J. Timothy Katzen, MD, FACS

Thank you for your question regarding whether you can undergo an anchor breast lift, a reverse tummy tuck (abdominoplasty), and whether the stomach skin can be pulled up at the same time. Thank you for your history and your pictures. Most plastic surgeons would not advise performing a reverse tummy tuck and an anchor mastopexy (breast lift) at the same time. The anchor breast lift incision is created in the shape of an inverted letter T. The blood supply to the nipple-areolar complex can be either superior or inferiorly based. Nonetheless, the horizontal component of the anchor mastopexy forms the foundation of the breast lift. If this incision is inferiorly dissected to create a reverse tummy tuck, this jeopardizes the vascularity or blood supply to the nipple, breast flaps, and incision. Also, if you perform a reverse tummy tuck and anchor breast lift through the same incision, the incisions and dissections are opposing vectors. That means the breast pulls the skin toward your head, and the reverse tummy tuck portion pulls the skin toward your belly button. These opposing forces could lead to wound opening. Therefore, performing the anchor mastopexy and reverse tummy tuck through the same incision is very risky, and most plastic surgeons would not perform the anchor mastopexy and reverse tummy tuck simultaneously. In a closer analysis of your pictures, you don’t need a reverse tummy tuck. Most of your skin irregularity is above your C-section scar and below your belly button. Most plastic surgeons would recommend a mini tummy tuck by placing the incision slightly below your prior C-section scar and pulling the excess skin and fat lower abdomen tight. The mini-tummy tuck should get a flatter tummy than a reverse tummy tuck. Therefore, most plastic surgeons would not recommend combining a reverse tummy tuck with an anchor mastopexy. If you have any more questions regarding the tummy tuck or abdominoplasty, please contact an experienced plastic surgeon. Since an abdominoplasty can be a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing tummy tucks. Do your research. Make sure your chosen plastic surgeon has performed at least 100 abdominoplasties. Make sure they have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. Good luck! Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, , International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, and thank you for your question regarding whether you should consult now or wait, and whether you can combine more procedures. Thank you for your history and your pictures. Congratulations on your remarkable weight loss. Great job. With your current body fat percentage, you should be ready to undergo plastic surgery. Further weight loss is not necessary in your case. I would search for plastic surgeons who specialize in reconstructive plastic surgery after a massive weight loss. There are specialists nationwide who specialize in treating patients who have lost 100 pounds or more. Regarding the “significant fees for consultations,” there are many very well-qualified plastic surgeons who offer FREE consultations. Many reputable plastic surgeons offer virtual consultations, allowing you to consult with doctors from around the USA from the comfort of your living room. Virtual platforms include secure networks, as well as Zoom, FaceTime, and WhatsApp. Regarding your procedures, most plastic surgeons stage these procedures into two or three surgeries. The first surgery typically involves a 360-degree circumferential lower body lift. The 360 circumferential lower body lift includes abdominoplasty (tummy tuck), hip lift/reduction, and butt lift/reduction. During the procedure, the rectus abdominis muscles are plicated. The belly button is saved, but the abdominal skin around it moves. The pubic region is lifted and flattened. The skin of the abdomen, hips, and buttocks is removed. If you feel your buttocks are small, fat can be added to create more projection. If you feel your buttocks are too large, the size of the buttocks can be reduced during the lower body lift portion. Most experienced plastic surgeons specialize in reconstructive surgery after massive weight loss, combining the thigh lift with a 360-degree circumferential lower body lift. This would entail performing thigh liposuction on the anterior, inner, and outer portions of the thigh. This would also be combined with an incision from the groin to the knee. This thigh procedure is referred to as a longitudinal, vertical medial lift or reduction. If the extra skin and fat do not significantly bother you around the knee, you could have an incision from the groin partially down the inner third or inner half of the thigh. This is called a modified longitudinal vertical medial lift. You could combine the 360 lower body lift with the longitudinal vertical medial lift. Alternatively, you can undergo the 360 circumferential lower body lift and then wait at least a month before undergoing the longitudinal, vertical medial thigh lift, thigh reduction, or thighplasty. Once you have finished with the lower body, I suggest proceeding with the upper body surgery. The upper body lift would include a brachioplasty (arm lift or arm reduction) as well as breast augmentation. During your arm lift, arm liposuction is performed, and an incision is made from the armpit to the elbow. Regarding the breast, this is a personal choice. You do not necessarily need breast surgery, but if you desire larger breasts, most plastic surgeons would recommend a small to moderate silicone implant. Since you don’t need much of a breast lift, an incision could be made underneath the breast and the silicone implants inserted. Breast augmentation and an arm lift can be performed at the same time. All the procedures mentioned above are performed under general anesthesia with a board-certified anesthesiologist. All these procedures are outpatient surgeries; however, the body lift and thigh lift typically require a two-night stay at a recovery center. Before any surgery is contemplated, multiple labs, an EKG, and chest X-rays need to be ordered. I hope this information helps you in your search for answers regarding the 360 circumferential lower body lift. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact an experienced, board-certified plastic surgeon. Since the body lift is a major procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing lower body lifts. Do your research. Ensure they have performed at least 150 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic, and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, and thank you for the question regarding arm suggestions with the mommy makeover. Thank you for your history and your pictures. If your medical history is clean and your preoperative blood work, EKG, and chest x-ray are within normal limits, I believe you can safely undergo a tummy tuck (abdominoplasty), breast lift (mastopexy), and liposuction. You can also undergo arm liposuction with Renuvion and fat transfer to your hip dips. This will be the upper limit of surgery time. Essentially, you are seeking a mommy makeover with 360 lipo, arm lipo, and autologous fat transfer to the hips and butt tips. Good luck. Please consult an experienced, board-certified plastic surgeon. I hope this information helps you in your search for answers regarding the mommy makeover, arm lipo, neck lipo, and fat transfer to the hips. If you have any further questions regarding tummy tuck, abdominoplasty, breast lift, mastopexy, liposuction, or fat transfer, please consult with an experienced, board-certified plastic surgeon. Since the mommy makeover and associated liposuction are big procedures, please seek an experienced, board-certified plastic surgeon with significant experience performing the mommy makeover. Do your research. Ensure they have performed at least 150 mommy makeover surgeries and have the before-and-after pictures to prove it. Please carefully look over their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced mommy makeover plastic surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic, and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, and thank you for your question about which tummy tuck technique would be best to avoid a vertical scar. Thank you for your history and your pictures. Congratulations on your weight loss. Regarding your abdomen, you have a distended abdomen, probably due to increased peritoneal fat and rectus diastasis. Rectus diastasis is the weakening of one of the ventral anterior abdominal muscles, namely the rectus abdominis. You have some excess skin and fat. Your best treatment would be an extended high lateral tension abdominoplasty, also known as a high lateral tension tummy tuck. An extended high lateral tension tummy tuck means an incision would be placed low in the pubic region and then continue high over the hips. Some patients called this form of tummy tuck a "handlebar tummy tuck" because of the shape of the scar. During the extended high lateral tension tummy tuck, dissection would be done to the belly button and then further dissection to the bottom of the sternum. This dissection would lead to full exposure of the entire abdominal wall. You do not need the vertical incision. Once your abdomen is isolated, the rectus abdominis muscle can be flattened. You can see the distention of the abdomen, especially on your profile view. This is due to the weakened rectus abdominis muscle as well as retromuscular or intraperitoneal fat. Intraperitoneal fat is also called visceral fat. After the correction of the rectus diastasis, your abdomen should be flat. For further anterior wall reinforcement, you may or may not need placement of abdominal wall mesh to add further support. Then, the skin from the top of the belly button is brought down to the pubic region. Essentially, all the skin from your C-section scar to the top of your belly button is eliminated. The skin of the abdomen is then reconnected, and the belly button is relocated. Therefore, you do not need a vertical incision or a fleur de lis incision. You need an extended high lateral tension tummy tuck. I hope I have answered your question regarding which tummy tuck technique would be best for avoiding a vertical scar. If you have any more questions regarding the tummy tuck or abdominoplasty, please get in touch with an experienced plastic surgeon. Since an abdominoplasty can be a challenging procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing tummy tucks. Do your research. Make sure your chosen plastic surgeon has performed at least 100 abdominoplasties. Make sure they have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. Good luck! Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, and thank you for your request regarding can a plastic surgeon can fix your flat nipples and can you get a skinny BBL with a breast lift (mastopexy), breast augmentation, 360 lipo, and liposuction of your chin. Thank you for your history and your pictures. The short answer is "yes." Regarding your abdomen, you would be best served with a full abdominoplasty, also known as a tummy tuck. This would include the removal of excess skin and fat from the abdomen, repositioning of the belly button, and lifting and reducing of the pubic region. It would also include liposuction. Most plastic surgeons would suggest liposuction of your waistline and possibly even fat transfer to the hips for a more defined shape. In addition, liposuction can be performed on the superior iliac crests (also known as "love handles") as well as the lower back. This is called 360 Lipo. You could also undergo bilateral axillary or armpit liposuction and chin (or, more accurately, neck) liposuction. These procedures can be combined simultaneously. You may also consider breast augmentation. With a breast lift, the size of the implant you choose will determine the type of breast lift (mastopexy) you need. You may need a donut mastopexy or a lollipop mastopexy. If you choose a relatively small breast implant size, you may need a full anchor mastopexy. To correct flat nipples, several options are available. Flat nipple correction procedures often involve fat transfer beneath the nipple. However, fat grafting to the nipple could decrease nipple sensation. Therefore, if nipple sensation is a significant concern, consider other options. Another very popular procedure to correct flat nipples includes the placement of a permanent suture around the perimeter of the nipple. This suture is usually permanent and is like a lasso at the base of the nipple. However, this means your nipples would not be flat, and your nipples would be permanently erect. Therefore, please be careful what you wish for. The nipples can be made more projectile, but that means that at all times, they are projectile. That means it may be difficult to conceal nipple erection in certain clothing. This may or may not be an appropriate look for you. However, technically, plastic surgeons can correct flat nipples. Thank you for your interesting questions. Good luck with your surgery. If you have any more questions regarding how to correct flattened nipples, please get in touch with an experienced plastic surgeon. Since correction of flat nipples can be a challenging procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing nipple surgery. Do your research. Make sure your chosen plastic surgeon has performed this procedure. Make sure they have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. Good luck! Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)