Alan H. Gold, M.D., FACS
I am curious about techniques for tummy tucks. I had gastric bypass and went from 257 pounds to 135 pounds. My stomach is minimally saggy but the majority of the excess skin and fat is located directly above my belly button. My stomach muscles are in great shape. What types of tummy tucks would I be a good candidate for? I would prefer something less invasive than a traditional tummy tuck. What are my options?
First, congratulations on your commitment and success in achieving your weight loss goal. A consultation and physical examination to permit evaluation of your muscle tone and integrity and skin tone, as well as the degree and location of skin and soft tissue excess, are really necessary to make a definitive recommendation. However, I can offer some general advice. Before any consideration of abdominoplasty or any other body contouring surgery, you should be at or very close to your desired weight, and stable at that level. While there are a number of abdominoplasty techniques that permit us to address the varied needs of individual patients, it may be that a “more limited” approach might not be the best option for you. The most desirable location for the abdominoplasty scar is ordinarily, at least in part, along the lower abdominal crease just above the pubic hairline. The direction and extent of the scar as it extends laterally can be varied according to the desires and physical characteristics of the patient, as well as according to the amount and location of the redundant abdominal skin. With a skin excess predominantly above your umbilicus (belly button) as you describe, it is likely that your abdominal skin would need to be mobilized over your lower ribs and to the bottom of your breast bone. That means a full and complete elevation of your abdominal skin - not a "limited" or "more minimal" approach. It is also quite possible that after such a major weight loss, even with your good muscle tone, your abdominal muscles may have been separated from each other in the midline or a horizontal spreading of the muscles may have occurred as well. In that case, further abdominal recontouring and support can be achieved with a surgical tightening of those muscles. Although it may be possible to limit the extent of your lower abdominal scar because of the location of the skin excess you describe, it may also be necessary to extend that scar more laterally to permit the best improvement of any significant upper abdominal horizontal skin laxity. While the conservative view that "less is more" may often be appropriate, it may not be able to provide the optimal result for you. An ASAPS-member plastic surgeon possesses the training and skills necessary to determine the best approach to help you achieve your goals, and I recommend that you find one of our members in your area and schedule a consultation.
I had a breast reduction two years ago. I’ve recently lost 100 pounds and I am now considering getting implants because I am down to a breast size of 34. Is it possible to have this done after having a reduction?
Yes, it is certainly possible to have a breast augmentation after having had a breast reduction; and your case is not unique. I sometimes see patients such as you who have either had breast reduction at a younger age and naturally lose breast size through the years, or have lost breast size following pregnancy or significant weight loss. Some additional factors must be considered, though. The quality and elasticity of your breast skin and the possible need for tightening the breast skin at the time of augmentation must be evaluated even though it will be "filled" to some degree with the implant. Even if the skin is tightened, however, it may not be ideally supportive, and the size and weight of the implant may accelerate the natural stretching and sagging of the breasts over time. And finally, you should be as close to your goal weight as possible before the surgery to both minimize the potential future additional loss of some of your own natural breast size and to permit the most appropriate implant size to be selected.
I have stretch marks on my breasts due to pregnancy and breastfeeding. I am interested in having breast augmentation because I am very small chested, about a 34A/AA. Is there any way to get rid of the stretch marks on my breasts – will the implants help to make the stretch marks fade or will they make them look worse?
Stretch marks are actually scars within the skin....the result of broken elastic fibers. There is no treatment available to remove those stretch marks without removing the skin itself. Stretch marks which are initially red will usually fade and whiten with time, and become progressively less noticeable. Sometimes the appearance of persistently erythematous (red) stretch marks can be improved with lasers used to lighten them, and there are other "light-based" treatments that claim to improve (but never remove) obvious stretch marks.
Breast implants, by re-stretching the skin, will usually make stretch marks appear far less obvious....not worse. But one word of caution - stretch marks indicate a loss of skin elasticity and support. Too large an implant may place too great a stress on that already damaged skin, and may accelerate skin thinning and breast sagging, so it's important to carefully discuss with your board certified plastic surgeon what implant and procedure would be best for you.