Obesity continue to climb in the United States. According to the CDC, more than 30% of the adult population is now considered obese based on the BMI. A body mass index of above 30 is considered obese. Overweight is above 25, and morbidly obese is about 40. There is a continued debate and conflicting studies relating to nonobese and obese patients when it relates to complications after surgery. Obesity has been related to postoperative complications including a 5 times higher rate of heart attack, 7.1 times higher rate of wound infection, and 1.5 times higher rate of urinary tract infection. In addition, obese patients are at a higher risk of pulmonary disorders like sleep apnea and hypoventilation syndrome (in other words, breathing slowly).
The problem with determining if obesity actually causes an increase in postoperative complications is that different studies have been designed using different methodologies. Also, there is no strict definition of complications relative to the level of risk of the surgery. Some studies have related obesity to an increased risk of postoperative pulmonary infection, collapse of lungs, and pulmonary embolism. However, other studies have found no association between overweight, obesity, and postoperative respiratory complications. When it comes to cosmetic surgery, one of the main concerns with obese patients—and this has been shown in multiple studies—is problems of wound dehiscence or wound opening after surgery, wound healing problems, and wound infection. There is no question that the more obese you are, the more likely you are to have wound healing issues and complications.
Typically, we have the BMI to determine the risks of obesity and complications of surgery, but recently, as I discussed before, the amount of visceral fat, which is the fat around the internal organs, has been shown to have a major role in postoperative complications. Adipose tissue is now recognized to be more than simply a lipid storage organ, but a highly active metabolic organ with endocrine, paracrine, and immunological properties. In addition, excess adipose tissue, especially in the intra-abdominal or visceral tissue, is considered a main metabolic syndrome where there is prothrombotic proinflammatory state associated with insulin resistance.
The bottom line is that even if there are conflicting studies related to obesity and complications, it is generally accepted that someone obese with a BMI above 30 is not going to be a good candidate for cosmetic surgery. Leaving the postoperative complications aside, an obese patient will have a less than satisfactory outcome due to the fact that cosmetic surgery mainly involves contour procedures rather than weight loss procedures. Patients believe that they can come and have a tummy tuck and liposuction and all of a sudden their body will diminish from a size 10 to 12 to a size 3 or 4, but this is not the case.
It is important that obese patients with a BMI above 30 reach a BMI that is within the healthier scale. In addition, it is important for the surgeon to assess the distribution of fat, including the visceral fat, because visceral fat has a significant role in proinflammatory conditions. It has been determined that it can actually increase the risk of prolonged recovery, poor wound healing, and blood clots. Combining cosmetic surgery with a healthier diet and decreasing your weight is of paramount importance when it comes to having a successful cosmetic surgery.