Breast lift/augmentation after significant weight loss (photos)

I am 37 years old and have lost 100lbs in 1 year. I am currently 147 lbs. my breasts have always been large (DDD), but droopy. Since the weight loss, I have lost ALL of my breast tissue. My breasts are seriously just sagging skin. The nipples don't actually point down though. I can see my rib cage where my breasts used to be. With the skin and little tissue in a bra I still am a C or D. I need suggestions for the best way to proceed. I am done having children and breast fed them for 5 total years

Doctor Answers 9

Breast Lift/Augmentation After Major Weight Loss?

Congratulations on the significant weight loss. You will be much healthier in the long run, unfortunately most women who do lose that much weight often feel very deflated and saggy afterwords. You still have some breast tissue but it is lost in all the extra skin. Given the degree of sagging, a breast lift is needed to restore your breast shape and elevate the nipple and breast tissue. Patients who have had a major weight loss will typically need a traditional or anchor type breast lift to successfully address the large amount of skin excess. These patients also often want to have larger implants. Attempting to complete a major breast lift and place a large implant at the same operation has a significantly elevated risk of complications and revision surgery, so completing the process in two stages will allow for more predictable and consistent results. You should look for a surgeon with demonstrated experience in breast surgery for the major weight loss patient.

Kirkland Plastic Surgeon
4.8 out of 5 stars 52 reviews

Breast lift with augmentation

Congratulations on your weight loss, that is a big accomplishment! After reviewing your pictures, I would recommend a breast lift with implants to rejuvenate the appearance of your breasts. I have performed this combination of procedures on many woman with breasts like yours and the results are phenomenal! I have provided a link below to my photo gallery of breast lifts with augmentation. 

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

Breast lift/augmentation after significant weight loss

I think the combination breast augmentation with a breast lift is the way to go for your present condition. I might suggest using silicone implants as due to you lack of breast tissue, they will reduce the chances of having ripples at the edge of your breast implant being seen or felt

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Breast lift/augmentation after significant weight loss

Thank you for the question and photos. You would benefit from a breast lift and augmentation. Often these are done at the same time, in your case, I would stage the operation. I would proceed with a breast lift first, followed by an augmentation 4-6 months later. Although this involves two operations (both done under intravenous sedation and not general anesthesia), the surgeon has more control about the outcome as if it would've been done together. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

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

Breast lift/augmentation after significant weight loss

Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue, have a great day!!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 396 reviews

Breast Lift


Without any argument or discourse, a breast lift is in order. Regardless of where you think your nipples are pointing, they are far below your inframammary fold and need to be above the fold, ideally about an inch. Your skin is extremely thin and inelastic, so removal of as much skin as possible would be ideal; this can be accomplished best with some volume reduction of your breast tissue. 

However, no matter how aggressive the lift, you will still have an upper pole deficit that is best rectified with the use of an implant. This is a complex and difficult surgery to perform well consistently, with a low rate of complications in the hands of the casual plastic surgeon.  Please visit a few ABPS certified/ASAPS member surgeons that specialize in cosmetic breast surgery.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

There are many options for you to consider

in how best to accomplish your goals.  If you really want a lot of fullness on top, consider having a reduction/augmentation.  If not so important, then a standard auto-augmentation mastopexy may be good enough.  Best to see your surgeon and find out what options you are offered and if you cannot make up your mind, post your options here and see what the gallery votes as best and the arguments given behind their position.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast lift/augmentation after significant weight loss

Thank you for your question.  Congratulations on your weight loss!  Based on your photos, it appears that you would benefit from an anchor shaped breast lift (mastopexy), which can raise your breasts and nipple positions, tighten your breasts making them perkier and rounder, adjust areola size and improve symmetry.  Implants can be placed at the same time or at a later stage in order to provide more volume and upper pole fullness.  An exam and thorough evaluation would determine your treatment plan.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

Breast lift/augmentation after significant weight loss

Thank you for the question and pictures. Congratulations on your weight loss!
Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery.  
You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.
Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.

To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. The attached link may also be helpful. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 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.