Loose Skin & Muffin Top After ETT (photo)

We plastic surgeons must work within limits established by nature, and our commitment to the safety of our patients.  Your photos show a good result.  You will never be rid of all your excess skin after a 135 lb. weight loss.  If there is any criticism your plastic surgeon may be due, in my opinion, it is that he/she may not have confirmed that your expectations were appropriately adjusted before your procedure.  

Potential complications of major body contouring surgery include wound dehiscence, skin necrosis, recurrent seromas, deep venous thrombosis, pulmonary embolus, and death.

You have come through OK.  Enjoy what you have and who you are.

Congratulation on your weight loss. Your surgeon should have explained to you that patients who undergo massive weight loss (greater than 100lbs) have stretched out inelastic skin. This type of skin undergoes a secondary relaxation and might need further tightening later. You would've benefited from a lower body lift than an ETT. This explains the muffin top. After massive weight loss, there's looseness in the back and buttocks as well and it sounds that this was not addressed during your consultation or you elected not to have the more extensive procedure done. Discuss this with your surgeon. Good luck.

You are a candidate for an abdominoplasty. When you are in the sitting position place your hands under the skin apron. Follow this out laterally until it tapers off. This will give you an idea of the length of the incision necessary for your abdominoplasty. Your plastic surgeon, during an examination, will be able to advise you on the length of the incision needed to give you a full correction.

Massive weight patients often require a revisional procedure following an abdominoplasty. In fact, many plastic surgeons will stage the abdominoplasty first knowing that a revision will be necessary at the time of the breast or upper body procedure. The bottom line is that the elasticity and natural contraction of the skin is lost following massive weight loss. Overtightening of the abdomen can lead to numerous problems with skin necrosis, poor wound healing, and large scars. Being conservative can avoid the larger problems, but can lead to issues with laxity and loose skin following surgery. This is why the consultation process is so important! Educating patients on the expectations following surgery and the possibility of revisional surgery is critical, particularly in the post-massive weight loss patient.

If you lost a large amount of weight and have skin that isn't elastic, thn it is possible that the skin has not tightened as you would expect and you will need a revision. I would personally prefer to have the abdominal issues straightened away before proceeding to the breast augment/lift as it will be difficult for you to make a decision about implant size with your abdomen in its current situation. Also, this is a cautionary tale. You could experience similar sagging after breast surgery as well and this may be a reason to undergo a mastopexy alone rather than implant insertion which could exacerbate the laxity of the skin.