Breast lift and panniculectomy - smaller breasts, excess skin and mons lift. Would this also lift my thighs? (Photos)

Question

I had gastric bypass 10 years ago and lost about 170 pounds, which I have maintained. I constantly have to wear compression garments to keep the excess skin contained, but I continue to struggle with rashes and chafing. I would like recommendations regarding a breast lift and panniculectomy. I want to be smaller in my breasts and have the extra skin removed. I also have excess skin on my lower abdomen and my mons area sits lower than I would like. Would this surgery also provide any lift to my thighs?

David Mateo de Acosta Andino, MD · Answer

For the abdomen, I would recommend an abdominoplasty (tummy tuck) rather than a panniculectomy alone. While a panniculectomy removes excess skin, it does not address underlying muscle separation (rectus diastasis), which is very common after both weight fluctuations and pregnancy. An abdominoplasty allows us to tighten the abdominal muscles, remove excess skin, and create a more contoured, functional result. During the same procedure, we can also elevate and improve the position of the mons pubis using the same incision, which directly addresses the concern you mentioned about that area sitting lower than desired. If you wanted to further enhance your outcome, I would recommend liposuction to the flanks and mons area to improve contour and overall balance.
In patients after massive weight loss, there is sometimes excess skin in the upper abdomen as well. In those cases, a fleur-de-lis abdominoplasty can be considered, which adds a vertical component to remove that additional laxity. However, many patients prefer to avoid the vertical scar. For that reason, I often combine a traditional tummy tuck with Renuvion skin tightening to help improve skin quality and laxity without requiring that vertical incision.
Regarding your thighs, a tummy tuck will not provide a meaningful lift to that area. While there can be a slight improvement in the upper inner thigh, it is typically not significant. A thigh lift would be the more appropriate and effective option. I generally do not recommend performing a thigh lift at the same time as a tummy tuck, as the proximity of the incisions can increase the risk of wound healing complications due to compromised blood supply.
For your breasts, if you are looking to be smaller and lifted, a mastopexy would be the best approach. Based on your photos, it looks like your degree of ptosis (sagging) may be mild, so a modest lift combined with volume reduction can achieve a more proportional, elevated result. This can often be safely combined with your abdominal surgery so that you go through a single recovery period.
Ultimately, the exact surgical plan would be tailored to your anatomy and goals after an in-person evaluation, but your main concerns are something we address together very frequently with excellent outcomes.

Daniel Barrett, MD · Answer

Dear Thoughtful842190,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. 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

Mario Arturo Moran Romero, MD · Answer

Congratulations on your weight loss and maintaining it, that’s a big achievement.In post-bariatric patients like yourself, it’s important to distinguish between procedures that are functional and those that are aesthetic and functional.A panniculectomy is very effective to address issues like rashes and chafing, but it typically provides a limited aesthetic result, since it focuses only on removing the excess lower abdominal skin.If your goal is to improve overall shape and contour, a lower body lift is usually a better option. This procedure addresses not only the abdomen, but also the flanks, lower back, mons area, and can provide some improvement in overall body balance.Regarding your breasts, based on pictures, this is a pseudoptosis rather than true ptosis because the nipple is still in a relatively good position, but there is excess skin and loss of volume.In these cases, I usually do not recommend a breast lift, as it can over-elevate the nipple. Instead, options such as: Breast augmentation (implant) Or staged fat grafting can help restore volume and improve shape more naturally with less scar.

Jeremy S. Nikfarjam, MD · Answer

What an achievement!

You could be a good candidate for a panniculectomy and you may also want to consider including diastasis repair (a traditional tummy tuck).  Our practice treats a lot of massive weight loss patients and are often successful in obtaining insurance coverage for that procedure.  For the breast, a lift would not be typically be eligible for insurance coverage but could be a good option to achieve your goals.

Good luck to you!

Leila Kasrai, MD, FRCSC · Answer

A panniculectomy only removes the tissue that hangs below your waist (pannus). Based on your photos, a tummy tuck may also be recommended to improve your lower abdomen. These procedures wouldn’t tighten the loose skin on your upper thighs. That would require an additional procedure called a thigh lift.

Sameer Karkhanis, MS, DNB · Answer

Hello! Congratulations for your weight loss journey. You have lot of excess skin with lipodystrophy. Hence, you an ideal patient for tummy tuck with 360 liposuction and mons lift. Its not possible to achieve thigh lift in tummy tuck, you will require another procedure for the  same. Either you can combine this with tummy tuck or the procedures can be staged. Just doing a breast lift would not give you the better fullness or cleavage. i would suggest a breast lift with breast implant for you. breast implants for smaller sizes are recommended to give more natural results.
We routinely do tummy tuck with breast lift & thigh lift at our Centre for Cosmetic Surgery, Mumbai, India.
Thank you,

Regards,
Dr Sameer Karkhanis,
Centre for Cosmetic Surgery, Mumbai, India

Zoran Potparic, MD · Answer

Based on these photos, you would need a lot of surgery; this includes breast augmentation with breast lift, abdominoplasty with mons pubis lift, and selective liposuction of the anterior abdomen and flanks. This can be done as a single procedure, or it can be devided in two separate procedures. In-person consultation with a board-certified plastic surgeon with a good reputation in body contouring surgery is recommended. Good luck.

Gary M. Horndeski, MD · Answer

You are an excellent candidate for 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. This will also lift the upper abdominal skin. You would also benefit from a tummy tuck. This will remove excess skin from the anterior abdominal wall and lift the pubic area. These can be done together or separately. You may also need a circumferential body lift later.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions and congrats on your weight loss! Rather than pursuing a panniculectomy, which only addresses the skin hanging over the waistline, you need to be deciding between a tummy tuck (which will address all the anterior skin from the waist to the belly button) or a body lift (which will address excess skin in the lateral hips and lower back as well). A panniculectomy is a medically necessary procedure which focuses on functional outcomes rather than cosmetic outcomes and would provide less skin removal and an inferior aesthetic outcome. Make sure to see a surgeon with adequate experience in massive weight loss patients. 
As for the breast, more photos would be required but you will probably need a breast lift (mastopexy) to achieve your goals.
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  From the submitted photos and description of your concerns the recommendation would be a tummy tuck.  This would address the excess fat and skin on the abdomen as well as correct abdominal wall laxity.  The mons can be addressed during this procedure as well.  Your legs would not really be impacted but if that is a concern for you you can explore other procedures such as a thigh lift.  You can discuss your desired look for your breasts and learn more about options during a consultation with a board certified plastic surgeon.  I've included a video that I hope you find helpful.

Breast lift and panniculectomy - smaller breasts, excess skin and mons lift. Would this also lift my thighs? (Photos)

Answers (11)

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