FAQ

The treatment of droopy breasts following massive weight loss is a breast lift. An implant is used if the patient also wants to be bigger. Though the procedures are technically the same, patients undergoing breast lifts and augmentations that have lost a lot of weight usually have greater amounts of skin excess. That means that the lifts need to have wider scars and need to be more aggressively done. Given how significant of a lift most of these people need, the lift and the implant are frequently split into two separate stages in order to be as aggressive, safe, and accurate as possible. The skin is often more damaged meaning that there will be some tendency for the breasts to stretch a bit after the lift. Notwithstanding those issues, weight loss patients who have had breast lifts with or without breast implants are some of the most thrilled patients in Dr. Teitelbaum’s pratice.

A tummy tuck is the gold standard treatment for laxity of the tummy. Extra skin can be removed and remaining skin tightened. Residual fat can be removed and recontoured. Some weight loss patients have hernias in their abdomens, and these can usually be repaired during tummy tuck. Others have developed a rectus diastasis – a separation of muscles in the middle of the abdomen – and that can be fixed as well with a tummy tuck. Patients who have lost a lot of weight differ from the typical tummy tuck patient in two ways. First is that the looseness extends farther out to the sides and even to the backs, thereby requiring longer scars. The second issue is that their skin is often more damaged. Depending upon the severity, some crepiness or stretch marks may remain and the skin may not stay as taught for as long. This is obviously disappointing news. After all that work at losing weight it seems only fair to be able to have a totally taught stomach after plastic surgery, a stomach that will stay taught for many years. While this can occur, it is important the inherent qualities of the skin obviously determine the final outcome.

A thigh/buttock lift is also known as a lower body lift. With weight loss there is often deflation and sagging of the buttock. There can be looseness on the outer thighs and the front of the thighs. The lower body lift has a tummy tuck component which is no different than a standard tummy tuck. But the incision then extends all the way around the back. The surgeon focuses attention on the buttocks and outer thighs and lifts them to a higher and better position, reducing the amount of looseness in those areas. The buttocks are often so deflated from weight loss that even the buttock lift does not make them perfect, but the improvement is significant. The thigh component works for the front of the thighs and the outer thighs. Most of the improvement a body lift gives to the thighs is in the upper third of the thighs, but the improvement can go quite a ways down toward the knees, but not all the way. The lower body lift does not help the skin of the inner thighs; for that an inner thigh lift is done. The most common approach involves an incision in the inner groin crease. This can tighten just the highest bit of loose tissue in the inner thighs. If the inner thighs are loose most of the way down toward the knees, then the only procedure is a thigh lift with a vertical scar that is the whole length of the thighs and placed along the inner thigh. While the scar is certainly dramatic, so too is the improvement. Like all plastic surgery patients having weight loss surgery, the critical issue each patient needs to answer for themselves is how much improvement justifies the scar.

There are no steadfast answers about how much is safe to be done at the same time. It depends upon the exact combination of procedures, the height, weight, and physical condition of the patient, how significant of a problem each is and the procedure it requires, and even the opinion of the surgeon. Some surgeons are more aggressive about combining large numbers of these problems, while others believe it is more prudent to separate them. Dr. Teitelbaum sometimes combines many procedures, but in general terms he more frequently favors splitting up procedures because he always makes safety his first priority, and believes that results are better when the entire operating room team is focused about delivering the maximal result on fewer areas at a time.