The breast is composed mainly of fatty tissue, which is why massive weight loss often leads to significant sagging and loss of breast volume. Plastic surgery can offer effective solutions for these patients through specialized procedures aimed at increasing breast volume and lifting the breasts by removing excess skin.

Breast reconstruction after massive weight loss differs significantly from standard cosmetic breast augmentation and lifting procedures. In general, the incisions are much larger due to the extensive amount of excess skin that must be removed, and very often they need to be extended toward the armpit area in order to effectively address sagging and restore the overall body contour.

How is breast reconstruction after massive weight loss performed?
The procedure usually involves an incision around the areola, a second vertical incision extending from the areola down to the breast crease, and finally a horizontal incision along the inframammary fold, forming an inverted “T” pattern. As previously mentioned, the horizontal incision is often extended toward the armpit to remove excess skin and address sagging in that area.
Excess skin is removed, often together with part of the areola (if enlarged), without removing breast tissue. The nipple and areola are repositioned higher, and the skin is tightened around the breast, lifting it back to its natural position.
In most cases, due to significant fat loss, the breast appears very deflated; therefore, a breast lift is commonly combined with the placement of silicone implants. In some cases, if there is sufficient tissue in the axillary area, it may be used for autologous breast augmentation, either alone or in combination with a silicone implant.
The sutures used are typically internal and absorbable. In rare cases, a drain may be placed on each side to prevent fluid or blood accumulation.

What should I expect after surgery?
The entire procedure lasts approximately 3 hours, and you can usually return home the same afternoon.
As mentioned, the stitches are internal and absorbable. Postoperative discomfort is generally mild, more like a stinging sensation, and is easily managed with simple pain relievers such as paracetamol or similar medications.

After surgery, you will need to wear a comfortable supportive bra (sports bra or nursing bra without underwire) for about one month. Initially, some swelling will occur and the breasts may appear slightly higher than desired. Over the next 2–3 months, the swelling gradually subsides and the breasts settle into their natural shape.
Scars will initially appear red and somewhat firm, then gradually soften, fade to pink, and eventually become pale and barely noticeable. This scar maturation process takes several months but can be accelerated with daily massage and special silicone sheets.
Temporary numbness around the nipple is common and usually resolves within a few months. Since the procedure affects only the skin and does not interfere with the milk ducts, breastfeeding ability is generally not affected. However, future pregnancy and breastfeeding may reduce the longevity of the results. It is also important to note that results are not permanent—gravity, aging, and weight changes can eventually lead to renewed sagging.

What complications may occur?
Mastopexy is generally a straightforward, safe procedure with few complications. The most common issues involve minor wound infections caused by bacteria normally present in the milk ducts. These may slightly delay healing but rarely affect the final result. Rarely, postoperative bleeding may occur and require treatment in the operating room. Scarring itself is not considered a complication and, as mentioned, typically fades significantly over time.

When can I return to normal activities?
From the first day after surgery, you are usually able to move around freely, although it is advisable to avoid household tasks for about one week. Sexual activity should also be avoided for at least three weeks. A return to light work is recommended after one week, while full resumption of normal activities is expected after about one month.