Losing a large amount of weight is an achievement, but it can be surprising how much the process can change your breasts. Deflation and descent are two of the most common concerns, both of which can be addressed with different types of cosmetic surgery.
Dr Ellis Choy is a Sydney Specialist Plastic Surgeon who helps his patients understand how their bodies have changed and what their surgical options are. He recommends different methods based on the condition of the breast tissue and the goals of the patient, among other factors.
How Major Weight Loss Changes Breast Tissue
Loss of Volume and Fat
The breasts are made up largely of fat, so weight loss affects them directly. Breasts may look smaller or emptier after weight loss, particularly in the upper pole. A narrative review from the Aesthetic Surgery Journal Open Forum noted loss of size and fullness in those who lost extensive weight, regardless of how they lost it.
Skin Elasticity and Collagen Changes
Skin has to stretch to accommodate weight gain, and after major weight loss, it does not always retract. Collagen and elastin fibres lose their tension, which reduces the skin’s ability to conform to the body’s slimmer shape. Loose skin no longer supports the weight of the breasts adequately, and the breasts may descend down the chest wall as a result. How much skin elasticity you retain or lose will depend on your age and how much weight you lose.
Changes in Nipple Position and Breast Shape
As volume drops and skin loosens, the whole breast may sit lower on the chest, and the nipple areola complex often moves down with it. After weight loss, the nipples may point downward rather than outward. The upper breast may also look flatter, with the volume now concentrated in the lower part of the breast.
Finding the Right Procedure for Your Underlying Concern
Breast Lift for Excess Skin
A breast lift, or a mastopexy, removes excess skin and lifts the breast higher on the chest. It also lifts the position of the nipple and areola to allow them to be more forward-facing. A lift can be used for patients who are happy with the size of their breasts but are troubled by loose skin and tissue descent. A breast lift does not increase the volume of the breasts.
Breast Implants for Lost Volume
A breast implant adds volume in areas that have lost fat due to weight loss, especially in the upper breast. Implants are available in different sizes and profiles, so there are many options for those who want to increase breast size. Breast augmentation surgery on its own does not address skin laxity and tissue descent, just volume.
Combined Lift and Implant for Skin and Volume
Many post-weight-loss patients want both skin removal and added volume. Breast lift and augmentation surgery can be performed for these patients. During your consultation, Dr Choy will discuss whether this approach might be right for you. He will evaluate factors such as:
- Visible Skin Laxity Without Volume: Loose skin hangs over the chest with little of your own tissue underneath to fill it out.
- Volume Loss Below the Nipple Line: The lower breast looks empty even though the skin envelope is stretched and roomy.
- Nipples Positioned Below the Breast Crease: A lift is usually needed when the nipple sits at or below the inframammary fold.
- Noticeable Asymmetry Between the Breasts: Uneven weight loss can leave one breast a different size or position than the other.
- Stretched or Enlarged Areolas: Skin expansion during weight change can leave the areola larger than it once was.
Should a Breast Lift and Augmentation Be Done in One Surgery or Two?
Many patients can have a breast lift and augmentation together in one operation, known as augmentation mastopexy. For patients who have lost a greater amount of elasticity or who have thinner skin and breast tissue, Dr Choy may suggest doing the two procedures separately, in stages.
In a staged approach, the breast lift comes first. The goal of the first operation is to tighten and lift the loose skin and provide the patient with improved breast symmetry, shape and position. Once the breasts have healed from the lift, the second operation is done to place the implants. Volumisation is more predictable when the tissue adjustments of the lift are already complete. A staged approach also allows more time for the patient’s weight to stabilize.
With a single-stage approach, there may be a higher chance of requiring revision surgery due to the unpredictability of how the breast tissue will respond to the simultaneous stretching of the breast pocket with the implant and the tightening of the breast soft tissue envelope with the lift.
During your consultation, Dr Choy will assess your skin quality before discussing which approach may suit you.
Why the Timing of Breast Surgery After Weight Loss Is Important
Reaching a Stable Weight
It helps to wait to have the surgery once your weight has settled and has been steady for several months. If you plan on losing more weight, it is possible to develop more loose skin that affects your result. Regaining weight can also stretch the skin again. Dr Choy will want to be sure that your weight is currently stable and likely to remain that way.
Letting Skin Settle Before Surgery
After major weight loss, it is normal for skin to continue adjusting for some time. Giving it time to settle before discussing your options for surgery allows Dr Choy to assess the true quality of your skin and make a more accurate surgical plan.
Planning Around Future Pregnancies
In addition to weight loss, pregnancy and breastfeeding can have a major impact on breast size and shape, which may affect your surgical results. If you are planning to have children after weight loss, it may make sense to wait to have your surgery until you have had children. Be sure to bring this up at your consultation so Dr Choy can talk through the considerations regarding family planning and cosmetic surgery.
Breast Procedures as Part of a Full Body Contouring Plan
Breasts are rarely the only area affected by a major weight loss, and patients often have loose skin on the abdomen, arms, thighs or lower face. If you are interested in a more comprehensive post-weight-loss body contouring procedure, this will need to be carefully planned and discussed with Dr Choy, as it can involve multiple surgeries and extensive recovery. Dr Choy will consider your priorities and your health when discussing these decisions with you.
Common Questions About Breast Lift and Implant Surgery After Weight Loss
How Long After Weight Loss Surgery Can You Have a Breast Lift?
Surgeons generally suggest waiting until your weight has been stable for around six to twelve months. This gives your body time to settle and gives a better sense of your final skin quality before any surgery is planned.
Does Private Health Insurance Cover Breast Surgery After Weight Loss?
Cover depends on your policy and whether the surgery meets specific medical criteria. Some post-weight-loss procedures may qualify for a Medicare item number when set requirements are met. Your eligibility is reviewed during your consultation.
How Long Do the Results of Breast Surgery Typically Last?
Results can last when your weight stays stable, though ageing and gravity will always continue affecting your breasts. Staying at a steady weight will help you have longer-lasting results.
Book a Consultation With Dr Ellis Choy
Breasts respond to weight loss differently, so the right plan starts with a personalised assessment. Dr Ellis Choy will examine your skin and tissue, listen to your goals and explain your realistic options for breast surgery in Sydney. To arrange a consultation, call (02) 8962 9388 or visit us online.
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