I'll explain later), and/or a breast reduction.
In addition, patients must meet criteria, commonly:
100 pound or more weight loss
1 year out from gastric bypass surgery
6 months at a stable weight
increasingly they are requiring medical complaints associated with the skin condition:
-rash unsuccessfully treated by another physician.
-back or neck pain
-an abdominal hernia present

Breast Reduction:
the amount of tissue to be removed is often determined by insurance companies using a formula called a "Body Surface Area" (BSA). There are several different ways to calculate this depending on the formula used, but they all are based on your height and weight.
Unfortunately, most people who have had massive weight loss through surgery have DEFLATED, sagging breasts, not large enough to qualify for a covered procedure by insurance.
often, weight loss patients benefit more from a breast lift, a breast augmentation, or a combination of a lift and augmentation.

I like to discuss Abdominal body contouring in terms of buying a car. General motors (when I started practicing anyway) had 3 price levels of cars:
Entry level: Pontiac
Midrange: Buick
Luxury: Cadillac

In abdominal body contouring:
Entry level: Panniculectomy
Midrange: Abdominoplasty
Luxury: Circumferential Belt Lift

In the analogy: they are all cars. They will all get you from point A to point B. The difference is how good they look and the extra features as the price goes up.
Insurance will pay for the Pontiac.
A panniculectomy is the removal of the apron of skin that hangs down over your lap. No tightening of skin up to the ribs, no tightening of muscle, no relocation of the belly-button. In fact, if the belly-button is located within the apron of skin, it is removed in this procedure.

This is an overview obviously.  

Article by
Jacksonville Plastic Surgeon