How would you place a TT, BBL, breast reduction, and arm lift?

I have lost a lot of weight over time from 245 to 173. I am 5'4 which means my BMI is slightly under 30. I have large breasts, a protroudong stomach with extra skin, large arms (with stretch marks), and a relatively flat butt. If I'm looking to get a tummy tuck, bbl, breast lreduction, and arm lift, how should I stage the surgeries? I have fat in my back that could be used for the bbl.

Doctor Answers 11

Body restoration operation sequencing after weight loss

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Congratulations on your sustained weight loss.  This is a tremendous gift that you have given yourself.  The unfortunate byproduct of a large weight loss is the excess skin, stretch marks and often dissatisfaction with one's physical appearance.  Body contouring after weight loss has been shown to increase the probability that one will maintain that achievement.  Although it is attractive to perform as much as possible in one procedure, risk increases with the combinations and length of surgery.  Staging this amount of body renovation into two to three well planned procedures will give you increased safety with optimal aesthetic outcome.  Common combinations include Abdominoplasty or circumferential torsoplasty with regional liposuction, followed by breast-arms-further liposuction with fat transfer during a second procedure. Staging also allows your surgeon to make fine adjustments to the previous procedure due to anticipated relaxation of the skin.  Most importantly, seek the opinion and expertise of a board certified plastic surgeon with significant experience dealing with body contouring after significant weight loss.  After a thorough evaluation, a thoughtful and safe plan that achieves your goals can be determined.

Find the right surgeon

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Far more important than deciding if a tummy tuck or a mommy makeover is for you is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let him explain why one technique may be better than another and if you need a tummy tuck. Many board certified plastic surgeons provide a free first time consult and you should take advantage of that!
See the below link on some suggestions on finding the most qualified Plastic Surgeon for you!

Multiple cosmetic surgery procedures

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Dear Washingtonian,   Front and side view pictures would have been very helpful and congrats on your weight loss with your sheer personal  determination. However, you still have ways to go in order to reach a healthy BMI of 25 or less.   Cosmetic surgery is purely elective and you do it because you want it as oppose to having to do it,  like appendicitis,  gall bladder disease etc.  As such, complication rate should be reduced to a minimum. Combination surgery increases the complication rate, especially tummy tuck and liposuction. According to a recent article in the plastic surgeon journal based on data from insurance company that insures only cosmetic surgery cases, the combined procedures of tummy tuck and liposuction increases severe complications X 10 !  Other procedure combined with tummy tuck increase complications X 2-3 .   If you were my patient, I would have recommended to you to start with tummy tuck , since this procedure is a core procedure which will change your body significantly due to weight loss . That will occur due to the abdominal  muscles tightening that will reduce the amount of food that you can eat and your sense of hunger. 6-8 weeks after the tummy tuck surgery you and your surgeon can reassess your  situation. For example , you might need only breasts lift as oppose to breasts reduction, which has less  complications and cost less.   Finally, important issue. BBL is a total waste of your time and money, because the fat disappears completely or almost completely  after few months or even sooner. I have seen it on many patients who came to my surgery center for butt implants surgery, after their big disappointments from the fat injection to the butt procedure. Think about it this way. If fat injection was consistent and reliable, most women would have preferred it for breasts augmentation over breasts implants. The reality is that breasts augmentation with implants is the number 1 cosmetic surgery in the US... Fat injection to the butt does not work and your best option is butt implants, which do not disappear and when done correctly in expert hands, create a very attractive and natural looking butt.    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive. Also, check the reviews on 'RealSelf' for reviews and positive experience reports.                                     Best of luck,                                                          Dr Widder

Multiple procedures, some advices:

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Thank you very much for sharing your concerns with us. For safety reasons, to be a good candidate for the procedures you want at the same time, your labs and cardiovascular preoperative evaluation must be optimal.
Therefore, you must be a healthy person, within an appropriate BMI and no history of diseases that increase the surgical / anesthetic risk degree.
Finally, I recommend you a skilled certified plastic surgeon in body contouring surgery and experienced in cases like yours where the planned operating time is less than five hours. Respectfully,
Dr. Emmanuel Mallol Cotes.- 

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 370 reviews

Multiple procedures

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Hello and thank you for your question. Congratulations on your weight loss.  You are smart to focus on safety here and dividing four procedures into two stages is a good idea.  There are several combinations of ways to stage this.  One way which makes sense is to do liposuction of the arms, abdomen, flanks, back and a bbl as the first stage.  Then do a tummy tuck, breast reduction, and arm lift 3 months later.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

How would you place a TT, BBL, breast reduction, and arm lift?

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Congratulations on your significant weight loss; you should be very proud of this accomplishment!Generally speaking, combination surgical procedures are done routinely.  However, you are wise in being concerned about the safety of combination surgery; risks/possible complications do increase with increased length of surgery…  

 It is best to evaluate each patient's suitability for combination surgery on an individualized basis. During this consultation process, after a complete history and physical, the SAFETY  of combining these surgical procedures becomes of paramount importance.  Plastic surgeon, anesthesia provider, duration of surgery, surgery facility all important  considerations. Exactly how the procedures are staged can vary depending on many factors including patient and surgeon preferences. 
Your best bet: choose your plastic surgeon very carefully; everything else including  good judgment/advice/planning, anesthesia provider and safe surgery facility will follow.  You may find the attached link, dedicated to patients who have experienced significant weight loss, helpful to you as you consider options. Best wishes.

