Mastopexy and mammoplasty combined with brachioplasty after bariatric surgery

Introduction

After massive weight loss, the skin does not always adapt to the reduction in body volume. In the breasts, deflation and sagging may occur; in the arms, folds of skin can cause discomfort and make wearing certain types of clothing difficult.

Mastopexy, mammoplasty, and brachioplasty allow different aspects of these changes to be addressed. In selected patients, breast and arm surgery can be performed in the same operation. This possibility depends on overall health, the extent of the corrections, and the expected recovery.

Author: Dr. Fernando Amato — CRM-SP 133826 | RQE 51573 | RQE 51436.

Indications and Considerations

Mastopexy and mammoplasty: what is the difference?

Mastopexy aims to lift and reshape sagging breasts by removing excess skin and reorganizing the tissues. It does not necessarily require the use of implants.

Mammoplasty is a broad term for surgeries that modify the breasts. Reduction mammoplasty decreases volume, whereas augmentation adds volume. The choice depends on the remaining tissue and the patient's goals:

• Sagging with satisfactory volume: mastopexy without implants may be indicated.
• Sagging with still voluminous breasts: breast reduction can be combined with repositioning.
• Sagging with significant volume loss: combining mastopexy with breast augmentation can be discussed.

Lifting the breast and increasing its volume are distinct goals. The consultation should clarify what each technique can provide and what limitations remain, particularly regarding upper-pole fullness of the breast. [1]

What does brachioplasty treat?

Brachioplasty removes excess skin from the arms and can also address localized fat. Its indication is particularly relevant when skin laxity persists after weight loss.

Liposuction alone cannot replace skin excision when significant laxity is present. The choice of technique depends on tissue elasticity, the amount of fat, and the distribution of excess skin.

The scars are permanent, and their extent corresponds to the degree of correction needed. Therefore, surgical planning must include a clear discussion regarding location, visibility, and the potential for scar widening or thickening. [2]

Can breasts and arms be operated on at the same time?

Yes, this combination is among the options available in post-bariatric treatment. However, the indication must be individualized. A single operation consolidates treatment for both regions, but it also combines the recovery demands of both. [3]

Operative time warrants careful attention. A study of patients undergoing brachioplasty after massive weight loss found an association between longer operative times and a higher rate of surgical complications. This finding does not determine individual risk or imply that every combined procedure is inappropriate; rather, it reinforces the importance of careful patient selection and appropriate surgical planning. [4]

When the combination of procedures represents an excessive burden on the patient, staging the treatment may be the most appropriate choice.

How to know if it is time for surgery?

Planning should not only consider the time elapsed since bariatric surgery. Among the points evaluated are:

• Weight stability: ongoing weight loss or significant fluctuations can alter the outcome.
• Clinical conditions: diseases that interfere with healing or increase anesthetic risk must be evaluated.
• Nutritional status: anemia and nutritional deficiencies must be investigated and treated.
• Smoking: tobacco use impairs wound healing and requires specific guidance before surgery.
• Realistic expectations: the correction involves scars and does not prevent future tissue changes.

These criteria help determine both the timing of the surgery and the appropriateness of combining procedures. [5,6]

Why is nutritional assessment important?

After bariatric surgery, weight loss alone does not guarantee that the body is ready for another operation. The evaluation must verify whether the diet and nutritional follow-up meet the patient's needs.

Investigating anemia and vitamin deficiencies is part of this preparation. The necessary tests and corrections should be defined by the care team, taking into account the history and type of bariatric surgery. [6]

What are the risks?

Among the complications described in brachioplasties after massive weight loss are:

• Seroma: fluid accumulation under the skin.
• Hematoma: blood accumulation.
• Infection.
• Dehiscence: reopening of part of the surgical wound.
• Nerve injuries and changes related to sensation.

Combined surgeries also require evaluating the specific risks of each procedure. Preoperative discussion should cover potential additional treatments and revisions, without promising an event-free recovery. [4]

Recovery and postoperative care

Recovery planning must take into account that both breasts and arms will be operated on simultaneously. It is important to arrange help at home in advance and clarify which activities will be temporarily limited.

Care may include dressings, use of drains when indicated, restriction of physical exertion, and regular follow-up. Walking is usually encouraged according to the team's guidance, while exercise and heavy lifting depend on medical clearance.

There is no single timeframe for returning to work or full routine: the extent of the surgery, healing progress, and occupational demands influence this decision. [6]

Results and expectations

Surgery can improve body contour and reduce excess skin, but it does not eliminate all traces of massive weight loss. Tissue quality and individual healing affect the outcome.

Maintaining a stable weight helps preserve the corrections. Even so, aging and new weight fluctuations can change the breasts and arms over time. [2,5]

The decision to combine mastopexy or mammoplasty with brachioplasty must balance the patient's goals with the conditions required to undergo surgery and recover. An in-person evaluation is essential to define this plan.

Also read: mastopexy in São Paulo, brachioplasty, and plastic surgery after weight loss.

References

1. American Society of Plastic Surgeons. Breast Lift — Mastopexy. Institutional patient information.
2. International Society of Aesthetic Plastic Surgery. Arm Lift. Institutional patient information.
3. Stony Brook Medicine. Post-Bariatric Reconstructive Surgery.
4. Gusenoff JA, Coon D, Rubin JP. Brachioplasty and concomitant procedures after massive weight loss: a statistical analysis from a prospective registry. Plastic and Reconstructive Surgery. 2008;122(2):595–603. DOI: 10.1097/PRS.0b013e31817d54a9.
5. American Society of Plastic Surgeons. What is Body Contouring?
6. Cleveland Clinic. Surgery After Significant Weight Loss.