Justin Heller, MD

Trusculpt ID is a  way to reduce unwanted fat with no down time.   It can reduce fat up to 24% in a single treatment and treats 6 areas in only 15 minutes. Treatments can be repeated in 4 weeks to further tighten and fat reduce.  

Tuberous breasts are caused from a constriction band that forces the developing breast to be confined to an area below the areola. This causes an enlarged areola and a smaller width on the chest wall.  To fix this the construction must be released and the areola size reduced.  Fat grafting can enlarge the breast however it will do nothing for the two other issues of tuberous breast.  In your situation I would recommend a lift which would reduce the areola size, correct the droopiness, and an implant to even the volume between the two breasts.

 When looking at the breast it is important to understand the appropriate shape and nipple position. In a breast that would be amenable to a augmentation alone we would like to see the nipple position above what is called the inframammary fold. What this is, is the fold under your breast where your breast hits your chest wall.  You can place your finger in this location and feel if it is above or below your nipple position. If the nipple is below, then you need a lift.  A breast lift allows removal of the extra skin, elevation of the nipple position, and restores the overall youthful shape. 

In your situation, I would recommends a lift for the these reasons.  Additionally, when looking at your breast shape you can see how they look elongated. To address this the incision pattern I would recommend would be around the areola, a vertical incision and perhaps very small if any along the infra-mammary crease. 

Non-shaped, or round implants have described like low, moderate, moderate plus, and high profile. Simply put for a given volume the higher the profile the more height it has, the lower the profile the more width it has. A 455 moderate plus will likely have similar projection as a 400 high profile but the slope on top will also be a little more natural and a little wider width. In my practice high profile is rarely used as it is very artificial looking. 

There exist multiple patients who have not had children who benefit from a tummy tuck. These patients typically have lost a substantial amount of weight or have excess skin hanging. In your situation the redundant skin around your belly button makes you a better candidate for tummy tuck. Liposuction will serve to define your hips and waistline better as well. The tightening of the belly muscles will flatten your stomach and pull in on hips. This may seem unusual given no children to do but weight gain occurs below muscles as well as outside of them. This when weight is lost these muscles may stay stretched apart. However, if planning on children in the future this belly tightening would be undone when pregnant. The tummy tuck can be done without this but the results would be less dramatic. 

When  pregnant the body undergoes several changes. The belly muscles separate, the skin becomes lax of the low abdomen, and the shape of the waist becomes less defined. In a tummy tuck we are able to tighten the belly muscles back to where they were, remove excess skin from above the bellybutton to below where a C-section scar would be, lift the outer thigh, and restore the body shape. Of course an in person exam is always best but based on the photos provided a tummy tuck will flatten your lower abdomen, remove a large percentage of the stretch marks, give a flat belly back as well as restore your waist line.

There are several causes for this after tummy tuck. The list is as follows:

1.  A fluid collection

2.  Fat from upper flap thicker than mons area and given need to close may require liposuction at later date. 

3. Loosened muscle repair. 

4.  Recurrent skin laxity which can happen in patients with massive weight loss frequently  

An exam will help determine which of these is your situation and which is solution is right for you  

Depending on technique utilized a lift of the outer thigh can be achieved with a tummy tuck. This can augment the shape change of a tummy tuck making a beautiful silhouette. However, for the inner thighs a separate dedicated procedure if typically needed. 

While very rare, fluid collections can occur after tummy tuck. Most are not a cause for alarm and can be dealt with by close follow up with your surgeon. In your case when a blood collection is present and provided not enlarging and you are not symptomatic should have minimal effect on your outcome.  Limiting turning movements and wearing your binder can aid in minimizing this risk. Also will likely need to stop lovenox but I recommend sequential compression device for your legs. Exam is everything so follow closely with you doctor.  

One of the key things to consider with a tummy tuck is where your fat is distributed. To explain fat can exist around our internal organs or can be outside above our muscles. Diet and exercise or certain weight loss treatments can help reduce intra abdominal fat. Whereas a tummy can tighten muscles, remove fat, excise extra skin, lift outer thighs and vaginal areas. In your case it appears your belly muscles may be separated and while a tummy tuck will help flatten this and change your body shape if you were to lose some additional weight your shape change would likely be more dramatic. As an aside, a BBL is a large procedure and combined with an a abdominoplasty can make for a difficult recovery.