According to the American Medical Association, reconstructive surgery is defined as surgery “performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. It in generally performed to improve function, but may also be done to approximate a normal appearance.”
Patients who have had bariatric surgery and who successfully lose substantial amounts of weight—often hundreds of pounds—frequently face new problems due to excess skin. The areas most affected are the abdomen, thighs, arms, breasts and buttocks.
Folds of excess skin cause many problems that can seriously affect a person’s health and quality of life. People often suffer from severe rashes that lead to chronic skin infections, intertrigo dermatitis, foul odors and skin breakdowns.
Patients are often surprised that their successful weight loss can cause severe lower back pain, which comes from heavy breasts and an abdominal pannus that pulls them down. Balance can also be affected, and people suddenly find themselves falling unexpectedly with no apparent cause.
These problems are never “cosmetic,” yet insurance companies frequently deny surgical treatment to alleviate them. Surgeons may recommend numerous reconstructive options, depending on factors including the amount of skin and where it is located.
These reconstructive procedures often receive a denial of coverage:
- Panniculectomy and/or abdominoplasty
- Breast lift/breast reduction
- Brachioplasty (arm lift for “batwings”)
We can help appeal denials of medically necessary reconstructive surgery in appropriate cases.