After massive weight loss, breasts have poor shape, projection, and skin elasticity. The nipples are distorted and ptotic. Mastopexy is difficult and historically includes the use of excess nearby tissues. The senior author reviews his experience with 24 patients over the past 4 years. Body contouring is offered after the weight loss is stable. Breasts may be reshaped by mastopexy and/or augmentation; three examples are presented. More often the breasts are reshaped during an upper body lift. This lift is a reverse abdominoplasty that ends along the inframammary fold scar of the Wise-pattern mastopexy and extends laterally along the back roll. When the breasts need enlargement, nearby discard tissue is used for augmentation. The spiral flap has been devised for that purpose. When more tissue is needed, silicone implants are used. The long inframammary scar of the McKissock vertical bipedicle mastopexy forms the junction between the breast and reverse abdominoplasty. Proper inframammary fold construction is pivotal to the upper body lift. We have successfully combine breast reshaping with upper body lift for this difficult deformity after massive weight loss and present two demonstrative examples. Breast reshaping is best performed during an upper body lift.
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