Body lift with a Brazilian butt lift?

Good day! Thank you for your questions regarding staged reconstructive plastic surgery after massive weight loss. I would also suggest staging your surgery into three separate surgeries.
Your first surgery should be a 360 circumferential lower body lift. Your body will take about 6 to 7 hours to perform and will take approximately two weeks to recover. I would suggest you have a modified 360 circumferential lower body lift.  The modified 360 circumferential lower body lift would include a posterior upper buttock "turn-down flap".  During the posterior upper buttock "turn-down flap", the upper buttock is de-epithelialized--that means the top layer of the skin is removed. The deep dermal layer and the remaining upper body fat is "turned down" or flipped into the buttock like a paddle.  Usually, this upper buttock flap of buttock skin and fat is just thrown away with the 360 circumferential lower body lift specimen.  If you are considering this upper buttock "turn-down flap" procedure, please find a plastic surgeon with significant experience in this technique. For some plastic surgeons, this is not an easy procedure to perform.  Also, the posterior upper buttock "turn-down flap" has a small percentage chance of opening the incision.  
One month later you can have your second procedure. Your second procedure would be thigh liposuction and a spiral medial thigh lift.  During the thigh liposuction, thigh fat is aspirated (removed) from the legs. The fat that is withdrawn from the thighs can then be injected into the buttocks. The spiral medial thigh lift would take approximately 4 hours to complete. For your spiral medial thigh lift, the incision would go from the groin to the knee. The fat transfer to the buttock or Brazilian Butt Lift (BBL) would take approximately 1 to 2 hours to complete. Give yourself two weeks to recover and a month before proceeding with your next surgery.
One month after your spiral medial thigh lift, you can have your third and final procedure.  Your upper body lift would involve an arm lift (brachioplasty) and a breast reduction (mastopexy). The arm lift (brachioplasty) and a breast reduction would take approximately 6 to 7 hours to complete.  It will take you and approximately two weeks to recover from an arm lift and a breast reduction.
Thank you for your question regarding staged reconstructive plastic surgery after massive weight loss and combing autologous fat transfer to the buttock (Brazilian Butt Lift) with a 360 lower circumferential body lift. If you have any more questions regarding the 360 circumferential lower body lift, spiral medial thigh lift, thigh liposuction, and breast lift, please call my office.

You address a great concern here and that is in order to achieve the best results after massive weight loss, you may need several procedures to attain that goal.  In order to maintain volume in the buttocks, fat grafting and/or implants are great.  Having said that, I would need to evaluate you in person to give you the most detailed plan.
Good luck and thank you for your question!
Dr. Schreiber, Baltimore plastic surgeon

Thanks for your question, Grimmilk, and congratulations on your weight loss.  It is certainly true that many weight loss patients in addition to having loose skin have lack of definition and projection of the buttock.  Postural changes with weight gain often lead to a little tilt of the pelvis forward, giving the appearance of a flat bottom, and then buttock volume often goes away with weight loss.  Many body lift patients don't have sufficient adipose tissue to perform a BBL, but you should know that during a body lift there are ways to perform buttock auto augmentation.  That is, the skin and soft tissue of the lower back, upper buttocks, and hips, normally discarded during a body lift, can be developed as flaps and then turned to augment buttock volume and projection.  Fat grafting in the setting of a body lift may be more problematic for a variety of reasons, as incisions above the buttock and normal post op anemia could affect the blood supply to the tissue and may influence fat graft take.  I would encourage you to seek a plastic surgeon with an interest in and considerable experience performing bariatric body contouring.