I want a Tummy Tuck & my BMI is over 40. Should I have reservations that one doctor will do the surgery and another will not?

Question

I lost 100 lbs from gastric bypass in 2012. I had a consultation with a plastic surgeron and he is going to do my pannalectamy and abdominalplasty. My bmi is 43.3 and another surgeron said she wouldn't touch me unless I was under 175 lbs. I have bad rashes and the extra skin is killing my back.

Jed H. Horowitz, MD, FACS · Answer

Congrats on your weight loss success! The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. #Weight, and more specifically body mass index (BMI), need to be considered when deciding. For instance, studies have shown that patients with BMI > 30kg/m sq (placing them in the obese category) have a higher complication rate. Therefore, it is important for patients to be as close as possible to their normal body weight prior to surgery for at least six months. Such will decrease your chances for complications. 
Begin with an in-person, one-on-one consultation to determine if you are an ideal #candidate and which technique is best for you. Most importantly, your procedures should be performed by a #Plastic Surgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery.

Carmina Cardenas, MD · Answer

You have to know that just being a BMI 43 patient the risk of very serious complications is a reality. I totally understand about the urgent for you to finally get rid of the saggy skin on your abdomen but you have to acknowledge that YOU want a successful surgery, no local or systemic complications that may put your life at jeopardy, WE as care providers want exactly the same for you. You should be at least on a BMI no higher that 30-33be encouraged. Yes you can!!!!send you a hug of encouragement. Dr. Cardenas

Anthony Perkins, MD · Answer

Congratulations on the weight loss.A BMI greater than 30 does increase your chances of postoperative complications, I would suggest against those surgical procedures at your current weight.All the best!Dr. Tony Perkins.Plastic Surgery of Short Hills

William B. Rosenblatt, MD · Answer

We take many things into account when dealing with massive weight loss patients. For me, I will do a pannulectomy but a real TT is usually reserved for patients with BMIs closer to 30. With a BMI of 43 you are at much greater risk of post op issues.

Robert L. Kraft, MD, FACS · Answer

BMI is one part of the equation.  Many patients who have undergone bariatric procedures will also have anomalies in their bloods, including significant anemia from malabsorption.  Therefore, my first issue would be your bloods and whether you could pass a medical clearance without addressing iron deficiencies, etc.  I would much rather know this up front than to be cancelling a major operation a few days in advance, after everything has been arranged.  Extra skin will not "kill your back".  I know that it is uncomfortable and that the overhanging panniculus will produce rashes.  An BMI of 40 puts you at much higher risk of surgical and anesthesia complications which would have to be taken into account by the surgeon in making the decision of whether to operate.

Richard Bloom, MBBS (Hons), FRACS · Answer

Hi there, Firstly well done on the weight loss!!!!! Bariatric surgery can be a hard road and takes lots of commitment. It is in no way an easy solution for weight loss.Now to your question, whilst BMI is not a hard and fast indicator for surgery, at a BMI of 43 you would be at significant risk for complications both surgical and anaesthetic. Also, and just as important, you are not going to get a great aesthetic result at your current weight.I know at times the weight loss can seem like an insurmountable hurdle, but if you can get your weight down further you are going to do much better from your operation. So don't give up, keep at it, you are on the right track. When you reach your target weight  go back to the surgeon who said he wouldn't touch you until you were under 175 lbs!!!!!Best of luckRichard

Brooke R. Seckel, MD, FACS (retired) · Answer

I believe you know the answer to your question.  It sounds as though one surgeon gave you honest advice and is looking out for your health.  Doing abdominoplasty or panniculectomy with a BMI over 30 is known to produce complications.  Trust your instincts and go with the surgeon who seems to have more knowledge and is concerned about your health.

Laura A. Sudarsky, MD (retired) · Answer

Any elective surgery with a Bmi over 35 puts you at increased risk for serious complications such as infection, blood clots, and even death. You should get your Bmi down to a safe level before having elective cosmetic surgery.

I want a Tummy Tuck & my BMI is over 40. Should I have reservations that one doctor will do the surgery and another will not?

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