I wanted to make a quick point about one of the necessary metrics we use to determine whether it is safe to proceed with surgery in the practice.

On our appointment requests, we ask about body weight. This is because, despite all of the many shortcomings of using BMI, it remains one of the better ways of estimating the risk of complications after certain procedures.

I appreciate that BMI, on its own, is not necessarily the best indication of a patient's overall health, but it remains a valid metric to work with in this regard.

We have data in particular which relate to two common operations, and from which we can extrapolate to other similar procedures. There is reasonable data relating to both DIEP flaps for breast reconstruction, and breast reduction surgery.

Now, for both of those procedures, the data would suggest that for patients with a BMI over 32, the risk of complications (and specifically, the risk of wound healing complications) goes up significantly.

Why does that matter?

Well, wound healing complications are a problem for a patient, because their recovery is delayed, their return to normal function is delayed, the ability to get back to work, and life and whatever else they do is delayed. Which is bad.

Wound healing delays change scars for the worse. If a patient has delayed wound healing, their scars are prone to "hypertrophy" - basically, thick, raised, red scars that can be itchy. So, this impacts on the aesthetic outcomes, and hence patient satisfaction.

Wound healing delays can end up costing a patient money, depending on whether complex dressings, or even hospitalisation is required to manage a complication.

So yeah, reliable wound healing is a priority for me, and anything that alters wound healing has to be factored into whether someone is a surgical candidate.

For the same reason, I don't operate on smokers, or people with uncontrolled diabetes.

I promise, our BMI criteria are not punitive, or mean, or discriminatory. They are necessary to ensure we can offer our patients the best possible outcomes, with the least possible risk.

I hope that makes sense.

As always, if you have any questions about that please get in touch.