Article by Dr. Kimberly Singh, Board-Certified Plastic Surgeon
The longer I and my partner, Dr. Nour Abboushi, are in practice together at Panacea, the clearer it becomes to us that overweight and obese women have been systemically under-served and ignored to the point of neglect by the plastic surgery community.
Every day, we receive plus-size tummy tuck inquiries from women with high BMIs who have been treated as second-class citizens, sometimes for years. They have been told over and over — directly and indirectly — that they are “too fat” for an abdominoplasty.
“Come back when you’ve lost weight.”
“You need to lose another 20 [or 40, or 60] pounds.”
“It’s not safe to have surgery at your size.”
“Your BMI has to be 25 or less.”
“We don’t operate on patients who are overweight.”
Plus-Size Plastic Surgery Consultations Often Do Not Consider the “Whole” Patient
More often than not, comments like those above are made without ever taking the time to fully consult with the patient about their needs and goals, or any real understanding of their overall health and wellness. More patients than we can count have never gotten further in a tummy tuck consultation than a visual “once-over” before being immediately deemed a “poor candidate” based on looks alone. Some have never even made it to a 1-on-1 consult as they are immediately disqualified based on their weight or BMI.
I am honestly not sure how any of this fits in with our ethical obligation as physicians to refrain from intentional harm. There is simply no way, in this day and age, that one could be unaware that this type of treatment — the lack of respect and consideration for overweight individuals — can cause irreparable emotional harm. It is our duty as medical professionals to listen to women and their needs and goals without ever, ever body shaming them.
Why are Overweight and Obese Patients Treated Poorly?
The poor treatment of higher BMI patients is likely the result of several factors. One is the ingrained belief so many of us carry that tells us obesity or “fatness” is a moral failing. Our culture as a whole doesn’t believe that people who are overweight “deserve” health and happiness, and that plus-size plastic surgery, such as large-volume liposuction and plus-size abdominoplasty, is some sort of easy “short-cut” they shouldn’t get to take. “Fat people” should have to work for it right? They just aren’t trying hard enough.
Whether we like it or not, most of us have some degree of fatphobia, and that can translate very easily into a negative bias affecting the way doctors treat overweight patients. It’s something that every practicing physician needs to understand and work to actively combat.
Another is perfectionism. Surgeons are, by their very nature, perfectionists. I would suggest that we would all prefer our surgeons to be perfectionists, for obvious reasons. I am certainly a perfectionist, and I want only the very best outcomes for my patients. However, some types of perfectionism can also result in an unwillingness to take patients who perhaps don’t fit a preconceived aesthetic ideal, even when a perfect, technical surgical outcome may be possible. It’s a type of perfectionism that truly is the enemy of the good.
And you know what?
I find this incredibly sad because the outcomes of plus-sized plastic surgeries can absolutely astonishing. These women are transformed, physically and very often, emotionally. It is one of the coolest things Dr. Abboushi and I get to do because the positive impact feels so substantial and visceral to both of us.
However, do all of these women fit into the tiny, suffocating box that is the Western European ideal of beauty? Of course not. But we don’t take patients based on any ideal outside of the patient’s own. We want to help them achieve their aesthetic goals and be the best version of themselves, rather than a random, outdated idea of beauty that should have been thrown in the garbage half a century ago.
The Risks Associated with Tummy Tucks for Overweight & Obese Patients are Low
Finally, there is a prevalent belief in the plastic surgery community that plus-sized patients are at a far greater risk for major surgical complications than their average-BMI peers. This belief is, quite simply, wrong. While, there are, indeed, surgeries that can be riskier when performed on overweight or obese patients, this just isn’t true for plus-size tummy tucks and even high BMI liposuction, and the research exists to prove it:
“‘Tummy tuck’ surgery (abdominoplasty) can be safely performed in obese patients, with no increase in complications compared to non-obese patients, reports a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).”
And yes, this includes plus-size abdominoplasties when performed alongside liposuction:
“’Abdominoplasty, with or without concurrent liposuction, in obese patients is a safe and effective procedure with similar perioperative complication rates as the non-obese patient population,’” write ASPS Member Surgeon Laurence Glickman, MD, MSc, FACS, and colleagues of Long Island Plastic Surgical Group, Garden City, NY. The findings help to alleviate concerns that obese patients are at higher risk of complications after tummy tuck.”
So, while Dr. Abboushi and I believe that additional precautions may be necessary when performing higher BMI tummy tucks, if a patient has reasonable expectations regarding their surgical outcomes, and they are able to receive medical clearance from their primary care provider, then they are at least as deserving of compassionate care and treatment — including plus-size tummy tucks and high-volume liposuction surgery — as any other patient who walks into our Atlanta office.
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