The perfect sequence

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To be honest there is no perfect sequence, it will depend a lot on the area you would like to improve the most.I love to start with the Lower Body Lift which is a Circumferential Tummy Tuck and a Real Buttocks lift, because the BBL will NOT lift the butt and I normally combine with some lipo and some fat transference to the buttocks. I like to start with these procedures because, the muscle Repair I do, help all of my patients to lose some more wight, and because of the combination of procedures, you will be looking and feeling  awesome because your body in general will change dramatically and THAT will give you a lot of strength and faith to continue. You may continue with the upper body: breast and then arms.Be encouraged.Dr. Cardenas

How would you place a TT, BBL, breast reduction, and arm lift?

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Congrats on your weight loss!   Staging procedures can be done in many different combinations depending on what you want done.  In your case, I would recommend doing your liposuction and BBL first to allow for the most fat available for the butt enhancement.  After 3-6 months, you could have your breast reduction and TT done along with possibly your arm lift.  I have combined those 3 procedures in the past but it would depend on your exam and medical history.  With any elective procedures, safety should always come first.  Make sure you have an in person examination with a board certified plastic surgeon.

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 78 reviews

The number one concern with multiple procedures should be safety

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Your situation is a very common one, and it is one of the reasons why I love to do body contouring after large weight loss.  You have done the hard work to bring your weight into a healthy range, and now I get to be the "finish carpenter," and make everything look and feel better and help you complete the transformation!  The one caveat though, and it's a big one, is that we have to be mindful of safety.  It has been well documented that the number of procedures done at one time and the length of time someone is under general anesthesia is directly related to the rate of complications after these procedures.  Some of these complication rates are even higher in our bariatric patients who have lost massive amounts of weight, just by virtue of the effects of morbid obesity on the body itself.  Things like blood clots in the veins, with potential to break off and embolize, or travel to the lungs is an uncommon, but very devastating complication, and it must be taken into consideration.  This is a big reason why I sit down with my bariatric body contouring patients individually and hash out their specific goals and what procedures it will take to achieve them.  It is very typical to be contemplating multiple procedures in these patients, so it then becomes an issue of planning and staging things properly such that we first give due consideration to patient safety, and then properly plan things to get the best outcomes.  For instance, we wouldn't want to do two procedures that may "compete" with each other or affect the chances of success of each other.  An example of this is while a patient may require both a lower body lift and a thigh lift, I personally would not perform them both at the same time, as they both place “competing” tension across the pubic and groin tissues, and this may affect things like ultimate scar location, shape or position of key structures like the pubic area or genitals, and wound healing.  I would do one first, probably the body lift, and then the other after things had healed in that area.  Another consideration when adding in fat transfer, such as with a BBL, is how you will be positioned during the procedure.  While it is possible to do procedures requiring supine and prone positions both during the same anesthetic, such as tummy tuck and BBL, proper sequencing of the different parts of the operation, positioning, and padding during surgery must be taken into consideration.  For instance, breast surgery and arm surgery fit very well together as they are two different body parts that can be easily accessed in the same supine position.  However, it would likely decrease the survival of transferred fat cells, and hence the overall success of a BBL to do that first and then lay you on your buttocks in the supine position with hours of pressure on the buttocks and transferred fat grafts needed to complete a tummy tuck at the same time.  These things must be considered, and operations that make sense together can be planned together, while operations that don’t fit together, for whatever reason, should be staged.  One final consideration that must be made is that, while some of you may find this hard to believe, I know, we surgeons are human.  Like all of us, fatigue can be a factor, especially on very long and involved cases.  We are never at our best 6 or 7 hours into a big long procedure like an aesthetic body contouring case, as we are in the first few hours of the case.  I was a college athlete and lifelong fitness fanatic, and I have as much stamina as the next guy, but if I'm being honest with you, I am tired by hour 6 or 7, and I think I would do my best work coming back another day for stage 2 rather than squeezing in another procedure and extending the length of the case.  Bringing in assistants to help speed things along may help to some degree, but there may also be some quality control issues with that, as there may be some differences in how things are done between the two surgeons.  Some of the key considerations people generally have when they are planning their surgery are cost and financial concerns and logistics, like downtime, return to work or household duties, and such.  Oftentimes, it is these things that win out and force people to consider a more ambitious plan.  This can affect both safety and risk as well as overall quality of the outcome.  It then becomes an issue for each patient and surgeon to prioritize all of these considerations to come up with a plan that works the best for the patient first, and then the surgeon given his or her abilities and requirements to do the best job of meeting the patient’s goals possible.  This is why your selection of surgeon is of paramount importance, and you should always consult with only board certified plastic surgeons with extensive experience in bariatric body contouring surgery.  They will be most well equipped to offer you the best options and safely help you meet your goals.    In addition to being certified by the American Board of Plastic Surgery, the only generally recognized organization which certifies true plastic surgeons and has the term “Plastic Surgery” in its title, your surgeon should also participate in the Maintenance of Certification program administered by that board. This program requires that surgeons who participate continue to update their credentials and professional standing regularly, as opposed to practicing on a single lifetime certificate like those plastic surgeons who elect not to participate. To find further information about this program and any surgeons you might consider for your surgery, I suggest visiting these sites: and Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Combined Procedures

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Additional procedures that may enhance the result are Liposuction, Breast Procedures, or Thigh Lift. Mommy makeovers usually include multiple operations.  Brazilian “butt enhancement” can be done at the same time to provide best body contours. Arm reduction or brachiaplasty is also common. If you choose to get a mommy makeover you would likely be able to get all three procedures combined at one time. The mommy makeover is a combination of procedures to bring a woman’s body back to the way she looked prior to pregnancy. Most commonly some variation of a #TummyTuck and #BeastSurgery are performed. Additional procedures can include liposuction, umbilical hernia repair.  The most common #breastprocedures include #mastopexy or #breastlift, #breastaugmentation, or #breastreduction. Your best option would be to seek out a local board certified plastic surgeon and schedule a consultation to discuss all of the results you are looking for, and find out if all procedures will be possible at once.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 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.