Weight Related Issue in Plastic Surgery

While plastic surgery can perform dramatic changes on one’s body, it is not intended for weight loss.  In general, patients should try and be a reasonable weight before surgery.  This results in better outcomes with less risk.

There are many definitions for what is a reasonable weight.  Ideally, everyone would have a Body-Mass Index (BMI) of 22 to 25.  Realistically, a “good” weight for many people is a BMI between 25 to 30. Beyond that level, surgical risk begins to rise, and patients and their surgeons should consider surgery more carefully before proceeding. Exceptions to this would be patients who have already lost tremendous amounts of weight (>50 pounds,) either through diet or surgery and can lose no more.  In higher risk patients like this, it is often prudent to limit the scope and duration of the procedure in order reduce complications. For instance, instead of one operation consisting of a breast reduction and a tummy tuck, thought should be given to doing them separately.

In general, weight loss before surgery leads to better outcomes. Simply, fatty tissue has a poor blood supply and responds badly  to surgical manipulation. Additionally, weight loss after some procedures is “deflating,” and can ruin the result, as in a breast reduction where breast shape can be lost with post-operative weight loss. An interesting exception to this is abdominoplasty, where post-operative weight loss usually enhances the result.  However, prior to an abdominoplasty, patients should minimize their visceral or “belly” fat, as such fat prevents tightening of abdominal muscles which is one of the real benefits of an abdominoplasty.

Patients frequently lose weight after surgery.  Part of this is psychological, as a patient feels like they have a “jump start,” or mechanical, where a certain body part no longer impedes exercise, as in breast hypertrophy. There is also a physical component, especially after abdominoplasty, where metabolic changes seem to make weight loss easier.

If one is interested in weight loss, there are several basic ideas to keep in mind.

  1.    Diets all fail, because then the diet ends, the weight returns.  Sometimes a person is even worse off after a diet as their basic caloric needs are reduced and it is even harder to remain at their original weight.  What is required is a permanent “life style” change in how one deals with their nutrition.
  2.    Everyday consumption of “carbohydrates,” which are simple sugars and starches such as bread and pasta, make it difficult to lose weight and are often responsible for obesity. Weight loss is easiest with a menu of foods with a low “glycemic index.” This means foods that do not result in a rapid rise in blood sugar, which limits insulin release.  One function of insulin is to promote fat production, so by eating low glycemic index foods, one limits fat production. Sugar substitutes unfortunately are seen by your body as sugar, so it is also vital to avoid foods with artificial sweeteners, like diet soda.
  3.    Weight loss is slow. One pound of body fat equals 3500 calories.  If you reduce your caloric intake by 500 calories per day, you will lose one pound of body fat per week. Knowing this prevents getting discouraged during weight loss.  Real weight loss takes months.
  4.    Exercise helps heart and brain, and enhances muscle strength, but the role of exercise in weight loss is limited.  This is because increased exercise almost always leads to higher calorie intake. This is part of the reason why patients who exercise everyday become frustrated with their failure to lose weight.  Weight loss is more about nutrition than exercise.
  5.    A diet high in fiber enhances weight loss in two ways.  Fiber suppressed appetite and speeds the transit of food through ones intestinal tract, reducing caloric absorption. 
  6.    Processed foods are more readily absorbed by your body.  By consuming a diet with more unprocessed foods, fewer calories will be absorbed and weight loss will follow.
  7.    Some patients have real trouble losing weight.  This is particularly true for post-menopausal women. Some patients, particularly young men, can lose weight easily. Unfortunately, some patients can faithfully follow all of the above recommendations and still be unable to lose weight.  There are simply some metabolic factors that are not understood. As a result, some people need bariatric surgery to lose weight, but this should be a last resort. 

If you are overweight, make a decision to change the way you eat forever.  Limit simple carbohydrates, increase fiber intake and avoid processed foods.  Exercise to be healthy, but don’t rely on it to lose weight. Below are two references for weight loss.

Roberts, SB, Das, SK. Want to lose weight? What you need to know about eating and exercise.  Sci Am. 316(6):36-41. June 2017.

Montignac, M. (1989). Dine Out and Lose Weight. USA: Montignac.