38, 2 c-sections, 130 lb. weight loss - 360 or extended tummy tuck? Implants or fat transfer? Arm lift or skin tight? (Photos)

Question

I'm 38 YO mom of 2 girls age 5 and 7, both C sections. I lost 130 lbs 10 years ago after gastric sleeve surgery. Since I own a med spa that has morpheus, I have done at least 5 morpheus treatments to my stomach, arms and less of it to the thighs. I believe that is what has helped my skin bounce back better than most after my weight loss and subsequent pregnancies. In my perfect world, I would get a 360 body lift with muscle repair, lipo 360, lipo and skin tightening to arms and thighs with fat transfer to breasts and a breast lift. I have multiple sclerosis, hemiplegic migraines that are resolved now using estradiol patches and sublingual progesterone. I also have a rare genetic issue of bone mineralization that causes fibromyalgia like pain and I'm with pain management on butrans & norco. Due to these health issues, I'm afraid to get implants because I have progressive illnesses and even if I did not get breast implant illness I would worry that they are to blame. What all would you do if I were your patient? 360 vs extended tummy tuck? Implant vs fat transfer to breast? (I'm aware of the issues with it and multiple rounds possibly needed, just looking for a little more fullness I don't need huge boobs though it would be nice) Arm lift or do you think skin tightening is enough? Thighs I just want a little lipo and skin tightening there. If we do lipo to arms, legs and 360 torso, do you think there is enough fat to put in both butt and breasts?

Mehmet Ozdemir, MD · Answer

Given your remarkable 130 lb weight loss and the skin laxity visible in your photos, a 360 lower body lift is much more appropriate than an extended tummy tuck, as it will address the circumferential "deflation" by lifting the outer thighs and buttocks while tightening the abdomen. For your breasts, choosing fat transfer instead of implants is a wise decision given your MS and health concerns; while it offers a more modest volume increase (typically half to one cup size), it removes the risk of "breast implant illness" anxiety and uses your own tissue for a soft, natural result. Regarding your arms and thighs, your Morpheus treatments have done wonders for the skin quality, but because of the underlying tissue volume loss, surgical arm (brachioplasty) and thigh lifts are usually necessary to achieve the crisp contour you're looking for, as skin tightening alone often hits a ceiling with this degree of laxity. Since we would be harvesting fat from a 360 torso, arms, and legs, there is typically enough "liquid gold" to perform a beautiful breast fat transfer and subtle buttock shaping, though we would prioritize the breasts as per your request. Most importantly, because of your MS and pain management needs, we would coordinate closely with your neurologist to ensure a surgery plan that minimizes stress on your nervous system and manages your recovery comfortably.

Daniel Barrett, MD · Answer

Dear Versatile79067,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because 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

Sean Hill, MD · Answer

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon – Lone Star Plastic Surgery (Frisco, TX)
First &mdash; congratulations again on your incredible weight loss and maintaining it long-term, especially while balancing pregnancies and chronic medical conditions. After reviewing your photos and your goals, I actually think your situation may be a bit more favorable than you initially thought.
⸻

Carlos Alberto Ríos García, MD · Answer

That amount of weight loss, combined with pregnancies and C-sections, creates very specific changes in the skin and supporting tissues that often cannot be fully corrected with non-surgical tightening alone.
Based on your photos and history, I think your instincts are actually very reasonable and realistic.
In your case, I would personally lean more toward a lower body lift / circumferential approach rather than only an extended tummy tuck, because the laxity is not isolated to the front abdomen. You also have looseness extending into the flanks, lower back, outer thighs and buttock region, and a 360-type procedure generally creates a more harmonious improvement in patients after major weight loss.
For the breasts, I completely understand your hesitation about implants given your medical history and concerns. Since you are mainly looking for modest fullness rather than large augmentation, a breast lift combined with fat transfer could be a very reasonable option. The important thing is understanding that fat grafting usually provides softer, subtler volume enhancement and sometimes requires staged treatments to reach the desired fullness.
For the arms, the degree of skin laxity visible in the photos appears more significant than what skin tightening devices alone typically correct reliably. Technologies like Morpheus can improve skin quality and mild laxity, but they usually do not replace an arm lift when there is moderate-to-severe excess skin after massive weight loss.
As for fat availability, many patients after major weight loss still have enough donor fat for selective grafting, but usually not enough to aggressively maximize both breasts and buttocks simultaneously while also doing extensive contouring everywhere else. Prioritization becomes important.
The biggest consideration in your situation is not only “what can be done,” but what can be done safely and strategically considering:
* MS* chronic pain history* pain management medications* previous pregnancies/C-sections* healing capacity* operative time tolerance
In many patients with complex medical backgrounds, staging procedures can actually be the safest and most predictable approach instead of trying to do everything at once.
A thoughtful surgical plan often gives better long-term outcomes than the most aggressive one-stage transformation.

Gary M. Horndeski, MD · Answer

I would begin with your breasts. I recommend a breast lift using the Bellesoma. 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 or later, a tummy tuck or brachioplasty can be performed. You will most likely need a circumferential body lift in the second stage.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  From the photos you are a candidate for either an extended tummy tuck or lower body lift.  Liposuction can be added for additional contouring.  The fat transfer to the breasts is not something that I recommend.  The reasons you mentioned against it are true, but my main concern is that the fat can form microcalcifications which can interfere with imaging studies.  My recommendation would be an implant with a lift.  An exam is needed to know for sure but you should have a nice arm result with liposuction and J Plasma.  Visit with a board certified plastic surgeon near you to learn more.

Darryl J. Blinski, MD · Answer

Based on your post photos I recommend virtual consultation for better explanation. With that said I would recommend two separate rounds of Surgery first round would be the extended tummy tuck with muscle repair and liposuction of upper arms inner thighs with J plasma for skin tightening combine with fat transferred to breast under ultrasound. Round two after minimum of three months postop would be a continued liposuction 360 with possible arm lift or thigh lift if skin does not tighten enough or re-entertain use of plasma. Each procedure procedures fees would range from $10,000-$20,000. Best of virtual consult with.

Mats Hagstrom, MD (license on probation) · Answer

Weight loss patients usually don’t need liposuction.
Weight loss patient almost always have problems related to skin laxity and therefore skin surgery is the correct treatment option.
I don’t believe that any type of skin tightening other than direct surgical skin excision is going to do anything Noticeable.
Liposuction of your arms and thighs is not appropriate because fat isn’t the problem.
If you believe in implant illness, you’re most likely going to have symptoms if you get implants.
Those who believe in this condition are highly likely to develop symptoms.
Those who don’t believe in implant illness usually don’t have any problems at all because there are no real documented illnesses from implants from good scientific studies.
Placebo is powerful.
Therefore, I recommend you avoid implants.
Breast fat transfer may be an option.
Obviously that does require doing some liposuction.
Talented plastic surgeon with enough Liposuction experience should be able to harvest enough fat for some fat transfer procedures.
I don’t see a strong indication for a BBL.
It’s not going to treat issues related to skin laxity.
A wrap around a.k.a. 360 tummy tuck is appropriate.
If you’re going to do an extended tummy tuck, you may as well connect the dots and go all the way around.
 The more skin laxity you have the more important it is to do a 360 tummy tuck a.k.a. body lift.
Consult with plastic surgeons in your area.
Make sure you schedule in person consultations.
Bring pictures of yourself to use as a reference during the consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patient had similar body characteristics of the procedures they recommend.
They should be of other patients who’ve also had 100 pounds of weight loss.
There are significant differences among plastic surgeons when it comes to skill and experience for any of these procedures.
Provider selection is going to be the most important variable.
Finding the right plastic surgeon is much more difficult than most people realize.
Best,
Mats Hagstrom MD

38, 2 c-sections, 130 lb. weight loss - 360 or extended tummy tuck? Implants or fat transfer? Arm lift or skin tight? (Photos)

Answers (8)

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