How to Decide on Procedures & Choose a Surgeon when They Present Such Different Treatment Plans & Staging? (photo)

Lost 115 lbs, left w/ saggy skin...met with 5 board certified plastic surgeons, and instead of being closer to a decision, I'm more confused. I've been told different opinions and all these surgeons seem knowledgeable & convincing...Do I need a LBL or would an extended TT be sufficient? Can I put implants in at the time of BL or should it be staged separately? I'm unhappy with my breasts and stomach, prefer only one surgery & scars that are hidden. Yet I don't want dog ears or unbalanced body.

Doctor Answers 15

Surgeons will have different opinions; be sure your surgeon is experienced in the area of weight loss

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Congratulations on your significant weight loss. 

I can understand your frustration with so many different opinions regarding your procedures.  Truth is that there is no right answer and as I say, plastic surgery is like baking an apple pie. There are a thousand and one ways to make a really good apple pie!


If you were my patient, I would suggest a single surgery to include a circumferential body lift, breast lift, and implants.  The reason I would suggest a circumferential body lift as opposed to a tummy tuck is because the circumferential body lift would eliminate excess skin and fat of the lateral hips and raise the buttocks.

The surgery can be performed safely in one stage with an experienced plastic surgeon.  Seek a surgeon with experience in the area of weight loss patients. The surgeon should have performed a significant number of 360 body lifts combined with breast lifts with implants. 

Thank you,

J. Timothy Katzen, MD, FACS

Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Stageing for all body contouring surgery

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Great job!! I would wait for 6 months of weight stability before you have surgical procedures. Unfortunately there is no effective non-surgical method.  However, a body lift can truly change your life. Excess abdominal fat  and skin is removed, the abdomen and your core is tightened, your hips are raised and defined and your buttock has new definition and shape.  The combination is powerful and the results are immediate. I would do the body lift first, then stage procedures every 4-6 months. Healing time is 2-4 weeks. Any breast surgery thigh or arm lifts would be better staged because of the safety of being under anesthesia for a long time.The most important thing is safety. Please don't compromise on this! See a board certified plastic surgeon.

Choosing a Surgeon

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I think that an experienced plastic surgeon could perform both procedures, tummy tuck and breast lift with or without implants in under four hours. From your pictures, I do not think you really need and extended tummy tuck, but liposuction alone would not work. An anchor type breast lift with or without implants is the only lift that would probably work as you have quite a bit of sagging. the larger the implant usually translates into a shorter scar in the breast crease, though going too large is not good either. Hopes this helps you make your decision.

Confused, what procedure is best for me.

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Congratulations on losing the weight. I commonly perform multiple procedures in one setting safely. You can 2 team the procedure safely and get multiple procedures done in one setting. For example, lower body lift, medial thigh lift, and breast procedure in one setting safely.

Breast lift with or without implants can be performed. The decision on whether you want implants is whether you want to be bigger than you are in a bra. If you do then add an implant at the time of the procedure.

Extended abdominoplasty would work for you. I would ask you to look at your buttock/thigh region. If that area bothers you as well then you add the circumferential body lift to the abdominoplasty. If you are okay with the buttock/thigh region then leave it. The advantage of doing multiple procedures at once is one recovery period and hospital and anesthesia costs go down after the first couple of hours.

Board certified plastic surgeon is the way to go. Look for one with experience in post bariatric plastic surgery to give you guidance. Good luck.


Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

What Type of Surgery Should I Have After Massive Weight Loss?

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Dear ps2012,

Different plastic surgeons will often choose different combinations of procedures to obtain the desired results.  The plastic surgeon uses the stated goals of the patient in combination  with the examination to help in this process.  This is why you are facing such a variety of recommendations from all of your doctors.  You can help narrow which surgeon's recommendations are right for you by focusing down on your priorities.  The final shaping in clothing even though this may require more and larger incisions?  Smaller, more hidden incisions with less shaping?  How much costs you are willing to spend?

I would recommend you review the recommendations you have received and select those you feel really address your goals.  Then, review the before and after results of those surgeons.  Go back for a second visit.  Check on the certification of the surgeon and the accreditation of the surgery site.


