We were recently asked by a patient how BMI affects our decision to perform abdominoplasty. We thought this was an excellent question and I’ll paraphrase it below.
Every case is individual and I don’t necessarily have a cutoff or absolute BMI number that determines if I will or won’t do an abdominoplasty. I lot of factors play into the decision.
I tell all my patients I want them to be at a stable weight before the surgery. Significant weight changes after the surgery can compromise your result. I don’t insist patients reach an “ideal” weight, but at least I’m not trying to aim for a moving target.
Lower BMI patients are generally going to get a better result than higher BMI patients, but I’ve had many higher BMI patients who were extremely happy with the amount of improvement we were able to achieve. They were realistic in their expectations and I was able to meet or exceed these.
In the higher BMI patient, I consider multiple factors before deciding if I will recommend an abdominoplasty. These include:
Overall health and potentially complicating medical conditions
Previous abdominal scars
Potential for improvement
and other factors
If I don’t feel the operation can be done safely or the result will fall short of the patient’s expectations, I’ll tell them at the consultation. I’d rather disappoint them at our initial consultation than have them be disappointed (or endangered) by the operation.
Traditional abdominoplasty procedures have always involved the placement of drains to prevent abnormal fluid collection beneath the recently moved skin to prevent fluid collection. These are flexible tubes placed during surgery which attach to small suction bulbs, continuously pulling out fluid for the first few days or occasionally weeks after surgery. The drains are left in place until the fluid output decreases, and then are removed during an office visit.
What’s wrong with drains?
While having drains in place after an abdominoplasty is generally not painful, many patients find them to be a real nuisance. They must be emptied 2-3 times a day, can be difficult to conceal under clothing, the site where the drain exits the incision or drain requires care, they sometimes clog, and they may inhibit showering or bathing. If they are removed too early, fluid may accumulate beneath the incision which will require drainage.
The No Drain abdominoplasty
When performing a no-drain abdominoplasty, additional sutures are placed between the abdominal wall and the overlying fat and skin, closing off the space where fluid would otherwise accumulate. In addition to making drains unnecessary, the sutures are used to relieve some of the tension on the final skin closure, potentially helping to keep this scar from widening. The procedure takes a little longer to do, but the convenience and comfort for the patient after the operation certainly makes it worthwhile.
We can’t perform a no-drain abdominoplasty on every patient, but find that it is possible for most. Be sure to ask us during your consultation if we can do it for you.
While smoking is detrimental to a person’s health for a number of reasons, it is poses particular problems for patients undergoing surgery. Nicotine, whether from cigarettes, patches, gum, etc., causes vasoconstriction in the small vessels that we count on to heal newly created wounds. This is especially true in certain procedures where the normal blood supply is disrupted and the tissues are tightened at the time of closure, such as with a facelift, abdominoplasty, breast lift, breast reduction, and breast reconstruction.
We feel strongly that in certain cases the risk of significant wound healing problems outweighs any benefit we would provide with the procedure. In these types of cases, we will decline to do the operation unless our patient is nicotine free. This does not apply to all procedures we perform, so be sure to ask us when this rule applies.
Some patients may choose to go elsewhere for their surgery because of our caution on this issue. While surgery on patients that use nicotine products can be successful in some cases, we feel the risks of a bad outcome are unacceptably high.