Andre Eyler, MD

An abdominoplasty seems to be the only solution for your problem. In the photo it looks like you have muscle diastasis, that is a separation of the abdominal wall muscles normally caused by pregnancy, and an umbilical hernia. To correct this, the muscle must be suture together and it can only be done with a full abdominoplasty. 

The great thing about liposuction is that it tightens your skin. There is not much results difference if you loose weight first or after the procedure. Many patients who are overweight and have trouble in loosing it, look for a liposuction to help with the body contour. After you find yourself with a nice back contour and a smaller abdomen, the stimulus you have to keep loosing weight in immense. After you get to your desired weight your body contour will be much more satisfying, less saggy and firmer.  

I believe you intend to have a gluteal augmentation with both silicon implant and fat transfer. That is a very common procedure and it gives great results. The implants are limited in shape, oval or round, and sometimes you need fat to upgrade your results. As the prothesis go deep in the muscle, the fat can be grafted above it in the subcutaneous tissue to shape what the implant can not do. Also it is good to remind that you need to have a liposuction in your back and waist to better the result.

Your implants are high because they are positioned under the major pectoralis muscle. I am guessing you must have had radiotherapy too. What I would suggest is to have your implants changed to a dual plane position and some fat grafting to adjust contour. this will lower your implants and still have the protection of the muscle. The fat graft to the breast will also provide more volume and correct the depressions, specially in the scar area.

 Deciding about what surgery is best is a very difficult task. Bigger surgery with best results isn`t always the best for the patient. There are more complications involved and a more difficult recovery. 

  In your photos, there seems to have stretch marks, skin laxity and abdominal muscle diastase. The ideal surgery wold be an abdominoplasty (tummy tuck). Since you are not up to a big recovery, an alternative approach seems more suitable. 

  A lipossuction procedure promotes skin contraction in every case, in different degrees. Some have more contraction than others, but there is always some contraction. So loose skin is not the big problem, but the muscle diastasis will have no correction. The amount of muscle laxity can only be determined in a physical exam. If it is too much apart, you won`t have a flat stomach. 

  Also there is no impediment for you to have a lipossuction first and see what kind of result you get. Most patients with the same problem are happy with a sufficient result. In the worst scenario, you can still submit yourself to an abdominoplasty later with a small scar, because you will have less skin and fat to remove due to the contraction.

  In conclusion, go for a lipossuction and if it is not enough for you, you can in a more opportune time have an abdominoplasty.