5-5' 5-6' Struggle to get & stay below 200, 43 yrs old. Prior to kids 145-165. What would you recommend? (Photos)

Thank you for the question! It sounds like you might benefit from a combination of procedures known as a Mommy Makeover. This comprehensive treatment is designed to revive your before-pregnancy appearance by combining a tummy tuck, liposuction, and breast lift. This combination of procedures can also be modified to suit your individual needs.  While a mommy makeover can go a long way to restore your confidence, the present concern is your BMI. Typically, a plastic surgeon will perform a mommy makeover only if you bring your BMI below 30. Currently, your BMI is at 38.7, so I'd advise you to go through a weight loss program first. Once you succeed in getting close to your ideal weight, schedule a consultation to see whether a mommy makeover is right for you. 
An in-person exam with a board-certified plastic surgeon would be the best way to assess your needs and guarantee a reliable medical advice. Best of luck! 

Based on the photos provided you appear to be a candidate for a Mommy Makeover.  This would be comprised of a breast lift (with or without implants), a tummy tuck, and liposuction for contouring.  For your health and safety and to keep risk from complications from increasing it s best if you can lower your BMI below 30.  If you are struggling to do this on your own you may want to work with a trainer or nutritionist to help get you started.