Weight fluctuations and pregnancy can definitely impact mastopexy results
Thank you for your important question. Weight fluctuations and pregnancy have a dramatic impact on breast volume and size. If these factors occur after a mastopexy there will be a change in breast shape and size. Significant weight loss or pregnancy with volume change in the breast could cause recurrence sagging of the breast after a mastopexy.
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Change in breasts with weight change
As your weight fluctuates, so will the size of your breasts. This will have effect on the shape of your breasts and laxity of skin. Weight loss patients in particular tend to have less elasticity of the skin and so with further weight loss you will likely develop mor sagginess. This is a long-winded way of saying that you should achieve your optimal weight before having surgery.
What happens to mastoplexied breasts with weight fluctuations/pregnancy?
There will always be changes to the breast size and shape with weight alterations and pregnancy. If you get the lift now, you will possibley need it redone after babies and/or further weight loss.
Weight loss and breast size
You have undergone a massive weight loss ! Terrific !. I would advise you to wait until you have achieved your TRUE target weight. An additioanl 35-40 lb weight loss may be too much. An additional 20 lb weight loss following surgery would probably result in sagging follwing surgery due to loss of volume, Depending on the mastopexy techniques, it is unlikely that you'll be able to nurse. A pregnancy could also stretch out your skin resulting in further sagging.
Weight change and breasts
Breasts that inflate (pregnancy/weight gain) and deflate repeatedly lead to loss of breast volume and excess skin causing stretch marks, loss of elasticity and droopiness. Some droopiness occurs as women age regardless. I would lose all the weight that you reasonably think you can and just realize that the above is true for pregnancy and will help you make your decision.
Weight loss after mastopexy
Some photos might help to offer more specific answers.
It is hard to predict for an individual how much will change in breast appearance with 20 or with 35-40 pounds of weight loss. General advice is to hold out until you are close to your desired weight. Although I wouldn't expect too much change with 20 pounds, you also mention 40 pounds planned loss, and I would not be so certain.
What we want to avoid is to have a nice early outcome, and then after more weight loss the need for another lift!
The sequellae of pregnancy are not predictable either. Some women have normal looking breasts after nursing, some lose volume and consider implants and /or a lift. Skin in woman who have lost lots of weight starts with poor elasticity, and they are more likely to have less than ideal breast recovery after pregnancy.
As to nursing, the lift is primary a skin tailoring operation. Most women can nurse successfully after a lift.
Advice--consult with a plastic surgeon. All the best.