There are lots of very good plastic surgeons out there and no two will have the exact same recommendation but it is the final result that matters.  Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Treatment options

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Congratulations on your weight loss.  I'm glad to hear you only visited with board certified plastic surgeons.  Given your anatomy, there are definitely different treatment options.  Which is the "best" for you will depend on your goals, your anatomy, and of course, your budget.   There are different ways to treat excess skin.  My suggestion: review your surgeon's before/after photos and go with your gut feeling - pick the surgeon and the office staff with whom you feel most comfortable.  Best of luck!


Body lift vs extended tummy tuck after weight loss

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Firstly, congratulations on the weight loss - 115 lbs is quite the accomplishment. Based on both your photos and details shared within your question, I think the best path forward for you would be to combine an augmentation mastopexy (that uses a small implant to maintain superior fullness) with a full tummy tuck that can be extended laterally if the laxity in the flank area is excessive. A little bit of liposuctioning to the hips and lower back can also be performed if needed.

The reason I'd go with a combined tummy tuck + breast lift/augmentation over a lower body lift + breast lift/augment is simply that it satisfies each of the criteria laid out in your question:

  • prefer a single surgery ✓
  • breast and stomach bother you the most ✓
  • desire concealable scars ✓
  • desire a "balanced" body/result ✓ (see ** below)

The other advantages to an extended tummy tuck over an LBL in your case would be:

lower total cost - a LBL/BL would require you to stage the breast procedures 3 to 6 months after the LBL operation (any surgeon that would recommend combining a TBL or LBL with an augmentation mastopexy is, in my opinion, pushing the limits of safety for a single OR session). Total cost of an lbl + breast lift/augment would be over $20k  whereas a tummy tuck + breast lift/augment would be between $14-15k.
  • easier recovery - LBL would add a week to the initial recovery period and require 4 drains. A tummy tuck requires only 2 drains.

There's also the question of whether or not a LBL is even appropriate given that your lower body doesn't appear to suffer from an overabundance of loose/lax tissue. 

**One caveat to the above is the laxity present in your upper arms. I agree with both Dr. Stephenson and Dr. Grenley that if you are bother by this then an arm lift may be worth considering. That said, an arm lift would definitely undo several of the advantages associated with the single procedure plan outlined above since it would require a 2nd operation, leave you with semi-concealable scars and increase total costs by some $7,500.  

Of course, if you're upper arms are not a major concern, then I certainly wouldn't recommend an arm lift since, much like an LBL, the costs would far outweigh the benefits in your case.

The photo gallery linked to below is of a patient with a pre-surgery body type similar to your own. I'll add a few more angles shortly. Hope that helps and good luck with everything going forward! - Dr. DeLuca

Massive weight loss and surgery

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Unfortunately, it is like going to different restaurants, each chef makes his chicken soup a bit differently.  AS for you, a body lift may be good if you feel that buttock area is a bit saggy and loose. If not, just an extended tummy tuck may be reasonable. I prefer to not combine the breasts with a lower body lift  in most cases.  Good luck.

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

Procedure choice after weight loss

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I'm sorry that your consultations generated more questions than answers.

After losing lots of weight, plastic surgery involves a tradeoff - scars for better contour.  Although an accurate treatment plan depends on an actual consultation and examination of your skin quality and a number of other factors, based on your pictures I'd recommend an "extended" abdominoplasty in conjunction with a breast lift (and an implant, if you're not happy with the volume in your breasts). 

In the end, you have to be happy with the plan and trust that you and your surgeon are on the same page before you decide to do anything.


Hope this helps,

Dr. Hall

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

Confused after Consultations

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Thank you for your question and pictures. Congratulations on your weighloss!

Each plastic surgeon has their own comfort level and experience with such procedures so I am not surprised that you received different recommendations.  It is always best to get precise advice with an in person examination but from the photos you have posted, it looks like you are in need of breast lifting as well as breast augmentation surgery.  Whether to do these procedures in 1 stage or in 2 stages would depend on your goals as well as the quality of your breast skin.  I have worked with many patients who have lost significant amount of weight and a lot of times, the breast skin is very thin and therefore I suggest a 2 staged procedure to try to reduce potential complications after surgery.  You also look like you are a good candidate for tummy tuck surgery.  Whether you do a tummy tuck, extended tummy tuck or lower body lift really depends on your goals.

Make sure the surgeons you are visiting are board certified plastic surgeons who have experience with patients who have had significant weight loss (your skin elasticity is different than someone who hasn't had the significant weight loss).  Make sure you are comfortable with your surgeons credentials, experience and the examples of the work that you see.

Best wishes.

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.