Q: Dr. Eppley, I am 34 years old and am 5’ 6” tall and 165 lbs. To my own credit I have lost 54 lbs over the past year with diet and exercise; It has been tough but I have done it and I am determined to lose even more. But I appear to have hit a point now that the weight is not budging. My problem is that I now have an apron of skin and fat that hangs over that has started causing a lot of discomfort during any form of exercise. I am doing all I can from a diet and exercise standpoint. Should I go ahead with tummy tuck surgery now or wait until I lose more weight?
A: Now that you have hit the proverbial wall and have an overhanging apron (pannus), I think you would benefit by a tummy tuck right now. The psychological benefits would be enormous and would empower you to lose the additional weight afterwards. I have seen this effect many times in patients who look just like you and have the identical story. Tummy tuck surgery itself will casue some additional weight loss by what is removed, which is usually in the range of 3 to 7 lbs. (everyone thinks the apron weighs a lot more than it actually does) But an identical if not more weight loss occurs from the recovery process. (burning calories to heal) This is why many tummy tuck patients like you will be down in weight 15 to 20 lbs by 6 to 8 weeks after surgery. That provides a good surge towards your eventual weight loss goal.
Dr. Barry Eppley
Q: I am a 31yr old mother of two kids. I got out of a five year relationship where I got too comfortable and gained a lot of weight. About six months ago I started working out and lost over 30lbs along with a strict diet. I still have about 25lbs to go to reach my goal weight but I know that dieting alone will not give me the final results I want. I am interested in a tummy tuck, a monsplasty, and breast augmentation. I was born with one breast about 1 cup size bigger. I would like them to be equal in size along with a lift. Can all of these procedures be done in a single operation?
A: Congratulations on the results you have obtained so far. It is always surprising what effort and discipline can do for one’s weight. You should be proud that you have gotten this far. In pursuit of your goal weight, think of the plastic surgery as an incentive to get there.
The first step in body contouring is weight loss but this alone is often not enough to get the shape that one wants. There is no better combination than a combined breast and abdominal procedure to change a woman’s appearance between the shoulders and the waistline. In a few hours of surgery, some dramatic changes can be obtained. Putting these two operations together is very common and I have done it many times in my Indianapolis plastic surgery practice. Breast enhancement and tummy tucks together can still be done as an outpatient procedure.
Many larger tummy tucks require reduction of a large mons at the same time. It is done as part of the tummy tuck by modifying the location and orientation of the lower incision. Complete mons reduction may still require a secondary liposuction procedure for optimal flattening. Breast enhancement in most significant weight loss patients requires a combined lift with an implant, known as an augmentation mastopexy.
Dr. Barry Eppley
Q: I am interested in breast implants. After I lost all my weight (was originally 198 lbs), I have a muscular body but I have NO BREASTS!!! When I was heavy, my cup size was 40D. Now I wear 32B and you can see my ribs all the way down to my stomach. I workout every other day to stay in shape.
A: One of the few negative side effects of weight loss, like pregnancy, is the loss of breast tissue and volume. The more weight that is lost, the more breast volume that disappears. This is particularly seen after bariatric surgery where the weight loss may be 100 lbs or more. Many such women end up with no breast tissue at all and just two hanging empty skin envelopes.
Breast implants will definitely provide a return of volume but the key question is how much loose skin remains. If the amount of loose skin is only moderate and the nipple position remains at or above the lower breast fold, then an implant alone will be adequate. If, however, the amount of loose and hanging skin is more significant and the nipple is below the lower breast fold or pointing downward, then a breast lift may be needed as well as a breast implant.
Breast augmentation in some weight loss patients presents challenges to the plastic surgeon than one does not usually have in the typical small-breasted female. How much loose skin exists, and the key issue of current nipple position, can turn what appears to be a simple breast implant procedure into a more complex breast implant and lift procedure.
Dr. Barry Eppley