Gastric Sleeve or Tummy Tuck with Lipo? (Photo)

With a BMI of 31.4, you fall into the Obese Class 1 category, making you a strong candidate for a gastric sleeve procedure, especially if you have struggled with weight loss despite diet and exercise.
Since you also have PCOS and hypothyroidism, both of which make weight loss more difficult, a gastric sleeve can be a very effective tool to help:Reset your metabolismReduce hunger hormonesPromote long-term, sustainable fat lossAddress metabolic challenges tied to your medical conditions
If your goal is to lose 20–30 pounds, starting with a gastric sleeve is often recommended before considering cosmetic surgery like a tummy tuck. Significant weight loss can naturally improve the shape of your abdomen, sometimes reducing the amount of loose skin and making any future body contouring more effective and safer.
Many patients find that after reaching their goal weight through a gastric sleeve and building a consistent fitness routine, they either no longer need a tummy tuck or can achieve even better results if they choose to move forward with one later.
It’s important to have a full evaluation with your medical team to determine the best sequence of procedures for your personal goals and overall health.

you are a candidate for weight loss surgery, since you have a body mass index of 31.4, which places you in obesity I, I recommend that you have the sleeve and then the abdominoplasty, and some liposuction on your arms, it will be excellent for you.

Since you mentioned that you only have 20-30 lbs to lose, a gastric sleeve might not be the ideal option. Gastric sleeve surgery is typically recommended for individuals with a BMI of 35+ with health conditions or BMI of 40+ without. Since you're currently 161 lbs at 5'0", your BMI is around 31.4, which may not qualify you for this surgery unless you have significant health reasons related to your PCOS or hypothyroidism.
On the orher hand, a tummy tuck focuses on removing loose skin, tightening abdominal muscles (like diastasis recti from pregnancy), and shaping the waistline. It does not help with weight loss, but it can give you a flatter stomach if most of the problem is due to loose skin or muscle separation. Since you’ve mentioned muscle separation and stubborn fat in the tummy, it sounds like you’re a great candidate for this procedure.
Since your main goal is a flat stomach (and not necessarily major weight loss), a tummy tuck seems like the better option. It can tighten your abdominal muscles, remove loose skin, and reduce stubborn belly fat with liposuction. Since most of your weight is in the tummy area, and you’re already working out 3-5 times a week, you might be closer to your goal than you think.

Gastric sleeve surgery can be a good option since your BMI is 31.4 and you have comorbidities like polycystic ovarian syndrome. This surgery can help with long-term weight management. After achieving weight loss, a tummy tuck could address loose skin and muscle separation.
The ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for individuals with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI 30-34.9 and metabolic disease.
But even without metabolic disease, the guidelines say weight-loss surgery should be considered starting at BMI 30 for people who do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods.