Plus Size Tummy Tuck

Dr. Bob Basu: It's almost like we gave her a new lease on life. She came back in ... This was a whole different person walking in the office. She had a lot of energy. Her posture was better. She was glowing with positivity.

Announcer: Welcome to Behind the Double Doors, the Houston plastic surgery podcast with Dr. Bob Basu, telling the stories of plastic surgery patients and bringing you behind the scenes to learn everything you need to know.

Dr. Bob Basu: Hello. So today we're talking about plus-size tummy tucks. But this is a relatively new patient generated term that really refers to procedures that have been around for very long time, but it really focuses on procedures on patients who have a higher body mass index. Body mass index is a reference to a ratio of a patient's height and their weight. After patients have undergone a plus-size tummy tuck, they feel they have much more energy and they're able to exercise and lead a much healthier lifestyle. They are thankful that a practice treated them with respect, and did not just dismiss them because their body mass index or weight was simply higher. They're thankful for the curves that we've achieved for them. What I often hear is a renewed sense of confidence. Patients who have healed from their plus-sized tummy to come back to the office with a lot more energy and confidence. You see it in their posture, you see it in their overall presentation of themselves. They're smiling. They just feel good. It's almost like a new charge on life.

That's really invigorating for us, not just for me as a surgeon, but my team to see you that we're having this positive impact on patients. So one patient comes to mind obviously, I can't mention their name. But for the podcast, we'll just call her Jane. Ms. Jane Doe, presented to us and I remember her walking into the office... The posture and her overall feeling, she was very tenuous about asking about a plus-size tummy tuck. Of course, it's not a one size fits all. We have to do a formal consultation and a physical exam to determine whether a patient is healthy enough for the surgery, whether they're actually a good candidate for this. Then we have to determine what we can achieve and what's safe to do.

But after we did the consultation and we developed a plan she felt hopeful, and she was very thankful. She hadn't made the decision to proceed yet. But as an aesthetic plastic surgery practice, she was thankful not just to me, but to my entire team that we took her seriously. She told us that she had been to other practices throughout the country including Texas, and she felt that she was just dismissed because she had a higher body mass index. She was a heavier patient. I specifically remember her telling me that because she didn't look like the Barbie doll walking to the plastic surgery office, she really felt dismissed by a lot of the places. She wanted to thank us profusely that we treated her with respect. That feedback meant a lot to us, that we gave her some hope.

She did decide to proceed with surgery. She did very well with her surgery. After surgery, it's almost like we gave her a new lease on life. I mean, she came back in, this was a whole different person walking in to the office. She had a lot of energy, her posture was better. She was glowing with positivity. It's almost like we've recharged her with confidence. With the removal of 15 pounds of tissue from her torso, she was now able to... She was cleared, she was all healed.

She was able to now exercise, and get on a treadmill, and move forward in or her healthy lifestyle. So the plus-size tummy tuck for her was the first quantum leap forward. It wasn't the end all solution, but it was a first huge step forward for her to lead a healthy lifestyle. This is what it's all about for us as an aesthetic plastic surgery team is we're making a difference in people's lives. That's one of the reasons why I love helping patients with plus-size procedures when we can, because we make a difference in their lives. We get that immediate positive feedback.

So a lot of plastic surgeons out there will say that if your BMI is above 30 or 31, you're not a candidate for a tummy tuck. They're not being rude, or they're not being mean. Here's the reason why there's that cutoff. There are many studies out there that show that when your body mass index is higher... higher than 30, or 31, 32. As it goes higher, you are at increased risk for healing problems. This can be incisions opening up, tissue necrosis, fluid collections, infections, and the list of complications go on and on. So clearly treating patients that have more weight, more body mass index, the risk goes up, and those are the facts. That's what the literature shows.

Now in my experience, at least 50% of my practice is post-weight loss contouring. So I treat patients with head-to-toe procedures who have lost 100, 200, 300 pounds of weight, either through bariatric or weight loss surgery or through lifestyle, diet modifications. A combination of those two. But I've garnered a lot of experience for the past 16, 17 years where our patients may have lost 150 pounds, but their BMI is still high. It's still 38, maybe 40, even though they've lost 100, 150 pounds, they've plateaued. So we've modified and honed our techniques to offer some solutions for patients that are having excess skin and fat that they simply can't move forward. So we've kind of developed our technique over time to provide options such as a plus-sized tummy tuck on patients that have a higher body mass index.

