Eric Mariotti M.D.

What to Expect for Your Tummy Tuck, Breasts, and Arm Lifts

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By: Eric Mariotti, M.D. (February 2017)

Dr. Eric Mariotti, a board-certified plastic surgeon serving Walnut Creek, CA, explains how tummy tuck, breast enhancement, and arm lift can be an important form of closure for patients who have already put in considerable work on their weight loss journeys. Dr. Mariotti originally drafted this article for ObesityHelp.com.

Your journey started quite some time ago, so how does it end? Seemingly forever ago, you were carrying a lot of excess weight. Perhaps you have lost 80lbs, 100lbs, or even more! Through bariatric surgery, or diet and exercise, you were able to lose most or all of the extra weight that you had been carrying around for so long.

Before the weight loss, all you could think about is losing the weight and becoming healthy. Now you have achieved that goal, but are surprised at what that much weight loss has left behind. No one might have talked to you about what your skin may look like after losing half your body weight, and now you are now considering plastic surgery to complete your journey. However, this time you want to go into this next chapter much more informed on what can be expected in the short-term and the long-term.

Restoring Your Body's Natural Figure With Plastic Surgery

For patients who have undergone dramatic weight loss, exercise and diet may not eliminate sagging skin and excess fat. For some, just losing the weight is enough, but for others, restoring the body's natural figure signifies the end of all the hard work. Doing so may entail the services of a plastic and reconstructive surgeon.

According to the American Society of Plastic Surgeons, the most common surgeries following such weight loss include tummy tucks, breast lifts, upper arm reduction, thigh lifts, and lower body lifts, in that order. You may wonder what it is like to have such a procedure, but the unknowns have held you back. Does it hurt? How long is the surgery? Will I have drains? How long is the recovery?

In today's digital age, it is easy for any patient to begin their research online. There are surgeon's websites, plastic surgery society websites, forums, blogs, and of course, online review sites such as Yelp and ObesityHelp.com. All of these can be utilized, but none take the place of a consultationconsultation with a board-certified plastic surgeon. Each plastic surgeon may have slightly different answers to these questions, but I hope to shed a little light on each of them.

What to Expect for Your Plastic Surgery Procedures

Tummy Tuck: This surgery can be performed at a hospital or a surgery center, and can be done in conjunction with an overnight stay at the facility or as an outpatient procedure, depending on the physician.

This is the most common surgery after massive weight loss (MWL), with over 21,000 performed in 2015.

The abdominal muscles are tightened, and the excess skin is removed. It is most commonly associated with one or two drains, which remove swelling fluid from under the skin. These drains remain until the fluid decreases to a point where it is safe to remove. Other surgeons, myself included, may use a no-drain technique, where multiple sutures are used to close the space under the skin, thereby not allowing fluid a chance to collect.

Many surgeons, like myself, choose to inject Novocain to reduce or eliminate the pain after the surgery. I tell my patients that a tummy tuck feels similar to a C-section for most women, although some will say it is easier, while some will say it is harder. Recovery depends on what activity a patient calls "recovered." I insist that patients walk around the house the next day, and tell them to anticipate being able to drive at 10 to 12 days, return to work in 2 to 3 weeks, light exercise at 3 weeks, moderate exercise at 6 weeks and 10 to 12 weeks before vigorous exercise is tolerated.

Breast Lift: As the second most common procedure after MWL, we see many women who feel as though their breasts have deflated and headed south. A breast lift is still one of my favorite surgeries. The surgery is straightforward, the results are amazing, and the complication rate is very low. This surgery is done as an outpatient procedure, and many of my patients say that it feels tight more than it hurts.

Again, this is a surgery where some surgeons use drains, while others don't. I find myself using them in about 1 out of every 10 patients depending on the specific case. If done alone, I tell my patients that the recovery to do most normal, easy activities is 12 to 14 days.

The main thing I try to get across to my patients with this surgery, along with others, is that the results continue to evolve over many weeks, and the final results may not be until several months have passed.

This surgery can be combined with implants, as well. I have done many implant and breast lift combinations, but I tell women that because of poor skin elasticity after MWL, the rate for revision is certainly higher if the weight of an implant is introduced.

Arm Lift: As the third most common surgery after MWL, I see a lot of women (or men) that try and try, but are unable to get rid of the excess skin on the arms after that much weight loss. This surgery, if done by itself, is usually a shorter surgery, perhaps 1.5 to 2 hours — and done on an outpatient basis, as well.

I tell my patients that it will feel quite tight, and there will perhaps be a little bit of stinging near the armpits. Most surgeons will either wrap the arms with gauze or fit the patient with a compression sleeve to minimize the swelling, and only a few surgeons use drains for this type of surgery.

Arm reduction surgery can easily be combined with other body contouring surgeries. I find that the procedures for breast lifts and arms reduction go together quite well. In many women who have lost such a significant amount of weight, I connect the arm incision to the breast incision, allowing me to remove the excess skin of the chest wall (sometimes referred to as the "bra fat").

The main thing is to first choose your surgeon based on experience, skill and trust.

These 3 surgeries, as well as many other plastic surgery cases, performed on patients who have lost a lot of weight all entail real surgery, with real recoveries.

It may seem easy to go to Google or RealSelf for advice or research on postoperative care or expectations. After you have carefully chosen your surgeon, though, it is important to maintain that trust and follow his or her instructions as prescribed and avoid looking for advice online or from someone other than your surgeon. Doing so will give the best chance of achieving the outcome you and your surgeon had in mind.

If you'd like to make an appointment with Dr. Mariotti, simply request a consultationrequest a consultation online or call our office at (925) 685-4533.

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