Can You Get a Tummy Tuck With a High BMI? How I Decide

Great question, and it came from someone with a BMI of 33 wondering whether a tummy tuck is even on the table.

When I'm evaluating a patient for a tummy tuck who has an elevated BMI, there are really two things I'm trying to figure out as a surgeon:

1. Can I get a good result on this patient?
2. Is this a safe surgery?

Neither one is answered by the number alone.

Let's start with aesthetics. I look at the patient and figure out how their weight is distributed:

• Do they carry a lot of weight around the neck?
• A lot of weight in the midsection?
• A lot of weight in the lower body?

Two of those tell me something specific.

A lot of weight around the midsection can indicate visceral fat, and that matters enormously for this operation. Visceral fat makes a tummy tuck less likely to get a good result, and sometimes you can't even get enough laxity to perform one.

The reason is where that fat lives. A tummy tuck works on the skin and the muscle wall, not on fat that sits deeper inside the abdomen, so a belly that's round from that deeper fat can stay round after surgery.

A lot of weight around the neck can indicate a difficult airway, so it's something to always consider. That's less about how your abdomen will look and more about how safely you can be put under, which is one reason I care so much about who is managing your anesthesia.

Two patients with the identical BMI can be completely different surgical candidates.

Here's the honest, slightly uncomfortable truth about BMI.

BMI is not a great indicator of overall health.

But it has been found to be an independent risk factor for certain surgical complications. That means just that number being elevated, not taking anything else into account, leads to a higher complication rate.

So both things are true at once: it's a crude measure, and it still predicts risk.

That's the real question for you as a patient. My answer:

Which is why the next step is always your overall health. I look into my patient's medical history. I see what medications they're on. And we try to figure out whether the risk of the procedure makes sense.

In many patients with a BMI of 33, it does.

It's the same logic I use for patients with medical problems who want implants: the diagnosis, or the number, starts a more careful conversation. It doesn't end one. And it's the same reason the pre-op evaluation is the most important visit you'll have.

An elevated BMI doesn't automatically rule out a tummy tuck. What I'm actually evaluating is:

• Can I get a good result? That depends on where you carry your weight. Midsection weight can mean visceral fat, which makes a good result less likely and sometimes makes the operation impossible.
• Is it safe? BMI is a poor measure of health but a real, independent risk factor for certain complications, so your medical history and medications decide whether that added risk makes sense.

For many patients with a BMI around 33, the answer is yes. The only way to know is an exam, because your outcome depends on a lot more than one number.