The reason why we don't just say no to someone because their body mass index may be higher, is because some patients carry their weight differently. So there is no typical body shape. I'll give you an example. There're some patients that have a lot of weight in their thighs and buttocks. So the body mass index, the excess obesity or fat content is really centralized in their buttock or their thighs. It's not in their tummy. So in which case, I may be able to do a tummy tuck. In other patients, the excess fat is localized in the torso and the tummy area. In which case will I be able to do a plus-size tummy tuck? Or will I be able to modify my technique and do more of what's called a modified, panniculectomy making kind of looking like a tummy tuck. Again, there're some nuances and technical things that I modify depending on what anatomy a patient has.

So there's no one size fits all the common theme for patients that present for plus-size tummy tucks, is they want that heaviness and their tummy gone, and they would like to restore some curves if possible. Sometimes we can do simultaneous liposuction with these procedures, and sometimes I choose not to. Again, it depends on my evaluation and I apply my experience to see what we can do and what we can't do safely for the patient.

We do see plus-size patients wanting a lot of procedures in one setting. They want the tummy tuck, they want lipo. They want a BBL, which is buttocks sculpting with 360 lipo. I think we have to educate patients that they are at higher risk given their higher body mass index. Sometimes less is more. We're quite cognizant of the increased risks. So I will oftentimes break down procedures into smaller procedures, but that's a decision that I make based on the evaluation of their health status and their exam. Again, number one is safety, patient safety. So we recognize that plus-size procedures can be higher risk, and we do everything humanly possible to try to minimize those risks. So sometimes less is more.

It's very important for these patients to remember that despite what we do to try to minimize those risks, these are still higher risk procedures. They are complex procedures. This is not a simple tummy tuck that typically takes me two hours, two and a half hours to do. Sometimes plus-size tummy tucks can take three, four, or five hours for me to do. So they're much more complicated and we prepare the patient for that. They need to understand that this is a higher risk procedure. Part of my evaluation of the patient is looking at their overall health status. So if they're smoking, they have poorly controlled diabetes or other medical issues, this is not the time to proceed with elective surgery. If they're healthy overall, or the medical issues have been managed, and they have been cleared to proceed with elective surgery, then it comes down to anatomy.

The other patient that I would say no to, is if they have way too much intra-abdominal fat. So we all carry fat in two compartments, there's extra abdominal fat and there's intra-abdominal fat. Extra abdominal fat is a fat that we all carry underneath our skin that we can grab. This fat, extra abdominal fat, plastic surgery is really great at treating. We can treat that with tummy tucks. We can treat that with liposuction because it's the fat right underneath our skin. We all carry intra-abdominal fat, also known as visceral fat. Now this is the fad that's way below our muscles. Deep down where our organs are at. No plastic surgery procedure can treat intra-abdominal fat. If there's excess of way too much intraabdominal fat, there's too much pressure on the abdominal wall. This is not a good time to proceed with surgery because the risk for complications skyrockets.

In those patients, I will then refer them to a weight loss specialist. I have one or two colleagues that are really trusted, are fantastic at bariatric surgery or medical weight loss management. They need to lose weight first.

The third patient that I try to say no to are patients that have unreasonable expectations. If you're starting at a body mass index of 38 or 40, and your wish pics or desired pics are of patients who are body mass index of 25, that's a set up for problems. Because if the patient's expectations are wildly out of control, we are not going to have a happy patient. So incisions and scars are part of any body contouring procedure. Now, the basic principle that I tell every single patient when we're doing a tummy tuck or any body contouring procedure... Quite frankly, any surgery in plastic surgery, is that we have to accept some degree of scar to achieve that much, much better form. So it's scar for better form. That's a very basic principle that applies to almost everything we do in plastic surgery.

Now we try to hide the scars wherever and whenever possible, for instance, with a tummy tuck, or a plus-size tummy tuck, we tried to hide that incision as low as possible, ideally hidden in the bikini line or the undergarment line. Look, we don't want our patients to be riddled with scars. So we like to hide those scars in areas that can be hidden by a bikini under garment or an undergarment line. Of course, scars mature and fade with time, but it can take anywhere from 12 to 18 months for scars to mature and fade. We do all of our surgeries in our state licensed ambulatory surgery center. What that means is our facility meets hospital grade standards for quality and safety. The standards in our state licensed ambulatory surgery center far exceed any office-based surgical facility, because our operating rooms have the same degree of air filtration and infection control standards that a very good hospital does.

