My BMI is 32, I am 5'9" and I weigh about 219. I am getting a MMO. Do I need to get my BMI lower?

If you realistically can lower your bmi, it would be great. If you are really stuck at that weight it would be okay to go for the surgery now. Without pictures, it is hard to advise further than that
Good luck

I have operated on patients with a BMI of 32 with excellent results.  It is certainly more desirable to have a lower weight.  If you are not planning future pregnancies, the technique I recommend for a tummy tuck is abdominoplasty with mesh reinforcement.  The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.  At the same time, a breast lift can be done.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.Best Wishes,Gary Horndeski, M.D.