Yesterday, I had a patient with a BMI of 41 come to the clinic asking for an abdominoplasty (also known as a tummy tuck). For those of you who are not familiar with the acronym, “BMI” stands for body mass index, which is a measure of weight to height. The upper limit of a normal BMI is 24. A BMI of 30 is the threshold of obesity and a BMI of 40 is the threshold of morbid obesity. Both of the latter categories predispose patients to considerable health risks, which are largely preventable with appropriate intervention.
The peer-reviewed literature in plastic surgery is replete with articles stating that an abdominoplasty should not be performed with a BMI greater than 30. In some circumstances, that may still be too high for good results.
A high BMI makes preforming surgery significantly more complicated and potentially dangerous. It is not just the fat on abdominal wall that you have to consider, but also the visceral fat that takes up volume, making it nearly impossible to correct the separation of the six pack muscle in the midline, known as “diastasis recti”. The other reason surgery is not recommended is because morbid obesity greatly increases the risk of surgical complications, including wound healing, blood clot formation in the legs, and even blood clots traveling to the lungs. When this happens, the clots interfere with oxygenation of the blood and can even be fatal.
I recently had a patient, who had been treated elsewhere, come to my clinic after having an abdominoplasty when her BMI was 40. She had a wound breakdown and, for the past 3 months, had an open wound in her abdomen.
Abdominoplasty is an elective surgery; there is no excuse for putting a patient at unnecessary risks for complications, even if the patient is insistent on having it done.
I can say with complete honesty that I turn away nearly half of the people who visit my clinic for an abdominoplasty because they are too heavy and are not willing to lose weight to become a good surgical candidate. To give these patients another option, I have begun an in-house weight loss program. This helps patients safely lose weight so that they can become good surgical candidates.
Sadly, many patients who are rejected for surgery walk out the door, hoping to find a willing plastic surgeon. Unfortunately, there are no short cuts to getting the results that you want. Getting an abdominoplasty can be transformative for many patients, as long as they’re in good health beforehand.
If you want to learn whether you’re a good candidate for abdominoplasty, or for any of our other procedures, please contact us.
