Clinical negligence specialist puts the case for more tummy tucks to be available on the NHS

Posted: 09/06/2014

Louise Hirst from Northampton has recently spoken out regarding the availability of tummy tucks – or abdominoplasty -  on the NHS for those who have lost large amounts of weight.  Louise says that she was denied a ‘life-changing’ operation when she lost 17 stone in two years. She was left with a large fold of skin around her stomach (sometimes called an ‘apron’) and requires a  tummy tuck procedure but was told that she could not have the operation on the NHS as it is considered to be cosmetic surgery, so she will have to seek private treatment at a cost of around £8,000.

Following major weight loss, some people are left with excess folds of skin. Abdominoplasty involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. The procedure is performed under general anaesthetic and usually requires a stay in hospital for one or two nights afterwards. The surgery should not be considered as a way to lose weight and is only undertaken after the target weight has been achieved.

Currently, tummy tucks are only available on the NHS if there are overriding physical or psychological reasons. As the procedure is considered to improve the appearance of the stomach area, it is classed as cosmetic surgery which limits its availability on the NHS. However, it is often not just about appearance and there are functional reasons why a tummy tuck is necessary for some patients. This hidden downside of losing weight occurs as a result of damage to the deeper layers of skin, the dermis, which contains two proteins: elastin, which helps it retract, and collagen, for strength. When the skin is stretched too much through weight gain, these proteins tear and break, resulting in a loss of elasticity and strength. Unfortunately, while losing weight causes the fat cells to lose their fat, the skin cannot retract.

There are also unpleasant health problems linked to excess skin ranging from infections to back pain. One of the most common is intertrigo, a bacterial, fungal, or viral infection that often occurs due to the difficulty in keeping these excess folds of skin clean and dry. The skin rubs and becomes ulcerated and infected, sometimes so badly that hospital treatment is required. Some people also find that  the folds of skin make it difficult to exercise. Others have said that they were still having to buy larger size clothes just to accommodate the excess skin.

Elise Bevan, a solicitor in the clinical negligence team at Penningtons Manches LLP, said: “Many do not realise that dramatic weight loss can have deeply distressing side-effects and people are often left even more unhappy about their body because of the mass of excess skin.  Most are not prepared for this situation beforehand and post-weight loss can be a very disappointing and psychologically distressing issue for them.

“Unfortunately, funding for procedures such as an abdominoplasty is extremely limited on the NHS.  To obtain funding, patients have to go before an Exceptional Circumstances panel but, more often than not, trusts refuse to pay out despite the medical benefits of having the surgery. The NHS usually insists that patients remain at a stable weight for two years but, even after that, surgery is often not offered. Patients must usually have a BMI of 28 or lower and prove that their condition is having a huge negative impact on their quality of life.

“Last week, the National Institute for Health and Care Excellence (NICE) recommended that the NHS paid for overweight people to go to slimming classes. While this seems like a good idea, the health service may still not provide surgery for those who do manage to lose large amounts of weight, despite the combination of its physical, medical and psychological benefits. Our concerns are that the lack of availability of such surgery may not only deter people from the health benefits of weight loss but also that people will seek the procedure elsewhere in the cheapest possible way. The cosmetic industry’s lack of regulation may cause issues with the quality of their care and follow up treatment if complications arise. Abdominoplasty carries certain risks that may be serious or life-threatening and it is important to compare the benefits with the potential risks and complications and ensure that someone with suitable experience and qualifications carries out the procedure.”

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