Overweight Plus Size Tummy Tuck

The first and most important question you must ask yourself:  Is a Plus-Size Tummy Tuck Safe for Me?   For every woman, the goal of a tummy tuck is a flat tummy and a more defined waist.  The tummy may be hanging over the pubic area.  There may be more fatty tissue around the waist.  To restore a flat tummy and waist definition, skin and fatty tissue need to be removed.  For a “plus-size tummy tuck” and I apologize for using the term, more fat and more skin need to be removed during the surgery.  More fat can mean more blood loss and more operative time:  More risk.  So the question remains, Is a “plus sized tummy tuck” safe?

North Carolina plastic surgeon Dr.  Jeffrey A. Ditesheim focuses on each woman’s body, her frame and shape.  “I want to design first and foremost a Safe operation.  The aesthetic goals are a flat tummy and waist definition.  But to be safe only so much fat or skin can be removed at one time.  So maybe more than one stage will be needed to reshape the body” says Dr. Ditesheim, in Charlotte, North Carolina.

Apologizing for the use of the term “plus-size”,  the the quick answer is this:  Up to a point, “plus-size women can get a tummy tuck safely.     BMI is imperfect, doesn’t take into account  ethnic and racial body differences, but does permit a quick risk stratification.  In other words, some women considered “overweight”, “plus-size” or “large frame” are very good candidates for a tummy tuck.  Other women, particularly, women with BMI>35 are at considerably higher risk for serious complications including blood loss, wound problems and death.    When I looked at my  patient experience over almost 30 years, most of my patients would be considered “overweight”.  This is after all, America!   But women have different bodies.  Some women have more fat concentrated in their torso, some around their buttocks and thighs. Some are taller.      BMI is helpful to potentially determine where the safe range stops and where a greater danger and risk  is present.   In my experience, “plus sized women” who had a tummy tuck were from 5’1″ to 5’11” and from 158lb to 212lb.  Using the BMI calculation ( which puts height and weight together),  almost all women were between BMI:  28 and 35.  ( That is a woman 5’9″  193lb to another women 5’5″  212lb).   Restated, a woman who considers herself “plus size” may safely have a tummy tuck if her BMI is between 28 and 32, and always below 35.    Women at much higher weight or BMI> 35 are at much higher risk for a tummy tuck procedure.

If you’re interested in having a plus-size tummy tuck, please schedule an initial consultation at our Charlotte surgery center. During your consultation, Dr. D will assess your specific needs and discuss your goals and expectations.

When I looked at my patients in this “plus-sized” subgroup, almost all had a hanging tummy. To restore shape, these women needed between 7 to 14lb of fatty tissue removed.  Remember, removing fat, even with liposuction results in blood loss.  It is considered safe to remove up to 10 lb of fat for a healthy patient at one time, with a normal blood count.   Risk factors like older age, diabetes, high blood pressure, lower blood count can all add risk to the surgery.  So many of my patients needed two stages to achieve the body they desired.

If you have all your fat concentrated in your upper body, minimal in your buttocks and thighs, you may have a large tummy but a low BMI.  This woman ( 5’`10″  186lb) had a BMI: 27.  To give her the shape she desired, a total of 18lb of fatty tissue was removed in two stages.  The first stage, liposuction only.  In the second stage, additional liposuction and a tummy tuck.   The image below illustrates the stages of a Tummy tuck 360 procedure for this  46-year-old woman.

Plus size tummy tuck

Women with a substantial lower body, characterized by abundant fatty tissue in the buttocks and thighs, are often observed.

This woman expressed a desire for an improved body shape. Like many shorter-statured women at 5'2", she was dissatisfied with her "square" figure. VaserLipo was employed to create a smoother abdomen and accentuate her waist, back, and buttocks. Additionally, Renuvion was applied to enhance the outcome by firming up the loose skin following liposuction.

Larger women who don’t have excess skin sagging but exhibit thickness can sometimes undergo liposuction under local anesthesia for treatment.

After significant weight loss in plus-size women, an extended tummy tuck and liposuction are typically recommended.

Below are some qualifications and considerations for overweight tummy tuck surgery. If you’re a good candidate for plastic surgery, Dr. Ditesheim will suggest a course of action that safely helps you achieve your body goals.
● You are in good overall physical health
● You’re a non-smoker
● You can maintain a stable body weight
● You are not pregnant
● You have excess skin and fat in the tummy
● You want to fix an overhanging stomach
● Your BMI is less than 35.

Patients with certain medical conditions or chronic health issues, like uncontrolled diabetes, heart disease, clotting disorders, or severe obesity, may not be a good candidate for a plus size tummy tuck.

