Tummy Tuck & Lipo with high BMI?

Question

I previously had lap band surgery & am down about 100lbs. But I am 5'10 / 255 lbs. And that hasn't changed with diet or exercise in about a year. I am also a little "wide". I am interested in getting Lipotuck done. Pesky back fat & this huge fat curtain that just hangs over my pelvic area. My BMI currently says it is 36.6. In order for me to hit 30.8 I need to drop 40 lbs. But I've been at a plateau for a year. I don't see it happening. Can I still get the procedure done?

Robert P. Schmid, MD · Answer

Thanks for your question! Based on your description, your BMI (body mass index, a mix of height & weight, there are several free apps you can download to calculate this) is >35. 
I don't do tummy tucks on people with BMI's over 33, & I do >100-150 per year. There are just too many risks, to include infection, poor wound healing, & most importantly, blood clots & even death. I don't have your photos to look at, but judging by your BMI, you need to know that you are at a distinct increased risk for this surgery. Talk to a board certified plastic surgeon experience in body contouring to see if there's someone in your area who might feel comfortable doing your surgery.  Best of luck to you!

Emmanuel Mallol Cotes, MD · Answer

Thanks for sharing your concerns with us. A high BMI is a risk factor avoidable, I always suggest to my patients to be carefull losing weight before a surgery that is why a suggest a nutritionist to loss weight in a proper weight, being healthy. The BMI needs to be 30 or less for a safer procedure. Kind regards

Gerald Minniti, MD, FACS · Answer

Hello,I understand your predicament. You should be evaluated by an ABPS certified/ASAPS member surgeon who is experienced in bariatric body contouring. If it is determined that you do not have excessive intra-abdominal fat, then having a tummy tuck may be the best thing for your continued weight loss. The number 30 for BMI was based on old and questionable data, just like using the 'Caprini Score' to determine your risk of a throboembolic event (a blood clot) is probably not applicable to plastic surgery patients either. Regardless, you are at higher risk, and performing the surgery without muscle relaxation (something that surgeons are loathe to do because your breathing movements are disturbing) will likely lower your risk based on at least one series of tummy tuck patients. Best of luck!

Daniel Barrett, MD · Answer

Dear MrsMata,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.
If not, great! 
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

Bruce K. Smith, MD · Answer

Many patients after bariatric surgery will reach a plateau after losing 80 to 100 lbs, in which the weight loss becomes more difficult. At this point, you may be a candidate for a panniculectomy, or belt lipectomy in which the excess skin and residual fatty tissue only is removed. This procedure will allow further weight loss by making it easier to exercise. After panniculectomy, when you reach your ideal body weight or BMI, additional surgery can be considered for the arms, breasts, abdomen and thighs.

Sugene Kim, MD, FACS · Answer

Hi, MrsMataAlthough having a high BMI has an increased risk for surgery and post-op recovery, your healing will also depend on your current nutritional status, medical comorbidities, as well as your distribution of fat in your body.  Please consult a board-certified plastic surgeon to discuss all potential risks/complications of surgery and to find out your candidacy for tummy tuck with liposuction.Best regards.

Ricardo Ventura, MD · Answer

Hello, thanks for your question and provided information as well.. It will be better for every patient to lose weight before surgery, it will be safer and the patient can develop even better results. Congrats on your weight loss!! Good luck!

Kiran Polavarapu, MD · Answer

It would be safest for you to lose weight before considering a tummy tuck. Tummy tucks are great for contouring the abdomen, but are not tools for weight loss. Unfortunately, a higher BMI can also lead to complications during and after surgery. Good luck and congrats on your weight loss!

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your successful weight loss!  I agree that specific calculations, including BMI,  are not always helpful when it comes to determining a specific patient's suitability to proceed with surgery.
Having said that, it is always best (or ideal) to achieve long-term stable weight prior to proceeding with tummy tuck 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.
 Generally speaking, the “ideal” patient for tummy tuck surgery is one who has completed pregnancies, is psycho socially/emotionally/financially stable, has an excellent social support system surrounding him/her, is capable of arranging enough recovery time, does not smoke and who has reached a long-term stable weight.
 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you would be pleased with.   Then prepare yourself and your support system for a  significant recovery experience (physical and often emotional).
 
 Best wishes.

Jack Peterson, MD · Answer

I would recommend you return to the surgeon that performed your lap band and discuss your situation. I perform a significant number of post weight loss surgeries and I like my patients to be a BMI of 30 or less for several reasons.1) safety of surgery. Higher BMI have an increased risk of complications during  the post operative  surgery like pulmonary embolus or deep vein thrombosis2) Improved healing. Higher BMI patients have an increased risk of having wound healing issues, seromas and infection rates that will effect incision line cosmetic result3) improved cosmetic result. The closer you are to your ideal body weight, the better the cosmetic resultBest wishes on your journey,Jack Peterson MD

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