Lastly, I need to give a shout out to my anesthesiologist, Dr. Firat, she's phenomenal. She has extensive experience helping patients. From her work helping bariatric surgery patients, she understands the pulmonary dynamics. Meaning the unique physiological needs of patients who have lost weight. That's one of the reasons why our patients do so well after surgery is we have an anesthesiologist who has extensive experience helping post weight loss patients. So we work as a team to do our best to optimize outcomes and minimize the risks in these higher risk procedures. So every procedure is unique. Some plus-size tummy tuck procedures can take me three and a half hours, some need five hours. Some opt to have liposuction of the upper waist as with a lower waist. So it varies based on what we need to do.

The total cost of the surgery includes surgeons professional fees, the anesthesiologist professional fees, and the facility fees. The range is listed, I believe in our website. But I think it's best to contact our patient consultants who can give you more accurate range of the pricing. What I will tell you is the pricing is a lot higher than a regular tummy tuck. Because as I mentioned a regular tummy tuck typically takes us about two hours, two and half hours. A plus-sized tummy tuck can take anywhere between three to five hours. So it's very common for patients to opt for financing options, even if they have the cash, oftentimes with interest rates being so low, hold onto your cash, and you can break down your payments. Which makes these procedures readily accessible to a lot of folks.

So since plus-size patients have difficulty finding a surgeon who would want to take them on as a patient and have the experience to do these more challenging procedures, it is very common for us to treat patients who fly in from other states. Now, prior to COVID, we were seeing patients were flying in internationally for these procedures. So obviously the international travel has ceased. But what we do is we first initiate a virtual consultation to at least educate the patient about the procedure, the pros and cons, and the potential risks and limitations. Now, there are some inherent limitations of a virtual consultation and that's why I visit with the patient prior to surgery. We typically have the patient fly into Houston, ideally a day or two before surgery, so that we can revisit the procedure and the plan.

Actually, it's required that they travel with somebody else. They need to have an adult caregiver with them at all times. I recommend the patient stay in our area of Houston for about 10 days. At a minimum seven, but I feel more comfortable with 10 to 14 days of possible. The reason why I picked 10 days is because it gives us a chance for the patient to follow up with us. So that we can make sure their drains are coming out, they're healing well, and we're addressing any acute needs that may be necessary to be addressed in the first seven days after surgery. I simply would not feel comfortable if a patient had a plan to fly back home three days after surgery. I think that's very unsafe. Remember flying too soon after major surgery, I would say within seven days after major surgery, some people will say 10 days of major surgery, does increase your risk for a blood clot. So blood clot prevention is very important to us. So we want to make sure the patients in the Houston area for about 10 days ideally, longer if better.

We used to recommend certain hotels in the area, but a lot of patients are actually picking Airbnb's. So they have their own home for about a week or two, and they're more comfortable there. So we have an experienced team that can help patients out of state and internationally. We coordinate a lot of their travel logistics for them. We try to make this as seamless as a process as possible. So first we don't even refer to them as patient coordinators. They are patient consultants. There's much more to it than just a name, patient coordinators to give some basic information and they help schedule appointments. My consultants have been trained by me and my team to have a very good understanding of not just what the procedures are but the costs, and the financing alternatives, travel logistics. They're typically on the phone with what we call an inquiry or a lead for anywhere from 20 minutes to an hour.

They are really trying to echo what we're all about to the patient. So they have an understanding, they have a really good feeling of what our core culture is in our practice, and what we value and what we think is important. So our consultants spend a lot of time with the patients on their first phone call. Hopefully, the patients get a feeling of who we are and the type of care that we will deliver for the patient. If you're interested in learning more of a plus-size stomach doc, I encourage you to visit our website. We have hundreds of tummy tuck photos on our website. Many of them are plus-size procedures. I would encourage you to visit Basu, B as in boy, A-S-U plasticsurgery.com.

Announcer: Take a screenshot of this or any podcast episode with your phone and show it at your consultation or appointment to receive $50 off any service at Basu Plastic Surgery and Aesthetics. Basu Plastic Surgery is located in Northwest Houston in the Towne Lake Area of Cypress. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram follow Dr. Basu and the team at Basu Plastic Surgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis. T-H-E A-X-I-S.io.