Healthy Candidates for Cosmetic Surgery

MyBreast founding surgeon, Mr Norman Waterhouse, talks about healthy candidates for cosmetic surgery.

When considering any form of surgery it is obviously in your best interest to be in the best possible health.  Many elective non-urgent surgical procedures carry much higher risks if the patient is overweight.  Often because cosmetic surgery is designed to improve shape and form of the human body patients are surprised that plastic surgeons are also concerned about weight.  In the National Health Service there are specific guidelines that will deny surgery to any patients who have a BMI (body mass index) that indicates obesity.  So despite liposuction being the most common cosmetic surgery operation carried out globally it is sometimes confusing that plastic surgeons refuse to carry out surgery on the grounds that patients are too heavy. There are however a number of issues about weight that are not commonly understood.

Liposuction is very much surgery of the silhouette to improve shape and is not expected to be used as a means for weight loss.  Candidates are often turned down for certain types of procedures more often than others particularly body surgery that involves abdominoplasty and thigh surgery.  There is a general rule that if the BMI (body mass index) is in the obese range that surgery is frequently declined.  Although this is a general rule it is not necessarily fixed and exceptions can be made.

However there is a very good reason why elective cosmetic surgery should not be carried out if there is a significant weight problem and this relates to safety.  There is no doubt that any patient undergoing any operation whether cosmetic or reconstructive or of any form is at much greater risk from a number of common complications which include chest infections, urinary tract infection and delays in wound healing. Perhaps the most important however is the potentially fatal complication of venous thrombosis, so-called thrombo-embolic disease.  This is much higher in overweight patients and also in patients undergoing extended surgery.  It is also higher when the surgery is carried out in the limbs, abdomen and thighs.  The risks are often cumulative so to be overweight and to have lengthy surgery and to have other risk factors such as diabetes or a smoking history will escalate the risk significantly.

The BMI is not a fixed number and its significance can vary with body type and age.  It is unreliable in children, in athletes, and to some extent in people of certain body shapes.  On occasions the risks of being overweight will actually outweigh all others and this is certainly the case with bariatric surgery designed to produce weight loss.  This includes gastric banding surgery and gastric bypass.  Cosmetic plastic surgery is helpful when weight has been lost to reshape excess skin that results from excessive weight loss.

Even for cosmetic surgery candidates who are not in the clinically obese range of the BMI, being overweight can still result in some problems.

However common sense needs to be employed when selecting candidates for surgery.  Women presenting for large breast reduction cannot be expected to lose much weight prior to surgery.  Conversely often after a breast reduction has been carried out the procedure will result in much more comfort for the patient as well as an increased ability to wear more appropriate clothing and to take exercise.  Frequently after a breast reduction women will lose a lot more weight in the following twelve months as the breast reduction offers opportunities for a healthier lifestyle.

The BMI or body mass index is a measure of body fat.  It is now very commonly discussed and most people have heard of it.  It is a figure based on height and weight the ratio of which produces a number.  The ‘normal’ BMI is between 18 and 25.  Many people will find themselves in the slightly overweight category between 25 and 29.9.  To have a BMI of 30 however is to have a significant risk of an increased incidence of certain conditions such as heart disease, high blood pressure, Type II diabetes, gall stones and breathing problems.