Tummy tuck surgery is done under general anesthesia, meaning you will be asleep.
At higher weight, or higher BMI, the tummy tuck does not tighten the muscle or fascial layer.  The excess skin is removed with a scar that is placed low and can be covered with bathing suits

 One of the most important aspects of a plus-size tummy tuck is repositioning the belly button to sit in a natural-looking position. Some patients will also benefit from having liposuction during a plus-size tummy tuck.

Like any other procedure, Dr. Ditesheim’s plus-size surgical approach is unique to every patient. He uses the latest modern surgical techniques to ensure optimal results.

• Obesity, particularly weight over 200lb and BMI over 20 statistically has a higher risk of complications including prolonged swelling, possible delayed healing, and infection.
• Other medical factors like Diabetes and Hypertension ( high blood pressure) often seen in higher-weight women further add to risk of complications.
• More swelling or other complications can prolong recovery.
• There is more fat to remove to shape the body, so more than one session may be needed to be safe.

• Larger tummies (with more internal fat) may not be tightened internally ( repairing muscle stretching from pregnancy). Because tightening the large tummy will restrict breathing.
• Tummy Tuck 360 ( Tummy Tuck with circumferential lipo) req position changes ( patient on tummy and on back). This may not be possible for larger women
• More fatty tissue to remove, so more than one session may be needed.

Numerous physicians have a threshold for BMI and may decline to perform procedures on women with a BMI over 30 or 32. However, in my practice spanning the past 25 years, I have provided care to numerous women with higher weights, which often translates to a weight exceeding 200 pounds or a BMI exceeding 35.

At Ditesheim Cosmetic Surgery, how we safely perform tummy tuck for plus sized women:

• Not all women who are categorized as “plus-sized” are the same. Depends on the frame, the height, and where the fatty tissue is concentrated. ( upper or lower body)
• If the tummy is holding a lot of fat ( is very “thick”) ( a thicker fatty tissue layer) it is best to treat with liposuction first and in a second session so the tummy tuck and likely more lipo
• Patients are treated supine ( one position ) only
  Operating time is limited to 4 hr for safety
• Total fat removed one time is limited to 10lb
• Larger women ( over 190lb) no tummy internal tightening.

• There is more skin to remove for a plus sized women ( usually an Extended Tummy Tuck) scar is longer on the sides to remove more skin
• There is more fatty tissue to be removed for plus size women ( so may not be able to do all lipo 360 at the same time. May need a second session
• Tummy Tuck only for plus-sized women without lipo may remove the excess skin and stretch marks but not result in a good shape or waist definition ( good pic on website showing lipo for plus-sized women after a tummy tuck)
• No internal tightening for plus size women (restricts diaphragm and breathing)

• Plus size tummy tuck cost ranges from $15,460 to $20,455 for most women.  Surgical time is 4 hours.  Recovery is 2-6 weeks.
• Liposuction for plus sized women starts at $8,800
• These fees are for general anesthesia in our facility, and are estimates based on past patients.  Fees are for payment with cashier’s check.  Financing is available.

Dr. Ditesheim recommends most patients set aside two-four weeks off of work following a tummy tuck procedure for overweight individuals. Patients with physically demanding jobs may need to arrange for more time off. All strenuous exercise should be avoided for at least four weeks post-op.

You’ll have several follow-up appointments at our Charlotte office to check on your progress during your recovery period. Dr. Ditesheim will tell you when it’s safe for you to resume exercising and your regular activity. Please wait for the doctor’s approval before continuing physical exercise.

This 38 yr old woman was frustrated with her breasts and her body.  As a young woman who had finished her family, she wanted to feel young, to feel beautiful.  Her heavy and uncomfortable breasts (38DDD bra) were a daily physical and emotional handicap.  The hanging tummy caused her to avoid social activities.  No exercise or diet she could do on her own could restore her youthful body and confidence.  Her stated goal: “I want to be more comfortable with my body”

The Surgery:  A mommy makeover is a combination of procedures that will restore the beauty of the breasts and the body.  The breast reduction, tummy tuck and liposuction were performed in one surgical session.  Immediately after the breast reduction (from  bra 38DDD to 38D), the pain from the large breasts was gone!  An extended tummy tuck ( a tummy tuck for plus sized women) corrects the muscle and inner core weakness. This restores support to the back and improves posture.  Aquashape Liposuction is a gentle liposuction technique that uses a water-jet to remove fat cells.  Removing fat rolls and bulges in the bra area, the waist and under the arm really helps to shape the body.  Combining multiple procedures in one session has the advantage of “getting more done at once, with one anesthesia”.  For some women, this is safe and reasonable.  When there is more risk (smokers, diabetes, higher weight, other medical issues) it may be safer to have two 3-4 hour surgical sessions than one 6-7hr session.  Safety is always the first priority. 

Dr. Ditesheim and the Ditesheim Cosmetic Surgery staff are here to guide you toward a more confident, empowered you. Schedule your plus-size tummy tuck consultation today.

We look forward to hearing from you!