Your Weight and Plastic Surgery: Why It Matters

exercising-2womenSometimes patients will go into a plastic surgeon’s office excited about a decision to finally move forward with breast or body contouring surgery, but then afterwards emerge having found out they are not currently a candidate because of excess body fat. This scenario is not only disappointing, but it can be an emotionally deflating and potentially embarrassing experience for patients. As plastic surgeons we sympathize over the emotional pain that such patients feel, and we want to help them realize their goals. However there are several specific reasons that your plastic surgeon might recommend weight loss prior to undergoing a procedure and our motivations are only to provide you with the safest care and the best results.

According to the Centers for Disease Control (CDC), currently 69% of the U.S. population over 20 years of age is overweight. Of this percentage, 35% is obese. So how does the CDC calculate this statistic? First, the CDC defines “normal” weight, “overweight” and “obese” using a formula that calculates Body Mass Index (BMI). This is based on your height and weight. A “normal” BMI is 20-25, “overweight” is defined as a BMI of 25-30, and a BMI over 30 is technically considered “obese”. The BMI calculation is not perfect – for instance it does not take into account muscle mass versus fat mass – yet it is a pretty good basic measurement nonetheless. And it is important to us as plastic surgeons because BMI is a good predictor of the risks of surgery and the likelihood of a good result.

Many medical studies have shown that increased BMI is a predictor of potential complications that can occur from plastic surgery. A higher BMI is associated with an increased risk for wound complications, such as dehiscense (the wound opens up), infection, or tissue necrosis (tissues do not survive due to poor blood supply). The increases are typically small for patients who are overweight – a BMI 25-30, but they start increasing quickly as the BMI enters into the obese range. In general, it is a fair statement that the higher the BMI, the higher the risks of surgery. These complications can be significant, so as plastic surgeons we consider these risks with great thought.

In addition, the results that you can get are likely to be much better if your weight is in a better range. Let’s consider a couple of examples. Say, for instance, that a patient wants breast reduction surgery, but they are very heavy. Even when the breasts become smaller and more uplifted, it is extremely difficult for us to deal with the fullness lateral to the breasts (the “bra roll”), which significantly compromises the aesthetic result. In addition, it is much harder to get a beautiful transition between the breast and the abdomen due to the excess weight. On the other hand, let’s consider the patient that is overweight and wants a tummy tuck or liposuction. In this instance, the surgeon will not be able to remove all the excess fat in these areas, as it is technically challenging and can look odd as it is out of proportion to the surrounding fatty deposits. Even a lot of liposuction cannot fully solve this problem. Body contouring surgery is great for shaping your body, but it is not a method or substitute for weight loss or weight control.

What is the “cutoff” BMI number for plastic surgery? That is a difficult question, and there are some exceptions based on individual surgical procedures, body fat distribution, muscle mass and other factors. Many plastic surgeons consider a BMI above 30 or 32 to be in the range where surgery should be delayed until weight loss is achieved. If you are interested in calculating your own BMI, there are several free online tools, including the one from the Emory Bariatric Center.

As plastic surgeons I believe that we have an ethical responsibility to guide our patients related to their weight and desire for surgery. When surgery is unfavorable due to weight, there is the opportunity to partner toward a weight loss goal. Struggling with excess weight is a problem that so many of us deal with, and it is good to know that someone is on your side and understands. We can provide some advice, but even more importantly we can help guide you toward weight loss experts that help with diet modification and even newer procedures – such as the recently approved intragastric balloon – to assist with weight loss. Let the board certified plastic surgeons of the Emory Aesthetic Center, along with the Emory Bariatric Center, help you achieve the weight and body that you want. Imagine the joy of finally getting your weight under control, and then having the surgery you want to get the most effective results.

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About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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