www.PRSJournal.com 448 T he high prevalence of obesity (up to 25 percent in Spain 1 and >30 percent in the United States 2 ) has led to the current boom in bariatric surgery, 3 which has created a new and unique patient population that is difficult to man- age. After these operations, up to 96 percent of patients develop multiple redundant skin flaps, 4 because the body does not have the ability to retract the dermofatty excess. These problems have a negative impact on the quality of life of post–bariatric surgery patients. 5 To correct these sequelae of massive weight loss, multiple operations are needed by the plastic surgeon integrated in the Morbid Obesity Multi- disciplinary Team. 6–8 Moreover, this need arises in a group of patients with many comorbid condi- tions and therefore high rates of potential surgi- cal complications. In 2011, the American Society of Plastic Sur- geons recorded a total of 50,422 body contouring procedures after massive weight loss, and although it represents a decrease of 8 percent from the pre- vious year’s record, 9 until 2009, this was the subset of interventions that increased faster within the specialty of plastic surgery. 10 However, this problem is undervalued in most reference books on morbid obesity and by pre– bariatric surgery patients. 11 The cost study of these procedures is an issue that has not been previously Disclosure: The authors declare no conflict of interest and no sources of funds supported this work. None of the authors has a financial interest in any of the products or devices mentioned in this article. Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000428 Jordi Vilà Poyatos, M.D., Ph.D. José María Balibrea del Castillo, M.D., Ph.D. Benjamí Oller Sales, M.D., Ph.D. Antonio Alastrué Vidal, M.D., Ph.D. Barcelona, Spain Background: Post–bariatric, body contouring surgery to treat the sequelae of massive weight loss is an undervalued topic by patients and in most of the literature. The objective of this study was to determine the mean cost per patient of this treatment in a public morbid obesity unit, and compare it with the perception by the patients. Methods: Costs were estimated using a specific Diagnosis-Related Group–based method and a questionnaire in a sample of 100 patients who had completed body contouring treatment. Results: This study included 23 men and 77 women with a mean age of 48.5 years, a mean reduction of body mass index of 20.77 kg/m 2 , and a median follow-up of 58 months. These patients had undergone surgery, as needed, as follows: on the lower part of the trunk (109 operations; mean cost, €6348.6), cruroplasty (43 operations; mean cost, €3490), brachioplasty (28 operations; mean cost €3150), and the upper part of the trunk (10 operations; mean cost, €4290). The rate of complications has been high (up to 50 percent) and, al- though the more severe complications are rare (10.5 percent Clavien grade IIIb), these represent high costs (mean, €24462.6). Forty-five patients answered the questionnaire. Although they think that this surgery improves their quality of life, they have undervalued its total cost (17.58 percent; €2034) (p = 0.16). Conclusions: The average cost of post–bariatric surgery body contouring treat- ment in this unit is €8263.95 (1.66 operations per patient). The severe com- plications increase by 2.96 times the average cost per patient. (Plast. Reconstr. Surg. 134: 448, 2014.) From the Plastic Surgery Department and the General and Digestive Surgery Department, Hospital Universitari Ger- mans Trias i Pujol; and the Medicine Faculty, Surgery De- partment, Universitat Autònoma de Barcelona. Received for publication September 21, 2013; accepted January 9, 2014. Post–Bariatric Surgery Body Contouring Treatment in the Public Health System: Cost Study and Perception by Patients COSMETIC