One of the most common questions we hear from patients considering plastic surgery is whether they should lose weight prior to their surgery. Obviously, all physicians want their patients to be in the best health prior to any elective surgery and obesity adds risks to elective surgery. Yet, not all patients are the ideal body weight prior to their surgery. The question then becomes, what factors do we take into consideration regarding a patient’s weight?
There are 2 basic factors we consider regarding a patients weight and elective cosmetic surgery. The first is risk. Are the patient’s risks of surviving the surgery increased due to their weight and are their increased risks of complications. The second is result. Will a patient have a good outcome from the proposed surgery at their present weight?
In this first part of a 2 part series, we will consider risk first. Certain surgical risk factors increase in a patient who is significantly overweight. We call patients that are significantly overweight, obese. Obesity is defined as any patient who’s body mass index is greater than 30. Morbid obesity is considered anyone with a body mass index greater than 40. Body mass index (BMI) is determined by a formula that uses your height and weight. The ideal BMI is accepted to be 19-25. The BMI is a rough scale as it does not take into consideration extremes of muscle mass. As an example, in 2010, their were numerous news stories concerning Shaquille O’neal who had a BMI greater than 30. O’Neal, being a professional athlete, has a muscle mass that pushed his BMI calculation into the obesity range. [For anyone interested in checking their BMI, calculators can be found on the internet by searching BMI.]
So what does a BMI of greater than thirty mean? The average American male is 5’9” tall. The ideal body weight for this individual is from 130 -163 pounds. However, in 2008, this average American male weighed 195 pounds. That’s a BMI of 28.8 and would be equivalent to a body fat of 26%. For this individual it would mean carrying around 48 pounds of fat!
How does this extra poundage affect the surgical patient? Significantly! Studies performed by several different surgical subspecialties demonstrate dramatically increased risks for the patient with a BMI greater than 30. If our average American male had a 10 pound weight gain over the holidays, this would suddenly propel him into a BMI > 30 range.
In Plastic Surgery, numerous studies have demonstrated that the risks of surgery may be increased with a BMI > 30. Infections tend to be higher as well as poorer wound healing. The greatest risk may stem from an increased chance of a patient developing blood clots following surgery. Therefore, patients with higher BMI’s must be aware that their risks may be higher and certain surgical precautions will need to be taken during their surgeries. Ideally, patients with a BMI > 30 are encouraged to lose weight prior to their surgery, if they can.