Joseph Spaniol, MD, FACS

I see some elements of tuberous breasts in your photos but these are mild. Of course it's always more helpful to examine in person. Fat grafting is a great option to add volume to the breasts, and it's very helpful in tuberous breasts, but it is less reliable and often more costly than an augmentation with implants. Implants are much more reliable regarding your final breast volume, and your surgeon can aptly address the tuberous changes at the time of the augmentation as well. Ultimately which way you go should be driven by your goals, and a board-certified plastic surgeon can help you work through that process. Hope that helps!

Hey there, I agree with Dr. Chacon in that there are many less-invasive treatments which could refresh and rejuvenate. However, depending on your goals, I do think you'd be a good candidate for an upper blepharoplasty. This typically a very straightforward procedure and can be done in the office under local anesthesia. A comprehensive assessment at a reputable medical spa which also offers cosmetic procedures by board-certified plastic surgeons is a good place to start. I've attached a before and after of a patient of mine with a similar issue, shown 3 months after her in-office upper blepharoplasty. She was in her mid-40s at the time of her procedure, so older than you, but you can still appreciate the improvement. Hope that helps!

First of all, congratulations on your weight loss! Regarding your surgery, you have a few medical issues that need attention and optimization prior to surgery, but these are not road blocks. I would ask for your Neurologist to optimize and clear you for surgery, and coordinate with the anesthesia team regarding close blood pressure monitoring during your surgery. This can likely be done at a certified outpatient surgery center but your Neurologist and/or the Anesthesiologist may recommend closer monitoring at a hospital with arterial line monitoring during your surgery. I would request that your Plavix and aspirin be held a few days before and after surgery, and most managing physicians are ok with that. You will need to hold the Zepbound for 1-2 weeks prior to surgery as well per the hospital/ASCs protocols. Improvement in the urinary incontinence usually does occur after abdominoplasty with rectus diastases repair, but it is certainly not a guarantee. The evidence that is mainly observational and does not establish that repair causes the improvement. Urinary incontinence is usually multifactorial, and though most report improvement, some patients report no change, or (rarely) a worsening of their symptoms after diastases repair. On review of your photos, yes, you are a great candidate for an abdominoplasty. I would recommend liposuction as well of the waistline and back to further improve your overall abdominal and back contours. I think the medical issues can certainly be managed and you would have a nice result.

From your photos it appears that you have enough of your own breast tissue to camouflage the upper pole of the implant even if placed above the muscle, though your surgeon will confirm this with physical exam. I typically go above the muscle but within the muscle envelope (subfascial), which preserves the envelope of the pectorals major muscle to help blend the edge of the implant to your chest wall. This eliminates the risk of animation deformity that is certainly a concern when going dual plane, while still allowing a natural transition between implant and chest wall. Motiva is a great choice for you above the muscle, as they tend to ripple much less than other brands when placed above the muscle. Motiva offers Round and Ergonomix, and the Round is the slightly firmer of the two. This ripples the least and preserves more pper pole fullness than Ergonomix. I agree that you're also a good candidate for the Preservé procedure.