Jessica Walker, MD

Most plastic surgeons have a BMI cutoff for safe surgery. And it is not about the surgeon not being able to do the case, it is about safety under anesthesia. However, I often see your case with weight loss patients and I have a higher BMI cutoff for massive weight loss patients, pending your exam and your other medical history.
Based on your photos alone, Id say you are a good candidate, but again, I would need to perform and exam and review your medical history with you.
I hope this helps!

A lot of how we chose implants is based on the base width of your breast. The same size in a moderate profile will have a wider base than in a higher profile, but the same about of gel, so that is how it projects more. We choose the profile of the implant based on how wide your breast is. To go higher, but restricted to breast width, we go up in profile.
The best way to decide is with your board eligible or board certified plastic surgeon, as it is based on physical exam. With gel implants, and if they are under the muscle, you have less of a chance of an "augmented" look, but the size / profile are based on your own anatomy

You should do whatever exercise regimen works for you to achieve your goals. For everyone this can be different. For some, cardio is all they need. For others, they will plateau with cardio and need to at weight training. No specific exercise will affect your surgical outcome, but it is very great of you to get a ump start on weight loss as this will optimize your surgical outcome and ultimately will be safer to undergo elective surgery.

First of, I recommend you be seen in person by a board eligible/board cartified plastic surgeon for evaluation as a physical exam is usually needed to check on any muscle widening (diastasis) which is frequent after pregnancies as well as to assess the quality of skin. Based on the history of 4 pregnancies and these photos, You would likely get the best shape from a fully tummy tuck +/- lipo. The other options do minimal for skin tightening when you have this much laxity and lipo will make the skin more lax. None of the options aside from a tummy tuck will assess the muscle separation which we repair in surgery.

We definitely understand that cosmetic surgery is private for many individuals. However, for any surgery where you received general anesthesia, someone will need to drive you to and from, and we also recommend someone stay with you the first night. You may also have significant pain, and often times you may not be able to stand up straight for a week or so. You also should not do any heavy lifting for the first few weeks. So, it may be difficult to conceal this from any in house family members. But please see your board eligible/board certified plastic surgeon to discuss all of your options