Breast: Loose Skin, Sunken Striae Post-30lb Loss. Options?

After a 30-lb weight loss, the edges where my breasts attach to my body are marked by sunken stretch marks, especially on the tops and inner edges. There's also enough loose skin to pinch. I'm opposed to implants, and I don't want any cutting near the nipple--the risk of losing sensation is a dealbreaker for me. Is there any other kind of surgery? Can skin be removed from the outer-upper corner of the breast? Can tissue be folded in to fill the loose skin? I don't mind sag, just the loose skin.

Doctor Answers 7

Breast Lift with Auto-augmentation technique

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Unfortunately, there is no way to rejuvenate the breast without taking a risk to sensation.  The risk is low over the longterm, but something that must be accepted for surgery to be an option.

If you are happy with your current volume, but simply want the volume back where it used to be, you may be an excellent candidate for a breast lift with auto-augmentation.
This is my primary method of breast lift in patients who do not require a breast implant.  This will provide natural results with suture resuspension of the breast tissue to the upper pole producing fullness/cleavage without tension on your skin.   This will minimize stretching of the skin longterm.  
Also, by a avoiding the long horizontal scar, you will be able to show cleavage without visible scars and where swimsuits and bras that easily camouflage all your scars. 

This allows for a long lasting result because the breast tissue itself has been lifted, not just the surrounding skin.
I wish you a safe recovery and fabulous result!
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Breast: Loose Skin, Sunken Striae Post-30lb Loss. Options?

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If the nipple/areolar position is satisfactory it may be possible to excise skin without an areolar incision, but all the breast incisions can interfere with nipple sensation in occasional patients. 

The alternative to skin excision is enlarging the breasts. SInce implants are out, what is left is fat injections.

Without photos it is not possible to be more specific. A consultation with a plastic surgeon will be your best resource, but your exclusions may leave you with no surgical options.

When you are ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast Lift without Periareolar Incisions

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      Breast lift without periareolar incisions in the conventional sense cannot be performed.  In the case that a person has pseudoptosis, skin excision from the inframammary fold can lift the breast without lowering the nipple areola complex too much.

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Mastopexy or breast lift?

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It sounds like you want a mastopexy, but most techniques require skin incisions around the areola. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Mastopexy without areolar incisions

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You have conflicting goals: removal of the excess skin but without affecting nipple sensation. A lift will involve areolar scarring. Tissue can't be folded in; we are dealing with the human anatomy and not a piece of cloth. Fat transfer techniques may ultimately be an option for you. However, this treatment has its own risks and complications and is not suitable for everyone.

Breast Surgery after Weight Loss?

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Congratulations on your significant weight loss.

 Given that the risk of losing sensation is a “dealbreaker”, you should stay away from any type of breast surgery.  Breast lifting techniques involve movement of the nipple/areola complexes and excision of loose skin.

 I hope this and the attached link help.

Options for loose breast skin

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I am not aware of any current technique that will achieve what you are looking for without periareolar scars.  Some surgeons are working with fat transfer to enhance breast volume.  If the breasts are really saggy, this won't work well, but it might be a consideration.  I have used fat transfer in the setting of breast reconstruction, but not yet in the situation you describe.  There are potential downsides, so you would need to discuss this with a highly-experienced surgeon, preferably one who has published articles about this.

There are several skin tightening technologies on the market, but I doubt that any of them would achieve enough benefit for you.  There are some "in the pipeline" that may work better, but time will have to tell.

I hope this information is helpful.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 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.