Johnny T. Chang, MD

I would have to echo my colleagues' answers, that there is no good way to achieve a lift and a desirable shape without the circumareolar and vertical incisions (the lollipop), and possibly also a horizontal incision along the crease under the breast. In some cases, people can get a lifting effect with an implant only -- your photos do not look like that would work well for you, and it would also mean a significant increase in size. 

What I would like to add however is that the location and orientation of scars matter a lot in determining whether they look bad, and in general shape trumps scars, especially on the breasts -- what I mean is that a nicely shaped breast with scars typically will look nicer than a poorly shaped breast with no scars. That is the reason why people accept this tradeoff and opt to have breast lifts. In addition, whether you "scar easily" elsewhere does not mean you will scar the same way on your breasts. 

The fact is that breast lift scars will be very apparent, and do not generally "disappear." In some cases, the scar can be unsightly or even abnormal. However, this may be worth it to you for a better shape. I would suggest that you ask your surgeon to show you photos of patients who have scarred "well," "typically," and "poorly" to get a sense of what to expect. 

My colleagues have provided some very good answers -- it is often difficult to get insurance companies to cover these procedures, unless a functional problem can be clearly proven and demonstrated, and corroborated by photos as well as care providers other than your surgeon (for example, physical therapists and primary care physicians). 

My one additional suggestion is to simply call your insurance provider and ask them for their criteria for covering the specific procedure (in this case, brachioplasty). They actually typically will have documents spelling out the criteria that they are looking for. If after reading the criteria, you think you satisfy them, then providing the document to your surgeon may be helpful to guide their office consultation and notes. 

That said, ultimately your surgeon would have to feel comfortable that they are treating a true functional problem, and that he or she can address that problem adequately with surgery. 

Congratulations on your weight loss -- I assume that this was a healthy change for you, and you should be commended for achieving that.

I am unable to see your uploaded photos, so I will answer broadly. Brachioplasty can definitely help when you have significant excess saggy skin and not too much excess fat, after significant weight loss. The skin often will not retract completely after that degree of weight loss, in which case the only way to improve arm contour would be direct skin excision in the form of a brachioplasty (+/- spot liposuction as a touch-up). If there is actually significant fat, and not as much excess skin, however, then liposuction would be a a good way to improve that.

Brachioplasty does typically result in a significant scar however, which in some people can heal as a widened scar. The standard excision extends from the elbow to the armpit, plus an incision between the armpit and arm as well; there are modifications of this such as shorter scars, but they are appropriate for only certain specific patients. Placement of the incision on the inside of the arm is thus very important -- in normal walking and standing position, you want the scars to be hidden from front and rear view. Nonetheless, it is a significant scar, so you should make sure to see photos of what they may look like (both of how the scars are hidden, as well as how they look when they are not hidden - for example, when you flex and "show your guns").

That's not a silly question at all -- it is still amazing to me that putting the implant under a major muscle looks good. However, a ton of experience over the years has taught us that it does work, and works quite well on most people. 

In a subpectoral augmentation, the implant is placed partially (not completely) under the pectoralis major muscle (and above the pectoralis minor muscle). The muscle covers the top of the implant to varying degrees, whereas only breast tissue covers the lower portion of the implant. The pectoralis muscle is sometimes though not always partially detached from the chest wall. The degree to which the muscle is detached, how much of the implant is covered by the muscle, and how much is covered by breast tissue, is dependent on your anatomy as well as your surgeon's preferred techniques.

Implants are generally held in place very well by a few things. First of all, the pectoralis muscle is well-secured to the chest wall on multiple sides. Secondly, there are strong fascial attachments that secure the breast and surrounding soft tissue to the chest wall. Lastly, your body forms a capsule around the implant that helps to anchor it in place. Implants can and do migrate, sometimes enough to require surgical revisions; however, they generally are relatively secure where they are placed.

The direct answer to your question is yes, you can definitely get pregnant after a body lift, and it should not affect your ability to have a healthy pregnancy.

However, as with most things in life, there are tradeoffs for your choices. Many surgeons will recommend that you wait until after childbirth to have major body procedures, if possible. The primary reason is that you will likely lose at least some of the benefits of your surgery after childbirth. In addition, if you decide to have surgery again after having children, your results will likely not be as good as they were the first time.

That said, many young women may not want to wait until they have children. They would rather go ahead and have the surgery, and enjoy the time they have with their results before childbirth. After childbirth, they may return to have revision surgery -- understanding that results may never be as good as the first time around.

Discuss these tradeoffs in detail with your plastic surgeon. Once you understand them, you can make your own choice based on your goals and expectations. The simple answer is that yes, you can -- but whether you should is a decision only you can make.