Body/arm/back/breast EVERYTHING lift - do I need to remove and tighten skin as well? (photos)

Question

My main concern were always my boobs. I’ve heard terms from tubular breat -snoopy boobs. As I grew, I gained weight reaching max 330. Now at 27, no kids between 197-185(if I’m active). I’m unsure how serious I am about skin removal, I still have some way to go. My goal is to seriously strength train to sculpt and lose more fat with proper nutrition. However, knowing I NEED a lift, idk if it’ll look right if I don’t remove and tighten everything else. Opinions and suggestions please!

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding how to lift the body, arm, back, breast, basically everything! First, congratulations on your weight loss. Great accomplishment!  Second, though it would be fantastic if your skin snaps back and shrink wraps around your new body, it is highly unlikely that after 145 pound weight loss that the skin will do so. Unfortunately, your skin has been stretched and it is unlikely to bounce back.  Therefore, I would suggest several staged surgeries to reconstruct your entire body. 
For your abdomen, I would suggest either an extended tummy tuck or a fleur-de-lis abdominoplasty.  These procedures will permanently eliminate excess skinned fat of the abdomen, raise the pubic or mons region, re-create the belly button, and suture the weakened abdominal wall muscles. 
For your arms, I would suggest an arm lift, arm reduction, or brachioplasty. During your brachioplasty, arm liposuction is performed and an incision is made from the armpit to the elbow. 
For your back fat and skin rolls, I would suggest either a horizontal or vertical torsoplasty. Your best results will be obtained with the horizontal torsoplasty. During  a horizontal torsoplasty, an incision is made across your back and excess skin and fat is removed.  
For your breast, if you desire a larger breast size, I would suggest breast implants. If you do not desire breast implants, then I would just suggest an anchor breast lift (mastopexy). If you decide on breast implants, you will need a breast lift. The excess skin and fat on the side of the breast can be incorporated with the above mentioned horizontal torsoplasty.
Many of these plastic surgery procedures can be combined. In your case, I would perform the horizontal torsoplasty and the extended tummy tuck during the first surgery. Then, 1 to 2 months later, I would do the arms (brachioplasty) and breast lift (mastopexy) with or without breast augmentation.  I hope these answers help.

Tommaso Addona, MD · Answer

Thank you for your question and congratulations on the weight loss.
With any elective procedure post-weight loss, it is important to be at your goal weight for at least six months prior to the procedure. This ensures that you get the best possible aesthetic. If you were to lose additional weight after your procedure, you may notice excess skin they may require an additional procedure to revise. Based on the photos you provided, I would do the skin removal in at least two separate procedures starting with a panniculectomy and a breast reduction which are sometimes covered by insurance. You can also have the excess axillary tissue removed during this procedure. After this, you can focus on the back and arms. I recommend speaking with your plastic surgeon to discuss your concerns and goals.

Thomas Trevisani, MD · Answer

Congratulations on your weight loss! Based on your photos you appear to be a good candidate for staged body lift/ contouring procedures. You can start with circumferential  Breast lift (w/possible Augmentation), upper back lift, Circumferential tummy tuck/ Buttock lift -as stage 1, and then during the next stage address your arms and thighs. These are very lengthy and big surgical procedures that need to be performed by an experienced Board Certified PS. Good luck!

Gary M. Horndeski, MD · Answer

I would begin with your breasts using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. At the same time, you can undergo a brachioplasty (arm lift). The safe operation time is 6 hours. After these have been completed, you can consider circumferential lift, both anteriorly and posteriorly.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gianfranco Frojo, MD · Answer

I would set a goal weight and once you. have reached this, see a plastic surgeon to discuss body contouring. I would recommend a lower body lift first and then upper body lift followed by a thigh lift last. I would highly recommend seeing a board eligible or board certified plastic surgeon for a physical exam and accurate analysis with safe recommendations for potential surgical options. Best of luck!

Salvador Medina, MD · Answer

Your are a candidate for an upper body lift (wich includes a breast lift with implants, torsoplasty and an arm lift), and a lower body lift (circular abdominoplasty with liposuction).With these procedures we can take out all the excess skin on the breasts, arms, back, abdomen, and repositon thighs, butt and breasts.It is important to reach a weight were you feel comfortable and you can maintain and start with the breast surgery

Carmina Cardenas, MD · Answer

It is wonderful what you have achieved after losing all the weight!! Congratulations!! 
You have developed severe degree saggy skin and tissues  so you will be candidate for a wonderful transformation which should be staged because non of the procedures you will need will be short or minimu. All of them represent very large surgeries and in order to have safety as priority, non of surgeries should last more than 5-6 hours. 
Top to bottom you will be candidate for Extended Arm lift because your arms saggy skin cross the line of the axila. 
Lateral torso has double vector of excess of skin so you will need inverted T lateral torsoplasty (sides of chest).
Your trunk circumferentially will need a Lower Body Lift Fleur de Lis to remove the excess of length (360 incision) and also remove the excess of width through the Fleur de Lis. Muscle repair to create a flatter abdomen and smaller waist. Real buttocks lift and some enhancement on your body shape. 
The back will need an upper body lift which will include the back lift, and reverse Tummy Tuck. 
At the end of the process you will look astonishing!! Be encouraged. 
Just don’t try to do all at once, it will be very risky and you may end up with bad complications. 
My recommendation will be to look for an expert in this type of procedure which are definitely more like a reconstruction. 
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear sweetsunshine95,
congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider surgery, otherwise your results will be suboptimal if you continue to lose weight after the surgery. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Congratulations on your weight loss!  Once you have reached your goal weight and are able to maintain it you can begin considering surgery.  From the photos you will not be a candidate for less aggressive approaches, but will get the best results from skin removal and body contouring procedures.  I've included a video that I hope you find helpful.

Karol A. Gutowski, MD, FACS · Answer

Congratulations on your weight loss! Based on your pictures, it would be best to come up with a plan on how to address all of your concerns in a way that minimizes the number of procedures and maximizes safety. Your breasts may be improved on their own, or you can continue the procedure to remove the side and back skin excess. However, and in person assessment is best to formulate a treatment plan for you. You should consider a body lift and arm lift also. Learn more in the link below.

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