Would abdominoplasty be out of the question for me? (Photo)

Hello,
Ideally, losing another 40 to 50 pounds would put you in a position where an excellent and safe result could be gotten. However, based on your health and your physical examination, it may be possible to move forward with the surgery earlier. Please see a few ABPS certified/ASAPS member surgeons. Best of luck!

You will have a better cosmetic outcome and a safer outcome if you lose weight prior to having surgery. Generally speaking, we like to have patients Body Mass Index (BMI) less than 30 prior to having elective surgery. This means in your case getting down to about 180 lbs. Consult with a few plastic surgeons in person for a thorough exam and review of your options.Best wishes,Dr.Bruno

Your situation may be a bit challenging due to your weight, the prednisone, the enbrel, ... Your best advice will come during an in person consultation. 

Your procedure must be planned individually around you.  If weight is an issue and drug related, the first thing I would do is speak with your doctor precribing prednisone and Enbrel to consider alternatives that will control your symptoms as well or better without causing weight gain.  I would also find out what your dietary and exercise habits are, and why.  Losing weight will not resolve all of your belly issues, but will help you be much healthier and happier with your body and your tummy tuck result.  You need a good physician-surgeon partner to help you because of the added challenges your situation presents.

Hello and thank you for your question. Based on your
photograph, you will be a candidate for a tummy tuck with liposuction after additional weight loss.  This can be done through a low
incision, all completely below the bikini line. 
The belly button can be designed to look natural and have no scars on
the exterior.   Your muscles can also be
plicated resulting in a flat abdomen. 
Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Dear chubbybunny08,the optimal weight to have Tummy Tuck surgery is a very common question and for good reason. Having surgery before you reach your target weight can lead to suboptimal results if you were to lose more weight after surgery.
Good first questions to ask yourself are:
1. Am I at my goal weight?
2. Is my weight stable? have you lost or gained more than 10lbs in the past month? What was your weight last year?
3.  Are you eating a healthy diet and exercising?
If you are not at your goal weight or your weight is not stable, you should hold off on surgery.
Touch base with a qualified plastic surgeon to take it to the next step. And if your are not at your goal weight yet, consider this a goal to work towards.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Two things that would be best to manage in advance of TT surgery: 1.  your overall health, medical status2.  achieving a weight closer to your "best" weightSometimes it is helpful to talk with your medical doctor about a referral to a nutritionist or trainer.  And, it sounds like you would need medical clearance before moving forward with surgery.Good luck!In good health,Ellen Mahony, MD

You would need to have a formal consultation by a board certified plastic surgeon in person to know for sure.  You would need to have clearance by your medical doctor.    I definitely have done tummy tucks your size .  Best to see a board certified plastic surgeon.

You have several significant issues going against your desire to have a tummy tuck including a high BMI (weight), taking prednisone and on enbrel - and this is without knowing your medical history. All 3 can have significant impacts on healing and other issues. You will need to lose a significant amount of weight and see what can be done to get off the prednisone. Discuss these issues with your doctors and see how they can be effectively addressed otherwise it would be imprudent to still try to undergo a tummy tuck given the present situation.Steven Turkeltaub, MD

Thank you for the question and picture.  Generally speaking, it is always best to achieve long-term stable weight prior to proceeding with  body contouring surgery. Doing so, will increase the safety of the operation, will likely improve the outcome of the operation, and will decrease chances that additional surgery will become necessary subsequently. In my practice, I do not ask specific patients to achieve a specific weight prior to proceeding with tummy tuck surgery. I simply ask patients to achieve a long-term stable weight where he/she feels comfortable and does not expect significant fluctuation postoperatively.  As you know, recruiting other professionals such as personal trainers, nutritionists, physicians who specialize in weight loss concerns etc. may be helpful to you.  Having said the above,  occasional patients do benefit from panniculectomy surgery as a “jumpstart” to achieving their final goals. The panniculectomy operation involves excision of the lower abdominal wall pannus or  overhanging skin/adipose tissue. It is not considered an  aesthetically driven procedure;  it is often performed to help with concerns such as skin breakdown, infections/rashes…Best wishes.