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Which Procedure to Do First After Massive Weight Loss?

I have lost 155 lbs and am at my goal weight (via diet and exercise). Now, I need to get all the excess skin removed. I'm scheduled for a Tummy Tuck (Fleur-de-lis) and Breast Lift (mastopexy) in September.

I don't know if makes any difference if I do the Medial Thigh Lift (Thighplasty) and Arm Lift/Brachioplasty (revision) next or if I do the Butt Lift and Outer Thigh lift next. Basically, I'm not sure if the order in which you do the procedures makes any difference. Your input will be appreciated! Thank you!

Doctor Answers (21)

Proper sequence for body contouring

+3
Sequencing your body contouring surgery is determined by duration of the surgical procedures, your health and your specific priorities.
In general terms, I limit each operative event to 6-8 hours. Combinations are dictated by the procedures and understanding both technical considerations and how you will tolerate the recovery.
My preferred sequence is to address the abdomen, outer thighs and buttocks in the first operation. This is with either a lower body lift or a belt lipectomy. The majority of people will carry most of their excess skin in these 3 regions. This operation has the greatest overall impact of any single operation.
How we proceed from there is dictated by your needs and your priorites. Breast and extremity operations can be combined or staged over a third operative event if needed.
Congratulations on the weight loss, and I wish you all the best with your body contouring surgery.

Web reference: http://www.drrobkessler.com/body-surgery

Orange County Plastic Surgeon
5.0 out of 5 stars 78 reviews

What to do first

+2

Dear Moosie,

First of all congratulations! 155 pounds by diet and exercise you should be commended and rewarded. I am sure this is life changing for you and now you are faced with all the excess skin.

When I approach a patient following massive weight loss I always ask what bothers them the most and in what order and then go from there. I must say I am not a fan of doing a fleur-de-lis tummy tuck and then doing a buttocks lift.

I would start with a lower body lift which is basically a circumferential incision that gives the effect of a tummy tuck (without the fleur-de-lis) outer thigh lift and buttocks lift. After this you could go on to do the arms and legs or whatever else bothered you, but I would start with the lower body lift alone as the first procedure.

I have found that in most massive weight loss patients they will also need implants as the breasts are significantly deflated of volume and have a great deal of excess skin. I usually perform an augmentation mastopexy in these patients. My last procedure is an inner thigh lift.

Always seek out several opinions on surgery of this magnitude and I always perform my lower body lifts in the hospital with at least a 3 day hospital stay, usually more.

Good Luck

Boca Raton Plastic Surgeon
4.5 out of 5 stars 2 reviews

Order of surgery after massive weight loss

+2

 There really is no specific or correct order for the surgery after weight loss.  In most cases, patients choose to do their belly and breasts first.  This is then followed by the arms and thighs.  Some times the back is done at the same time as the belly.  Good luck with your surgery.

New York Plastic Surgeon
5.0 out of 5 stars 52 reviews

There is no right answer

+2

In dealing with folks with massive weight loss there are any number of combinations that can be wored out. The decision is based on the health of the patient, the risk vs benefits, the desire of the patient of downtime, expense, ultimate best result and other considerations. Some plastic surgeons prefer to do as much as possible all at once, some want to do in multiple stages. You need to sit down with your plastic surgeon and have at least two discussions regarding what your expectations are and how those expectations can best be managed.

Harrisburg Plastic Surgeon
3.5 out of 5 stars 8 reviews

Order of surgeries

+2

It does make a difference which order you do the surgeries. It's a bit complex to go over the various combinations in this type of forum. In general, the larger trunk procedures are performed first followed by the extremity procedures. Also, most plastic surgeons are reluctant to exceed six hours of surgery for elective procedures. Your surgeon is the best source of information with regard to order of procedures. Good luck!

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Procedures After Profound Weight Loss

+2

In your case, I would be inclined to initially perform a body lift. This is a TT with extension of the incision all around the flanks and back. It is a big procedure which will provide a lift of your outer thighs and buttocks as well as the TT. This can be followed by the other procedures in the order most meaningful to you. Good luck!

Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

There Is A Rhyme And Reason To The Staging Of Surgery After Massive Weight Loss

+1

The multiple body contouring surgeries frequently necessitated by massive weight loss should be sequenced in a logical fashion that maximizes patient safety and outcome, while optimizing recovery. We prefer to perform a lower body lift first, as this achieves the goals of abdominoplasty, lateral thigh lift and buttock lift with a single procedure. As this is the biggest single surgery of the sequence, we perform it first, and without any concomitant procedures to minimize operative time.  

Next, we will perform the breast surgery, which is usually a mastopexy with implant to replace lost breast volume, and usually pair this with a bilateral brachioplasty. This makes sense anatomically, as massive weight loss patients frequently have excess skin at the lateral aspect of the breasts as well as in the axillae, and the contiguity of these two areas allows us to deal with them as an anatomic unit in the same surgery.  

Following this we will next perform a bilateral medial thigh lift as the third stage. Although this surgery is a bit shorter in duration than the previous two surgical sessions, the inconvenient position of the incisions, and the higher risk of post-operative infection militate that we perform this as an isolated procedure.

Lastly, although you do not mention it, the majority of our post-bariatric patients do undergo some form of aesthetic facial surgery, usually a facelift, to address the excess skin and soft tissues in the face and, especially, the neck.  For many of our massive weight loss patients, this is often the most significant post-bariatric surgery they undergo, for the simple reason that all of the other areas can be camouflaged by clothes to varying degrees, but the face cannot be. We save it for last in our staging for surgical and logistical reasons, but in this position in our operative sequence it is the final coda that brings this surgical symphony to a close, and marks the beginning of an exciting new stage of life for our patients.

Los Angeles Plastic Surgeon
4.0 out of 5 stars 12 reviews

Plastic Surgery After weight loss

+1

I usually ask the patient what bothers them the most and then start from there.  I have patients who have had the tummy tuck and breast lift in 1 procedure and very happy with the results and then they proceed to either arm lifting or thigh lifting.  Really, there is no "set order".  Your surgeon should make sure that the duration of any surgery he/she performs will be safe for you.  Choose a surgeon who has experience with theses procedures and talk to other patient who have gone through it already- I find that this helps in regards to expectations, recovery questions, etc.

Good Luck!

Web reference: http://www.poustiplasticsurgery.com/weightloss.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 628 reviews

Breast lift and tummy tuck good combination.

+1

Hi.

I am sure you have had surgery by now, and your initial plan is good, to do the breast lift and tummy tuck first. I don't think it matters which two procedures you do next.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Procedure combinations after massive weight loss

+1

Dear Mossie,

As you can see, everyone has their favorite approach. I like to keep my operative time less than 6 hours, so two combinations work well for me. Certainly patient preference and body type is the deciding factor, but thinking about all patients, these are the combinations:

One (most chosen by patients)

  1. Body lift (circumferential abdominoplasty)
  2. Breast lift & brachioplasty
  3. Facial rejuvenation (face, brow, eyelids) & breast augmentation
  4. Medial thigh lift

Two (my preferred method)

  1. Breast lift & extended abdominoplasty
  2. Posterior body lift & breast augmentation
  3. Facial rejuvenation & brachioplasty
  4. Medial thigh lift

I tend to take a conservative route by keeping the breast lift and augmentation separate, but this allows me to achieve a more "perky" result as I am not so worried about complications when doing the augmentation component. In the same light, separating the tummy tuck from the posterior body lift in my second combination allow us to achieve a more significant lift. This is because I do not have to worry about putting too much tension on a fresh incision on the other side of the body (something we must contend with when performing a one stage body lift.)

Lastly, I like to keep the medial thigh lift as an isolated procedure and do it last. In my mind, it truly is the icing on the cake, and should only be performed once everything else is perfect. (This operation has a very high complication rate due to being close to the genitals.)

You need to speak with your surgeon about your overall goals, and come up with a plan that make sense to you.

Good luck!

Dr.B

Web reference: http://www.drmichaelbogdan.com/plastic-surgery/post-bariatric-surgery.cfm

Dallas Plastic Surgeon
5.0 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.