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20 Sep 2016

Abdominoplasty can significantly relieve back pain and incontinence for women who have had babies, a soon-to-be-published study has found.

The procedure, also known as a tummy tuck, is largely seen as cosmetic for post-partum women, and was removed from the Medicare Benefits Schedule in late 2015. It remains on the MBS for bariatric surgery patients.

But a study of 208 women in Queensland, New South Wales and the Australian Capital Territory has revealed dramatic reductions in back pain and incontinence following the procedure.

Canberra plastic surgeon Dr Alastair Taylor, who will present his findings in Japan and Sydney in October, said the results spoke for themselves.

“People are getting better,” Dr Taylor told Australian Medicine.

“We are seeing real and ongoing reduction in pain, and almost immediate improvements in urinary incontinence.”

Approximately 30 per cent of women will experience lower back pain and/or incontinence after giving birth, particularly after a vaginal birth, and the pain tends to get worse as they age.

“It’s not savage back pain, it’s more constant aching but the instability that comes from the fascial laxity means doing things like picking up a children and putting them in car seats is very difficult,” Dr Taylor said.

“A lot of women hit the gym to get their pre-baby bodies back, but they can’t regain their core strength. And when they injure themselves the instability means it takes them much longer to recover.

“Sewing those muscles back together seems to have some effect.

“As a friend said to me, if you bugger your ACL playing sport, you’d go get it fixed. Why should this be any different?”

Dr Taylor became aware of the pain relief benefits of the procedure after a physiotherapist approached him about four years ago.

“He said patients of his who had back pain and incontinence who have this surgery are getting better, and he wanted to know how it worked,” Dr Taylor said.

With no published research available, Dr Taylor recruited a number of surgeons for a study.

All patients presenting for the procedure, not just those with back pain, were tested on the disability scale before surgery, six weeks after, and then again six months following the operation.

On the scale, 0-5 is trivial, 30 is serious and 50 is bedridden or malingering.

Before the surgery, the average pain score of the 208 post-partum women was 11, which equates to a 22 per cent disability. Six weeks later, it was down to four and at six months it was 1.7.

On the urinary incontinence scale, the results went from an average pre-op score of six to 1.6 at six weeks, which was maintained at six months.

Dr Taylor said the results showed that abdominoplasty should be reinstated on the MBS.

“For a standard abdominoplasty, the Government was paying about $900 or $950 for the scheduled fee,” he said.

“Of course, it’s a four-hour operation with three to four days in hospital, so it’s going to cost a lot more than that, but the overall cost was about $12-13,000.

“Without the Item Number, the cost has gone up to $20,000. It can’t be done in a public hospital – you can’t get your patients in – and the private hospitals charge the cosmetic rate.

“And the Government’s making money on it because they get $2000 in GST.”

Earlier this year, Sydney mother of six Kimberlee King started a change.org petition to restore abdominoplasty to the MBS.

Ms King suffers chronic back pain and incontinence due to “significant separation” of her abdominal muscles after giving birth to triplets.

Dr Dan Kennedy, from the Australian Society of Plastic Surgeons, told the Mamamia website: "What the changes mean, for example, is that a man who has undergone extreme weight loss after bariatric surgery can have his abdominoplasty reimbursed under Medicare, and yet a woman who has incurred torn muscles as a consequence of childbirth cannot."

By the end of August, Ms King’s petition had more than 5000 signatures.

Maria Hawthorne 

 

 

 


Published: 20 Sep 2016