Tummy tuck - do I have to reach my weight loss goal before surgery?

Hello,

Try to get to the weight you feel you can maintain before surgery. This reduces the tendency toward revisions.

Best Regards,

JPD

The surgeons below have given good advice. Target weight loss will allow you the best chance to achieve the best result.

You gone this far, keep up the good work.

Michael J. Brown, MD

Loudoun Center for Plastic Surgery,

Washington, DC

First of all congratulations on your weight loss. There are several factors to consider when contemplating when to have your tummy tuck procedure. 1. First, are you still actively losing weight or have you plateaued for several months. If you are still losing weight, I would try to get as close to your goal as you can (as long as your think it it realistically obtainable) and then do your procedure. If your weight has stabilized, then it's probably okay to proceed. 2. One thing with massive weight loss patients (and many patients for that matter) is that their bodies have a set point for their weight and it may be unrealistic to achieve that, despite your goal of losing 30 more pounds. 3. While the concern of your skin relaxing after additional weight loss is a valid one, I have found that many massive weight loss patients all have some relaxation at some point despite pulling their skin tighter than the average tummy tuck patient- and some may benefit from additional excision at a later time, although certainly not to the degree that they had before. 4. One other thing to consider is the extra hanging skin impeding your ability to exercise and lose weight - i.e, are you developing rashes under the skin fold, is it causing any degree of pain, etc, etc. If so, then I would probably consider your procedure at this time.

When patients lose weight as a result of healthy changes in diet and a regular exercise program, that weight loss is real. Fad diets and pills often yield impressive results, but are too often followed by a yo-yo weight fluctuation pattern.

Having said that, healthy active patients often reach a weight plateau. This plateau weight may or may not be the "goal weight". Goal weights can be demoralizing if they are not sustainable. We all have a weight we would like to be, but that weight may not be realistic. Better to be happy at a healthy, sustainable weight resulting from a good diet and exercise.

And that is the time to have surgery.

To gain the optimal results for a body contouring procedure including a tummy tuck, you should be near your target weight. If you believe that you are within your acceptable weight zone, then arrange a consultation with a board certified surgeon to benefit from his/her expertise.

In general, patients should be within 5-10 pounds of their ideal "goal" weight before having a tummy-tuck, liposuction, body lift, or other combined procedure, but there are always exceptions.

In some cases, patients will experience a much greater capacity for, and desire to, exercise and maintain or improve upon their weight loss efforts if the surgery is done sooner rather than later. These patients are stuck at a plateau of their weight loss efforts, because they see no improvement of their body, but rather a worsening appearance because of the loose skin. They need help getting over the psychological hump in their weight loss efforts, and an early "reward" of the tummy tuck or other body contour procedure is just the push they need to get over that hump.

On the other hand, doing the body contour surgery too early in the process is destined to produce an inferior result, which will disappoint the patient and doctor alike in the event that the patient continues to lose weight and more skin laxity results. The surgery may need to be repeated in such cases, in order to achieve the best result possible. Also, surgery in these cases is riskier in terms of the potential for wound healing complications, infections, and DVT or PE.

Post-bariatric patients usually experience a dramatic loss of weight, and any patient who has lost a very significant amount of weight will most likely require a more extensive procedure than a tummy tuck alone, because of the generalized laxity of skin extending circumferentially around the trunk. These patients usually require a full body lift, and often require a brachioplasty (arm lift) and mastopexy (breast lift) as well, and may even experience facial laxity that necessitates a facelift.

Patients should try to reach their goal weight before a tummy tuck or body contouring operation and should be in optimal health. When you are ready, prepare to meet the "mini me" who has been hidden under your fat aprons for all these years.

If you are planning to lose more weight, then the tummy tuck results will more than likely be that much better.  I would wait if you plan on reaching your goal weight.  Good luck!

You should be proud of yourself for losing so much weight!

I tell my patients that they should be within 10 to 15 pounds of their goal weight before they have a tummy tuck, for the simple reason that the more weight that you lose, the tighter that you can pull the muscles towards the center and the more skin that can be removed. If you reward yourself with the surgery when you make that goal, you will feel even better knowing that you are as tight as you will want to be. Remember that you will lose some pounds with the surgery as the skin and fat removed will weigh something also. This is usually in my practice about 3 pounds, but it has been as many as 11 pounds.

To be in a positive nitrogen balance at the time of surgery will help you heal. If you are starving yourself at the time of surgery, you won't have the building blocks to heal the incisions. This can be a problem with those that have had bariatric surgery. Make sure that you are frank about your nutritional status with your Board Certified Plastic Surgeon when you are making your plans for your tummy tuck, as this can really make a difference in your outcome. You need all the building blocks of healing to stack the deck in your favor to have an uneventful surgery. Cofactors of healing are Vitamin A, D, and C, Zinc and Magnesium. But you have to also have lots of protein to heal incisions.

Congratulations on your weight loss - that is quite an accomplishment.

Here is how I approach this:

• Although I have a goal weight, how long will it take me to achieve it?
• How realistic is the goal weight I have chosen?

If you will get there in a reasonable amount of time and it is a weight you will maintain, then wait. You wouldn't buy a new wardrobe and then lose 30 lbs. Your skin is your wardrobe. If you contour the skin to your weight and lose 30lbs you will lose some of the cosmetic benefits.

However, if it is going to take another 6 months and the restrictions which you must maintain to stay at your goal weight are unreasonable, you are not helping yourself. You could have the surgery and remove the excess weight now and improve the quality of your life today.

You should visit your medical, bariatric (if you had weight loss surgery) doctor or a Board Certified Plastic surgeon so they can help you with this decision.

You've lost a 100 pounds so far and have 30 more to go to reach your goal. That's a great accomplishment! Getting the loose skin removed is going to be another big step in your overall change.

So, can you do it now or should you wait until you reach your goal? Wait. As you continue to lose weight, you will continue to lose the "filling" that is keeping your skin tone. Your skin has shrunk to fit your new body as you've lost weight, but after losing 100 pounds, your skins' ability to shrink has been maximized. This means that losing more weight likely won't be accompanied with more skin shrinkage and just result in loose skin. As far as your skin is concerned, 30 more pounds is a significant amount considering there is little 'shrinking power' left in your skin.

The last thing you want is to go through a surgery now, then lose more weight and be disappointed with loose skin afterwards. You're almost there, hang tough!

As long as your weight loss goal is realistic, you are best to have your surgery when you are closer to the goal weight. Additionally, it helps to be stable at the new weight for 6 months.

When you lose additional weight after a tummy tuck, you may diminish the nice tight appearance attained at the time of surgery with your skin becoming loose again.

One other thing to consider if you are losing large amounts of weight (massive weight loss >100 lbs), then a tummy tuck alone may not tighten your skin enough on the sides and will not address the excess skin of the lateral thighs and buttock. In those cases, a lower body lift is the best answer.

On a final note, the body mass index is an important number to keep in mind with cosmetic body contouring surgery. Patients that are above a BMI of 30 have been shown to have much higher complication rates including wound infection, seroma, delayed wound healing and DVT.

Most surgeons feel that you should be at a stable weight (within 10-15lbs) for at least six months and ideally a year. This will maximize your results.