Where to go from here? 36 year old mother of 3, 4 abdominal surgeries (3 C sections, Spleen and Gall Bladder removed) (Photo)

Congratulations, you are already a much healthier person than before your weight loss. Your comfort and appearance will improve even further with a tummy tuck or a panniculectomy, and you deserve to reward yourself with this procedure for all the effort that you have already put in. My concern is the effect that the scars from the spleen and gallbladder removal may have on your healing of the tummy skin. Unfortunately, the photos are not clear enough to see those scars. If the surgeries were done laparoscopically, you do not have to be concerned with the scars, but if the scars are long and run just below the rib borders, you should think twice about a traditional tummy tuck. The risks for skin death are just too high in that circumstance. 

Congratulations on your significant weight loss; you should be very proud of this accomplishment! Generally speaking, the tummy tuck operation provides for a more aesthetically pleasing outcome than a panniculectomy operation. The tummy tuck operation is best done once you have reached your long-term stable weight.  In my practice, I would offer you the panniculectomy operation at any point, if you have reached a plateau with your diet and exercise program, and simply wish to have the lower abdominal wall skin/adipose tissue removed.  Keep in mind,  that patients who undergo surgery when they are overweight, are exposed to greater risks. My best suggestion: seek consultation with board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. Then, learn about options, and the pros/cons/risks/complications associated with each option. You may find the attached link, dedicated to patients who have experienced significant weight loss, helpful to you as you learn more. Best wishes.