Difficulties in accessing post-bariatric reconstructive surgeries through the Brazilian Unified Health System (SUS)

Abstract

Obesity is one of the most prevalent health disorders in Brazil, and bariatric surgery, offered through the Brazilian Unified Health System (SUS), represents an essential resource in the treatment of morbid obesity. However, significant weight loss often results in excess skin and tissue laxity, compromising patients’ physical and emotional quality of life. This literature review aimed to identify and analyze the main barriers to accessing post-bariatric reconstructive surgeries within the SUS. The search was conducted in PubMed, SciELO, UpToDate, and Google Scholar, using the descriptors: “Post-bariatric,” “SUS (Unified Health System),” “Brazil,” and “Skin flaccidity/Excess skin.” The evidence indicates multifactorial limitations, including insufficient procedure availability relative to demand, long waiting times, regional inequalities in the provision of specialized services, and restrictive criteria that prioritize functional complications over psychosocial aspects or quality-of-life concerns. In conclusion, access to post-bariatric reconstructive surgery through the SUS remains limited and unequal, representing a challenge to the principle of integrality in Brazilian public health care.