Patients who lose a significant amount of weight often lose volume in their breasts. However, the skin envelope of the breasts may not shrink to the same degree as the breast tissue, leaving a deflated, saggy appearance. The breasts may appear flat on top with the nipple pointing down instead of straight out. Patients describe their breasts feeling “empty” or like a “bag of sand.”
The excess skin of the breasts after massive weight loss can be addressed with a mastopexy, or breast lift. In this operation, the excess skin is cut away, and the nipple is lifted to a more natural, youthful position. The breast tissue is then shaped, and the remaining skin is draped over the shaped breast and sutured back together. The goal of a mastopexy is to reposition the nipple, and add fullness and lift to the breast.
Some patients lose so much breast volume after massive weight loss that they require a breast augmentation with an implant in addition to a breast lift. The implant is often placed at the same time as the mastopexy; however, in certain instances, the operation needs to be staged to protect the skin.
The scars from a mastopexy vary depending on how much skin needs to be removed. For massive weight loss patients, a large amount of skin excision is usually required. The resultant scar is around the areola, straight down to the inframammary fold, and across the inframammary fold, like an upside-down T or an anchor.
Complications are rare, but may include bleeding, infection, difficulty with wound healing, asymmetry, skin loss, seroma (fluid collection requiring a drain), prolonged numbness, hypertrophic scarring, and need for revision.