Assessing Improvement in Quality of Life and Patient Satisfaction following Body Contouring Surgery in Patients with Massive Weight Loss: A Critical Review of Outcome Measures Employed
Body contouring following massive weight loss is a rapidly expanding field in plastic surgery. However, healthcare payers are reluctant to fund such procedures, viewing them as purely cosmetic. This has resulted in a flurry of studies assessing quality of life (QoL) and patient satisfaction following body contouring surgery in this cohort of patients to establish an evidence base to support the idea that body contouring is as much (or even more) a functional procedure as it is cosmetic. However, the methods employed in these studies are seldom ideal, and hence the conclusions are unreliable. The gold standard to assess QoL and patient satisfaction is to use patient specific psychometrically validated patient reported outcome (PRO) measures. Developing such measures consists of a three-step process which includes a review of the current literature, qualitative patient interviews to determine what patients consider the most important, and expert opinion. This study aims to appraise the currently available literature on assessment of QoL and patient satisfaction in body contouring surgery patients. This will hopefully provide an understanding of methodological weaknesses in current studies and inform future investigators of the design of ideal instruments for assessing QoL and patient satisfaction in body contouring patients. 1. Introduction Body contouring surgery has undergone a rapid expansion in the last decade, becoming one of the fastest growing areas within plastic surgery. As the number of obese individuals continues to increase, bariatric surgery has come to the fore as the method of choice for rapidly losing excess weight with approximately one quarter of patients opting for bariatric surgery [1]. However, when a previously obese or morbidly obese individual loses a massive amount of weight, it results in cutaneous contour deformities on various parts of the body. These cutaneous deformities may then lead to psychological distress as well as functional problems, offsetting the positive benefits brought about by weight loss surgery [2–4]. Hence body contouring surgery would intuitively appear to be the next step in rehabilitating the obese patient with massive weight loss (MWL). However, it has been a challenge to convince healthcare payers of the importance of body contouring procedures to the overall outcome of massive weight loss patients. Whereas funding for bariatric surgery has become easier to obtain due to mounting evidence of its benefits on the health of obese individuals and the economic implications of this benefit, it has yet to
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