As a Plastic Surgeon we frequently see people who have lost a lot of weight and are left with redundant folds of skin in various areas of their bodies such as arms, tummy, legs and not to mention breasts. One of the challenges in this particular patient group that differentiates them is that their skin has been overly stretched when they were at their heaviest and has lost its elastic properties – it has thinned out and its supportive abilities as well as wound healing abilities are compromised.
This situation is combined with the fact that they have lost volume and have “deflated” and have a significant amount of excess skin. Therefore, we have to tread a fine line of compromise between wanting to tighten and lift the breasts, although not too much as this may impair wound healing whilst at the same time being careful not to enlarge the breast with too large an implant (if an implant is warranted) as the weight of an implant will be sitting within the existing skin that was stretched and doesn’t have the support mechanisms that it otherwise would have done.
From my point of view, I would therefore aim to avoid using an implant and perform a breast lift alone whenever there is enough volume to do so, as avoiding an implant avoids the introduction of further potentially complicating factors. A breast lift in someone who has lost a lot of weight requires different surgical techniques that necessitate significant anchoring and supporting of the breasts on the chest wall to try and minimise the recurrence of drooping that will inevitably occur to a degree.
In situations when an implant is needed, the breast also has to be secured firmly to the chest wall as there is a higher than normal risk of the implant migrating inferiorly into the wrong position which would require further surgical revision to place it back where it ought to be.
As a result of these limitations and necessary compromises, it is not uncommon for there to be a degree of disappointment during the initial consultation when the importance of this compromise is discussed, as many people might see the opportunity to undergo plastic surgery as one that may give them a breast that they wish for…but in reality might not be possible to achieve.
Therefore, as Plastic Surgeons we need to be honest and open about the breasts our individual patient has as well as explain the background of why we are making particular recommendations for them as an individual. We need to back this up by showing them examples of other patients who have undergone similar procedures from similar starting points to show what is realistically achievable.
At the end of the day, we would always rather under-promise and over-deliver to ensure we have happy patients, rather than allow our patient’s expectations to exceed what is realistically achievable.