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!

Asked 30 months ago by moosie1234 in USA

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abdomen arms breasts buttocks thighs combination options timing

Proper sequence for body contouring

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... more

Robert W. Kessler, MD

Orange County Plastic Surgeon

ASAPS ASPS

What to do first

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... more

Steven Schuster, MD

Boca Raton Plastic Surgeon

ASAPS ASPS

Order of surgery after massive weight loss

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.

David Shafer, MD

New York Plastic Surgeon

ASPS

There is no right answer

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... more

John P. Stratis, MD

Harrisburg Plastic Surgeon

ASAPS ASPS

Order of surgeries

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!

Elan B. Singer, MD

Manhattan Plastic Surgeon

ASPS

Procedures After Profound Weight Loss

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!

John Whitt, MD

Louisville Plastic Surgeon

ASAPS ASPS

Plastic Surgery After weight loss

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... more

Tom J. Pousti, MD

San Diego Plastic Surgeon

ASAPS ASPS

Breast lift and tummy tuck good combination.

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.

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Procedure combinations after massive weight loss

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) Body lift (circumferential abdominoplasty) Breast lift & brachioplasty Facial rejuvenation (face, brow, eyelids) & breast augmentation Medial thigh lift Two (my... more

Michael A. Bogdan, MD

Dallas Plastic Surgeon

ASAPS ASPS

Order of procedures in body contouring

Typically, patients will begin with the abdomen or trunk area first. This can usally be accomplished with a circumferential body lift, which also address the buttock and outer thigh area. Once you've recovered from that, the next area to be done depends on which areas concern you the most. The breasts and arms are often done at the same time in the next stage. Then the inner thighs later at a separate stage. But again these last several areas are up to you and your surgeon. The most... more

William Bruno, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Order of surgeries after massive weight loss

You have stated that you are already getting the tummy tuck and mastopexy first. Those two procedures are usually the first ones done. As for what you do next, it is entirely up to you. Either combination of procedures is fine. Generally, patients usually will have the procedure they want the most done next.

John Diaz, MD

Beverly Hills Plastic Surgeon

Breast lift, tummy tuck, medial thigh lift after massive weight loss

Deciding what surgeries need to be performed in any particular order following massive weight loss is dependent on blood supply and operative time. First a total body lift, which includes the abdomen, lateral thighs and buttock is a great place to start. As these surgeries are moderately time consuming, require several months to full recovery and are demanding on the surgeon I would do this as the first procedure. Next the augmentation/mastopexy, arm lift and medial thighs could all be... more

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

I Prefer to Perform Arms and Leg Lifts Together

Lots of approaches here, so here is my 2 cents. My Stage 1 procedure is almost always a lower body lift (that includes tummy tuck, pubic lift, outer thigh lift, and buttock lift) plus breast lift, with or without implants. Stage 2 is arms and inner thighs. I may add implants to the breast at this stage, perform a bra roll removal, and I also do the inevitable touch ups from Stage 1. This approach gets most patients who want "everything" done fixed up in 2 stages. I dont like... more

John LoMonaco, MD

Houston Plastic Surgeon

ASPS

Most start with the tummy tuck

Hello, Congratulations on your weight loss. Most patients start with a Tummy Tuck (sometimes an "extended" or a lower body lift). This operation may serve as a "set point" for further work as it "re-establishes" the waist. Keeping the surgery time to six or so hours per operation is also a good point as it may limit the risk from anesthesia. The progression after the tummy tuck is more personal than practical. Patients choose differently on what they may do... more

John P. Di Saia, MD

Orange Plastic Surgeon

Sequence of procedures after massive weight loss

Overwhelming majority of patients desire to have the excess skin and tissue removed from their abdomen after losing weight. Beyond that every patient is different. Breast reshaping is likely the second most common request. As for arms, thighs, buttock or facial areas - it depends on which area bothers you the most. I would suggest making a list and prioritizing your desires. Also, if you are combining procedures, consider which procedures done together will make your recovery easier. more

Bahram Ghaderi, MD

Chicago Plastic Surgeon

ASAPS ASPS

Sequence of procedures after massive weight loss

Dear Moosie, The VAST majority of women prefer to do their tummies first because the transformation is immediate and it gives them a major psychological boost. I share the opinions of some of my colleagues. While the Vertical Scar (Fleur de Lis) Abdominoplasty gives a flatter tummy without having to extend the incision laterally and posteriorly, it is associated with potential decreased flow of blood at the bottom of the incision (vertical inverted T zone) and in some people MAY distort the... more

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

Sequence of procedures after MWL- Safety and Stages

Congratulations on your weight loss. There is not one correct sequence of procedures for every patient. Multiple factors should be included in the decision including what bothers you most, any health problems, as well as your unique skin and soft tissues. In general- if everything else makes sense and patients want to do multiple areas start with the trunk as the first stage. Many patients benefit from a circumferential procedure first-essentially a tummy tuck that goes all the way around... more

John E. Gross, MD

Los Angeles Plastic Surgeon

ASAPS ASPS

Sequence of multiple body contouring procedures following bariatric surgery or massive weight loss

I generally prefer to do the outer thigh and buttock lift first and then the medial thigh and brachiplasty afterwards. I feel that I can accomplish some improvements in the abdomen and anterior thigh when performing the outer thigh lift firts and therefore the medial thigh lift may not have to be as extensive. If I perform the medial thigh lift first it makes it more difficult to ascertain where the incision should end. However there is great variation in the sequence of these surgeries as... more

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Procedure order

Congratulations on your weight loss and your ability to keep it off. I would discuss all of these concerns with your surgeon. Some procedures might interfere with another. For example, an abdominoplasty may displace the inframammary fold of the breast and a mastopexy might also change the fold location so doing both simultaneously might make the fold location somewhat unpredictable. Also, depending on the type of mastopexy, the inframammary fold incisions (that are not always necessary)... more

Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon

ASPS

Surgeon preference within limits

It is important to divide all these procedures into 2-3 surgeries. The combination is usually the surgeon preference. I prefer to perform the body lift first(Tummy tuck and buttock lift). It is better no to perform the inner thigh lift in the same time due to prolonged pubic swelling. Breast and inner thigh could be done in the same time .Arms could be combined with the body lift. Best of luck!