Highlights
- New weight loss medications like Ozempic and Wegovy are causing dramatic weight loss similar to surgical outcomes.
- An increasing number of patients seek plastic surgery after massive weight loss, especially for the breast and abdominal areas.
- Significant breast volume loss occurs post-weight loss, resulting in loose, saggy breasts with excessive skin.
- Combination breast lift and augmentation procedures are often necessary to restore breast shape and volume.
- Internal support systems (meshes or internal bras) are used to prolong breast lift results despite poor skin elasticity.
- Techniques for massive weight loss patients build on but are more advanced than post-pregnancy breast surgeries.
- Demand for such plastic surgeries is rising as weight loss medications become more widely used.
Dr. Scott Newman, a board-certified plastic surgeon practicing in Manhattan, Long Island, and Westchester, discusses the increasing number of patients seeking plastic surgery after significant weight loss, particularly due to new weight loss medications like Ozempic (semaglutide) and Wegovy. These medications have enabled patients to lose dramatic amounts of weight—sometimes 50 to 100 pounds or more—comparable to what was previously achievable only through weight loss surgery. Dr. Newman highlights that these large weight losses result in unique challenges, especially regarding changes to breast tissue and skin that differ significantly from changes seen after pregnancy.
He explains that after such substantial weight loss, patients often experience a considerable loss of breast volume, as their breasts contained a large amount of fat that is now reduced. Despite the volume loss, the skin does not contract proportionally, resulting in loose, sagging breasts with excessive skin and stretch marks. This leads to a flat upper chest area, which is often a cosmetic concern for patients who want to regain a youthful, fuller breast shape and cleavage.
To address these issues, Dr. Newman performs combination procedures involving breast lifts (mastopexy) to reposition breast tissue and implants or fat grafting to restore lost volume. In many cases, he also removes some breast tissue to accommodate larger implants, which are supported by the patient’s muscle structure. To enhance and prolong the lift results, Dr. Newman frequently uses internal support systems, such as internal bras or meshes, which provide additional structural support beneath the breast tissue, helping maintain the breast’s new shape despite poor skin elasticity.
He notes that this evolving approach to breast surgery for massive weight loss patients draws from techniques used in post-pregnancy breast surgery but is adapted to address the more dramatic skin laxity and volume loss seen in these patients. The ultimate goal is to create a higher, fuller breast contour that lasts, even when the skin quality is compromised. Dr. Newman underscores that these procedures are now common in his practice, reflecting the growing demand as weight loss medications become more widespread.
Key Insights
- Impact of Weight Loss Medications on Plastic Surgery Demand: The advent of potent weight loss drugs like Ozempic and Wegovy has created a new patient demographic experiencing rapid and substantial weight reduction. This shift means plastic surgeons are now frequently addressing body contouring issues previously more common only among bariatric surgery patients, increasing the volume and complexity of post-weight loss procedures. This trend suggests a need for plastic surgeons to adapt their techniques and patient counseling to this emerging group.
- Breast Volume Loss vs. Skin Excess – A Challenging Combination: Unlike typical weight loss or post-pregnancy breast changes, massive weight loss patients often retain a significant amount of stretched skin but lose the fatty volume underneath. This creates a unique reconstructive challenge because the skin, which provides some natural support, has poor elasticity and cannot adequately contract to the new volume. Surgeons must balance removing or tightening excess skin while restoring volume, often requiring implants or fat grafting.
- Necessity for Combination Procedures: Dr. Newman emphasizes that breast lift alone is insufficient for many massive weight loss patients. The loss of volume necessitates implants or fat transfer combined with lifting techniques to achieve a natural, youthful breast shape. This dual approach addresses both tissue repositioning and volume replacement, ensuring better aesthetic outcomes than either procedure alone.
- Role of Internal Support Systems in Longevity of Results: The use of internal bras or meshes represents an important advancement in breast surgery for this patient population. These devices provide structural support from beneath the breast tissue, helping to maintain breast position and shape over time, especially when skin quality is compromised. This innovation reflects a broader trend in plastic surgery towards using biomaterials to enhance surgical durability.
- Evolution of Surgical Techniques for Post-Weight Loss Patients: While the surgical principles stem from post-pregnancy breast surgery, the severity and nature of changes in massive weight loss patients require modifications and enhancements to traditional techniques. This includes more aggressive skin removal, larger implants, and internal support, illustrating how plastic surgery evolves in response to changing patient needs.
- Increasing Prevalence of Massive Weight Loss Patients in Plastic Surgery: With more people achieving large-scale weight loss through medications rather than surgery, plastic surgeons will increasingly encounter patients with similar reconstructive needs. This trend underscores the importance of plastic surgeons being knowledgeable about these medications’ effects and tailoring surgical plans accordingly.
- Patient-Centered Outcomes Focused on Natural Look and Longevity: Dr. Newman highlights the goal of achieving a natural breast contour with fullness at the upper breast and lasting results despite poor skin elasticity. This patient-centered approach prioritizes not only aesthetic appearance but also the durability of surgical outcomes, which is critical given the challenges posed by the patient’s skin and tissue quality.
This comprehensive understanding of the interplay between massive weight loss, breast anatomy changes, and surgical solutions provides valuable insights for both patients and practitioners navigating this evolving landscape of plastic surgery.