St. Louis Breast Surgery Specialist

After massive weight loss, many women are left with long, flat breasts that have no shape and can cause skin rashes beneath the breasts. Fatty tissue in the breasts is effectively reduced with weight loss, but obesity so severely stretches the skin that breast re-contouring is the only option for getting rid of this deformity common among women, no matter what their breast size used to be.

Several types of breast re-shaping procedures are available, but all of them involve removing the excess skin and basically re-arranging the breast tissue to create a more natural-looking breast mound. Because fatty tissue is a major component of the breasts, significant weight loss often means that volume needs to be added to fill out the skin “envelope.” Contouring the breasts after massive weight loss can be done in several ways:

  • Breast lift only;
  • Breast lift plus a tissue flap taken from a nearby area in the same surgery; and
  • Breast lift followed 3 to 6 months later by the addition of breast implants.

Breast Lift

The main procedure for re-contouring the breast after massive weight loss is a breast lift, or mastopexy, which usually takes about 2 hours, or 3 hours if additional breast volume is needed. In a mastopexy, the skin excess is removed through an incision made around the areola and extended vertically between the areola and the inframammary crease (the natural fold where the breast joins the chest wall). The incision around the areola allows the nipple and areola to be raised to a higher position.

The long, flattened breasts typical of women after massive weight loss almost always have nipples that point downward and are located at the lowest part of the breast. After excess skin is removed around the incisions, the skin and tissue that remain are re-draped to create a natural breast contour. If there is a large excess of skin, another incision that runs horizontally along the inframammary crease may be needed.

Adding Volume With Your Own Tissue

Although a mastopexy will eliminate the problem of long hanging breasts after massive weight loss, many women find they then have breasts that lack sufficient volume. A good option to increase breast volume is to take excess tissue from the armpit area or side of the chest wall and add it to the breast mound at the same time as a breast lift. The tissue used is typically discarded during body contouring of the upper body

Similar to gluteal augmentation, your own tissue from an area near the breast (called autologous tissue) is transferred as a flap and molded to augment the breast volume. A real advantage of this type of breast augmentation is that the upper body (where the excess tissue comes from) is simultaneously re-contoured along with the breasts. Instead of throwing away the tissue from the chest area, it can be safely and effectively used to add volume where you want it.

Adding Volume With Breast Implant

Breast volume lost with massive weight loss can also be added with implants. As with the use of autologous tissue, breast augmentation with implants requires a breast lift to shorten the breast length and move the nipple and areola to a more natural position. Because of safety concerns about wound healing, we prefer to add breast implants several months after a breast lift so another short surgery is usually required. Breast implants have risks of their own, and the thin and non-elastic breast skin left after massive weight loss is likely to increase these risks.

If you are interested in any of these options, your surgeon will explain them and help you decide which method is best for you.