After Weight Loss, What is my Best Option for Tightening the Loose Skin?

I was heavy throughout my childhood and teens, losing weight in my early twenties. Ever since then, I've had serious sagging of my abdomen, pubis mons, and breasts (and a little on inner thighs and underarms). Is it possible to tell me from the photo if my only GOOD option is a full abdominoplasty and breast lift, and if I am a potential candidate for the "donut" breast lift where the incision is around the entire areola? Forgive the nudity - wanted to show the sag in the pubic area. Thank you!

Doctor Answers 10

Body lift procedure

Most people who lose a significant amount of weight will benefit from a circumferential body lift. I like to think that we are tailoring a new suit of skin to your new smaller body and to do that we need to tailor the front,sides and back of your body for the best cosmetic result. Most of my patients who have this procedure spend one or two nights in the hospital or go home with a Nurse.  I would perform the body lift first and then wait 3-4 months before doing your breast augmentation and lift surgery. Another good option would be to just do a breast lift at the time of your body lift and then 3-4 months later place breast implants to give you the final size you want. Doing multiple surgeries at once in my opinion increases your chances for complications. I hope this helps!  Please visit with a board certified ASPS member surgeon in your area for consultation.


Richmond Plastic Surgeon
4.9 out of 5 stars 59 reviews

Combination Massive Weight Loss Surgery

Although your frontal picture is helpful, it's virtually impossible to make a specific recommendation without a physical examination. Based on your pictures, you appear to have significant abdominal skin sag. This sag is most likely associated with redundant back tissue, buttock sag and lateral thigh sag. Your pictures also suggest significant loss of breast volume with associated breast sag.

A variety of surgical options are available to treat these problems. It would appear from your pictures that you would benefit from a lower body lift procedure. This procedure would remove a circumferential segment of skin and fat from the lower abdomen and back. It would simultaneously elevate the mons pubis, lateral thighs and buttocks. It's associated with excellent clinical results and high levels of patient satisfaction.

In addition, you would benefit from a breast lift procedure possibly in combination with breast augmentation surgery. The magnitude of your breast sag might require a lollipop or anchor mastopexy. In patients who want larger breasts or upper breast fullness, a breast augmentation may be indicated, as well.

It's possible to perform these procedures in combination provided the procedure doesn't exceed five hours. When this number is exceeded, the complication rate rises significantly.

If you're considering massive weight loss surgery, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Abdominoplasty and Breast Lift are Great Options

From your photo it appears that most of the skin laxity is on your front side and abdominoplasty will give you a tremendous change. A circumareolar breast lift will not give you enough lift. The scars from a vertical lift normally heal quite well as long as you are not a smoker.There is hope. Congratulations on losing so much weight.

William H. Huffaker, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 49 reviews

High lateral tension abdominoplasty and a mastopexy will give best results...

Dear Betty:

Congratulations on your weight loss! I believe your best result would be a high lateral tension abdominoplasty and a mastopexy. 

The abdominoplasty should be a high lateral tension because of your hourglass body shape.  The incision should be placed low in the pubic region to lift and reduce the mons.  Also, the high lateral tension should eliminate the significant amount of excess skin and fat of your lower abdomen. 

The umbilicus would also be addressed and revised.  Concerning your breast, I would suggest modest breast implants and a mastopexy.  I would begin with a doughnut mastopexy but if I could not get enough lift, I may have to convert that to a vertical mastopexy or lollipop mastopexy.  These two procedures can be done at the same time.  Please visit my website for more pictures of these types of procehures.

Thank you,

J. Timothy Katzen, MD, FACS

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 194 reviews

Options after weight loss

Based on your photo, I would likely benefit from a full or extended tummy tuck.  However, if there is laxity on your posterior flank and buttock, then a circumferential body lift may be needed.  With respect your breasts, a breast augmentation with a periareolar mastopexy is an option.  However, a physical exam is required to evaluate the laxity and quality of your skin.  You may need a circumvertical mastopexy which involves the "lollipop scar lift" in addition to your implants.  Please visit with a board certified ASPS member surgeon in your area.

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Abdominoplasty tightens skin

The best technique for the abdomen is an abdominoplasty.  The excess skin and fat will be resected, the underlying fascia will be tightened and the pubic area will be pulled up.  If you desire larger breasts, implants can be placed at the same time.  This should be done through a circumareolar approach without leaving a vertical scar which is unsightly and will widen in time.  The goal of breast surgery would be to align your nipples, remaining breast tissue and the implant in the same horizontal plane to give you higher position and maximum anterior projection.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Weight loss surgery

With massive weight loss, patients often have significant redundant skin in numerous areas which are really only amenable with direct excision.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Mommy make over

You are a candidate for a full abdominoplasty with a design to lift the mons pubis.

The breast is asymmetrical and will need a lift. You may need atleast a lollipop mastopexy incision for a good durable results

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Contouring after excessive weight loss

Only the full tummy tuck will do, including a lift over the pubis, though the pull can also help the inner thigh. Concerning the breast lift, the around the nipple lift gives the poorest stability to the lift and nipple, and tends to flatten and reduce breast projection. The vertical or 'T' will give the best shape and projection. They have taken your photo down, though with our experience we know full well the 'look'. Hope things go well.

Best of luck, Peter Johnson, MD

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Excess Skin After Weight Loss: Nip and Tuck

Congratulations on your weight loss, but now you have another problem...excess skin and sagging abdomen and breast. You would be a great candidate for a full abdominoplasty with mastopexy augmentation. I would not recommend a "donut" mastopexy for you because you need too much of a lift, including your outer chest. A donut lift can leave you with a widened areola and a flattened breast. Consider a longer scar for a better breast lift. You may want an inner short scar thighplasty too. I hope this helps. Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.