Would not do a panniculectomy unless I was at a BMI of 30 or less. Why is this such a set in stone requirement?

Thank you for your question on what to do with your abdomen after massive weight loss and then, weight gain. Also, why won’t plastic surgeons perform your panniculectomy with a BMI of greater than 30.  The reason plastic surgeons suggest a BMI to be less than 30 is that there is less risk of complications with a BMI of less than 30. Multiple studies have shown that the ideal BMI number should less than 30. Most insurance companies rely on a BMI of less than 30 for procedures, like a panniculectomy and/or breast reductions. However, that does not necessarily mean you cannot have a panniculectomy surgery if your BMI is not less than 30. Having a BMI of greater than 30 just means that you have an increased risk of complications like blood clots, wound healing, infection, pneumonia, etc. Also, with a BMI greater than 30, it is highly unlikely that your insurance will approve your procedure because of the insurance policies. Nonetheless, I have had many patients who had a BMI of over 30 on whom I have performed successful panniculectomy surgery. Before the panniculectomy surgery, the patient with a BMI greater than 30 and I entered into surgery realizing that they were at an increased risk of complications. In almost all cases where the BMI was greater than 30, the patient's insurance did not cover their desired procedure.
In your case, I would suggest the following. If you want your medical insurance to potentially cover your panniculectomy procedure, your BMI must be less than 30. Since you have multiple medical conditions and you say you cannot achieve a weight of less than 200 pounds, I would suggest you consider a medical weight loss program or even a surgical weight loss procedure, like a lap band or gastric sleeve. Please seek an appropriate medical or surgical specialist in gastric surgery for these procedures. Once you have achieved a BMI of less than 30, then revisit your doctors and submit for insurance authorization. If however, you are unable to achieve a BMI of less than 30, you will probably have to pay cash for your elective surgical procedures. Then, you will have to find a plastic surgeon that is willing to accept your case. You did not elaborate on exactly which medical conditions you have. However, some conditions will still allow you to have a panniculectomy or extended tummy tuck with your medical conditions and a BMI over 30. Thank you for your question on what to do with your abdomen with BMI over 30 and associated with other medical conditions. I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research.  Make sure they have performed at least 100 panniculectomies or extended tummy tuck surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Having a BMI over 30 increases the risk of complications during and after surgery and decreases the probability that the best results will be obtained from the surgery.A high BMI puts you at risk for Type II diabetes, hypertension, urinary stress, gastro esophageal reflux, osteoarthritis, sleep apnea, cardiovascular problems, cancer, and others health issues.  Take the necessary steps to participate in an exercise program and weight reduction program to become healthy prior to your panniculectomy.

Dear rep1070,
Congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider a panniculectomy, otherwise your results will be suboptimal if you continue to lose weight after the surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery