In what order should I stage my procedures after massive weight loss?

I need brachioplasty, breast lift, breast augmentation, (possible upper body lift?), abdominoplasty (possible lower body lift?) and a thigh lift. What is the best suggested order and grouping of these procedures if they must be done in stages?

Doctor Answers 8

Order for post bariatric body contouring

Hi BeTheUnicorn. Congratulations on your weight loss. Your figure is similar to a patient I did a couple years ago. I specialize in post bariatric body contouring and would do two operations 3-6 months apart.
1 First I would do a Lower body lift which gives you a tummy tuck, mons lift, lateral thigh lift, butt lift and if needed auto-augmentation of the butt and hips  (a procedure I developed to prevent a square or boxy look of the hip/pelvis area). With this I would also do a brachioplasty and possibly your breasts.
2. Second I would do the thigh lift, upper body lift (which looks like you do need) and breasts if not done the first time.

San Antonio Plastic Surgeon
4.9 out of 5 stars 52 reviews

Staging procedures after massive weight loss

Thanks for your question. There are different views on this but mine is to do the largest procedure first. In your case - as is most cases of massive weight loss - this would mean a lower body lift. This procedure excises tissue from around the entire body resulting in an abdominoplasty ("tummy tuck" is an understatement here) at the front, and a buttock lift at the back. It even tightens the lateral aspect of the thighs. I would not combine this procedure with anything else since it is rather extensive.

Subsequent procedures I do in pairs, usually in order of patient preference. These include but are not limited to:
Arm lift (brachioplasty)
Breast lift +/- augmentation
Upper body lift
Thigh lift

J. Brian Boyd, MD
Rolling Hills Estates Plastic Surgeon
5.0 out of 5 stars 5 reviews

Staging Bariatric Plastic Surgical Procedures

Congratulations on your success! There is no set order, but instead it depends on multiple factors, including your personal priority, proper grouping of certain procedures, and time. I have found that the most expeditious way is to group brachioplasty, breast lift/aug, and either upper body lift or abdominoplasty together. This essentially leaves the rest of the lower body and inner thigh for the second stage. I prefer to break up the lower body lift into abdominoplasty and posterior body lift to reduce the risk of complications.  Additionally, I think it is realistic to prepare for a possible third stage for minor revisions, as the skin can frequently loosen just enough to affect contours in some areas.
Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Staging Order for Massive Weight Loss Surgery

Dear BeTheUnicorn,

Again, congrats on the weight loss and keeping it off so long. The grouping of the procedures can very based on your goals.  There are a few ways to do this. This is one of the more common ways I approach it, but I will can tailor the order of these based on what bothers the patient most or their goals. 

1. lower body lift, with or without gluteal autoaugmention (the usually flat buttocks gets even flatter with a body lift so most patient benefit from augmentation of the buttocks at the same time), some times a vertical component  to the tummy tuck (fleur-de-lis abdominoplasty) needs to be added to address the horizontal skin excess (or this can be addressed later with lateral thorax excisions)
2. upper body lift with breast surgery, possibly adding the arms or thighs
3. thigh lift, and possibly lateral thorax excisions (if necessary depending on your horizontal skin laxity)

Some surgeons prefer to do everything on the front first followed by everything on the back feeling they get better results that way. The best way to figure out a good plan for you is to seek an in person consultation with a plastic surgeon so they can examine you and come up with a plan based on your needs and desires. Best wishes. 

Luis H. Macias, MD, FACS
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

In what order should I stage my procedures after massive weight loss?

It is usually more reasonable to divide the procedures with the tummy tuck/lower body lift performed first.

Find a board certified plastic surgeon who performs hundreds of tummy tucks and body contouring procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Congratulations on Weight Loss, Now Let's Get to Work

Great work on your weight loss. Part of your surgical plan would depend on what is really bothering you.  If it were up to me, however, I would start by anchoring your improvement in your core with a circumferential abdominoplasty/lower body lift.  Then, whether your upper body or lower body is addressed next would be up to you. A common next step is addressing breasts and arms second followed by thighs third. A bra-line back lift can be added if necessary and desired.  Good luck in your next step.
Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 117 reviews

In what order should I stage my procedures after massive weight loss?

Thank you for your question and photo. Congratulations on your weight loss. The way I prefer to stage these procedures, is to do the abdominoplasty and lower body lift first (this is where the money is!) You will feel better instantly with all that looseness gone from your body. My next stage would be extended arm lifts with a breast lift +/- an augmentation. I like to do the thigh lift last, but I often liposuction the thighs during the other stages to give you the best results with the lift. See a board certified plastic surgeon well trained in body contouring procedures for a consultation. Good luck.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

Order and grouping of body contouring after significant weight loss

Congratulations!  What an exciting time for you. At this point there is no standard order, and you will see different ideas from different surgeons. It is important to discuss with your surgeon all the factors that can play into this decision. I like to discuss with patients what is most distracting or bothersome to them and try to prioritize those areas.  As far as grouping, breast lift/aug with abdominoplasty and sometimes brachioplasty.  Lower body and inner thigh together along with other needed areas.  As you try and be efficient in planning your surgeries I do think it is wise to consider possible need for revisions.  Good luck. 

Michael Marion, MD
Sandy Plastic Surgeon
5.0 out of 5 stars 19 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.