BMI = 39.62: Is it Safe to Have a Tummy Tuck to Remove Excess Skin?

The issue is controversial. Everyone will agree that losing weight before surgery is safer. But I've operated on skinny people how were half as healthy as some of my husky patients. So, the answer is not in the number. If you go to my website you will see a video of a woman who's BMI matches yours. She was very healthy and I did her surgery without any problem. I took precautions and counseled her, but I did it. She was very pleased. I have a feeling that surgeons who refuse to see anyone because of a number are skinny themselves. A board certified plastic surgeon who has done many such surgeries (over 100) would be the one I'd recommend.

For anyone with a BMI of essentially 40, the risks of surgery are greater than for someone with a lower BMI--all other factors being the same. However, the term "tummy tuck" can be used for both an abdominoplasty where the skin and underlying tissue are separated from the muscle, the muscle is often tightened, the belly button repositioned and the excess skin removed, and a panniculectomy where the excess skin is removed often including the belly button. A panniculectomy is common after gastric bypass or massive weight loss (usually over 100lb) when the skin didn't shrink back to its former size. These patients often still are quite large but the benefits of the surgery outweigh the risks.

You don't give enough information in your post to tell which operation you are considering or which would be appropriate. You should consult with a board certified plastic surgeon to review your history, anatomy and goals. He or she will then be able to work with you to evaluate the risks and benefits of surgery and make a realistic and reasonable plan for you. Good luck.

That BMI is high of course and does give me pause.  I just checked the data for my practice and it is rare for us to do an abdominoplasty on patients with a BMI over 40.  One problem is that at this weight it may not be possible to completely repair the muscular "diastasis" and it would be a shame to go to the trouble of a tummy tuck without correcting the muscle malalignment.

Having said that, there are some patients with very large frames and admittedly are obese, who have an apron of tissue overhanging their pubic area and these patients can be very happy to have this apron removed, accepting that they still have an abdominal protuberance afterward.

You don't have to be at an ideal body weight to be a candidate and to be pleased with your result.  Often, it can be a motivator.  If it were so easy to lose weight, patients would have done it already, so in the real world this psychological advantage of having a flatter tummy after surgery can be important and a catalyst for patients who before were discouraged.

Ideally, you should get started on the good habits of diet and excercise, start losing weight, and then have a tummy tuck.  You don't want to have a tummy tuck, be inactive for a month, continue eating to excess and gain weight.  That would spell disappointment.

Like all Cosmetic Surgery operations, a great result and a happy patient depends not only on knowing HOW to operate but more so on knowing WHEN to operate and picking the RIGHT OPERATION for the RIGHT Patient.

Your questions touches on 2 issues: SAFETY and QUALITY OF RESULTS when performing a Tummy Tuck on a very large person. For readers who are not familiar with the BMI classification it is an easy way to separate people based on their relation of Weight and Height.  A score of 30 and over qualifies as OBESE while 40 and over qualifies as MORBIDLY OBESE and is the group which insurance companies often approve weight loss operations on.

QUALITY OF RESULTS - there is NO doubt that the closer a person stabilizes her/his weight around a BMI below 30 and preferably around 25-27, the nicer and more attractive will be the Tummy Tuck results.

SAFETY. Obesity is associated with a LOT more complications including a propensity for blood clots, pneumonia and improper wound healing after surgery including wound separation, death of the skin or of portions of fat under the skin among others. As a result, most Plastic surgeon to protect such patients "from themselves" would decline to operate on them at these BMI levels.

Dr. Peter A Aldea

That BMI is on the higher side and I usually would suggest weight loss first and try to get closer to a BMI of 30.  I have found that the surgery will yield better overall results and will be safer for you.

Based on your BMI alone I would not recommend a tummy tuck for you at this time. There are more complications associated with obese patients and tummy tuck surgery. I would plan on losing some weight to get your BMI under 30 in order to become a better candidate for this procedure. Also, as you lose weight, you will develop more excess skin which can better be addressed at the time of the tummy tuck. Generally speaking, you will have a better, safer outcome if you have a tummy tuck at a lower body weight.

Of course the BMI does not give me the entire picture, so I would consult with a plastic surgeon now and have a plan outlined for you.

Best wishes,

Dr.Bruno

HI sweetred  in the dalles, OR

I do not recommend that a patient with a BMI of essentially 40 undergo tummy tuck. There are two main reasons:

1. The risks of surgery are significantly increased. This includes risks such as with anesthesia, bleeding, infection, wound healing problems, blood clots, and even death. 
2. The result will be suboptimal. When someone is this obese, a tummy tuck will do little to improved the overall appearance. 

On the other hand, if someone is looking to remove the lower apron of fat for medical reasons, it may be appropriate. This procedure is called a panniculectomy; morbidly obese patients undergo this procedure when the apron of skin and fat (the pannus) is so large, it begins to interfere with hygiene, ambulation, or poses a risk for infection. This procedure is also high risk, but when performed in these circumstances, can be an acceptable form of surgical treatment.

Bottom line: Consult with a plastic surgeon to find out if you should be considering panniculectomy. Otherwise, a tummy tuck is NOT appropriate at a BMI of 40, and should not be considered until you get to a maximum BMI of 35 or less.  Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC   

The BMI is used to stratify risk in surgery. Ideal candidates for body contouring surgery will have a BMI under 30. Surgical risks and post op complications increase above 30. Once the BMI is above 35 the risks become prohibitive. In fact in my practice, I would discuss a limited panniculectomy with you but would not offer you an abdominoplasty.

Seek out a board certified plastic surgeon who does body contouring after significant weight loss to review this with you further. Your final result and the safety factor of the surgery will be dramatically improved with weight loss prior to body contouring.

I hope this was helpful.

In general, the closer you are to your ideal weight, the better results you can expect. Patients with a BMI can sometimes get a good result depending on distribution of the excess (if the excess is lower). There is a higher risk if several complications with a BMI > 40. Weight loss before surgery is safer and will get you better results.

In general for tummy tuck, you want to have mainly loose skin, and not just loose skin along with fat.  There's no standard magic number BMI, but most plastic surgeons would prefer if you're slightly overweight to thin to be the best candidate for tummy tuck.

With a BMI of greater than 30, I'm afraid you should lose overall body weight before considering a tummy tuck.  After getting clearance from your family doctor, please consider exercise with a personal trainer, coming up with a lifestyle change strategy that fits your needs, talking to a dietitian, and joining a support group.  You will be better off losing the weight before having surgery.  Best of luck to you!