Ask Dr. Schulman...

[Dr. Schulman 2]

Dr Schulman,

I have surgery scheduled in January to have a breast lift and a "bra roll" lift, along with some Lipo on my neck. I was also wondering if there's anything that can be done about the loose skin on my back that sits above my waist. Can that be removed also? I don't need a Tummy Tuck, my stomach and waist are fine, it's just everything above them that's loose and flabby.

It sounds like what you need is called an "upper body lift". This will remove the bra roll and the excess skin on your upper back. The incision is kept beneath the bra line and is a very powerful way of improving the upper back contour. This is a standard procedure that an experienced PS in body contouring will perform.

[BRANDYK 0]

Wow, thanks!! I'll talk to my surgeon about it.

[BRANDYK 0]

Oh and one more question, should I wait until after I have a child to do an upper body lift?

[Dr. Schulman 2]

Oh and one more question, should I wait until after I have a child to do an upper body lift?

This question comes up all the time. This is no rule that you should wait until after having children for plastic surgery...but it is true that pregancy comes with increased weight and subsequent weight loss (the very problem that caused the excess skin to begin with). So ieally, if children are in the near future, it may be best to weight so that you get the best aesthetic result possible.

With that said, having children after plastic surgery is not dangerous to you or the baby. The worst case scenerio is that some of the excess skin returns and you don;t have as good a result as what you had right after the surgery. You may need a small revision afterwards.

Regarding an upper body lift - this is one procedure that will be affected LEAST by pregnancy, so you should be ok. Many of my patients have surgery then get pregnant a few years later - some get a revision, but many are still happy without a revision.

[Nemesis 0]

Does everyone that loses a significant amount of weight, get left with loose hanging skin? I have about 150lbs to lose, I'm 32. I'm terrified of having skin hanging everywhere on my body after I lose weight. Is there anyway to avoid it, or decrease it?

Thanks.

[BRANDYK 0]

thanks doc!!

[Dr. Schulman 2]

Does everyone that loses a significant amount of weight, get left with loose hanging skin? I have about 150lbs to lose, I'm 32. I'm terrified of having skin hanging everywhere on my body after I lose weight. Is there anyway to avoid it, or decrease it?

Thanks.

Not everyone has a problem with excess skin. But, for someone who will lose around 150 pounds, the excess skin is likely. Unfortunately, there is nothing that canbe done to prevent it - it has to do with genetics, the amount of weight you lose, and the speed at which you lose the weight.

Fear of thsi excess skin should not deter you from losing as much weight as possible - the health benefits of losing weight far outweigh the cosmetic problems of excess skin (I am sure most bandsters would agree).

You will just have to see what happens. You always have options if the skin is excesive.

[Nemesis 0]

You are absolutely right, thank you

[BeckyinTexas 3]

Dr. Schulman...your advice is so correct. When I first started losing the weight, I told my lap band surgeon that I would tape and strap all the loose skin when the time came. I should be thankful that now all the loose skin is the major problem but I'm having some major body issues. I did what you suggested and contacted Southwest Medical in Dallas and they're sending me paperwork to fill out for the residency program. I'm just hoping and praying that this will happen for me. Thanks for all your advice. You go above and beyond and it's appreciated very much!

[Lap_dancer 8]

Hi Dr. Schulman:

Thanks for offering your thoughts and giving us a chance to field questions.

I peaked at 389 lbs. I carried most of my weight in my stomach so it hung very low off my body and against my thighs. My breasts were the second source of weight holding tanks. I'm now wearing a 46DDDD and although I notice some reductioin I still have the pain in my shoulders and back.

Honestly, In ever pursued a breast reduction because I was fearful I would be told I was so fat I just needed to lose weight. I do experience persistant pain in my upper shoulders and have indentations where my bra rests.

Although I have lost some size in my breasts they now hang longer. I was hoping to get some relief by now but to no avail. What are your thoughts on reduction at this stage of the game with another 120 pounds still to go?

Secondly, my stomach, I have some loose skin and a pannus that has rubbed against my pelvic area for so long, it's reduced any stimulation I use to feel. Again, when is a good time to seek evaluation?

Thank you in advance.

[Dr. Schulman 2]

Hi Dr. Schulman:

Thanks for offering your thoughts and giving us a chance to field questions.

I peaked at 389 lbs. I carried most of my weight in my stomach so it hung very low off my body and against my thighs. My breasts were the second source of weight holding tanks. I'm now wearing a 46DDDD and although I notice some reductioin I still have the pain in my shoulders and back.

Honestly, In ever pursued a breast reduction because I was fearful I would be told I was so fat I just needed to lose weight. I do experience persistant pain in my upper shoulders and have indentations where my bra rests.

Although I have lost some size in my breasts they now hang longer. I was hoping to get some relief by now but to no avail. What are your thoughts on reduction at this stage of the game with another 120 pounds still to go?

Secondly, my stomach, I have some loose skin and a pannus that has rubbed against my pelvic area for so long, it's reduced any stimulation I use to feel. Again, when is a good time to seek evaluation?

Thank you in advance.

It sounds like a breast reduction is appropriate for you. Your breasts are about 50% fat and 50% breast tissue. As you lose weight, you will lose fat...but not breast tissue. This explains why you have seen some improvement with your weight loss, but not much. A breast reduction will help ease your discomfort and will help speed your weight loss (think about how much easier it will be to get around and exercise). Just keep in mind that you may require a revision in the future depending on your additional weight loss.

Regarding you stomach, you may consider a panniculectomy to remove the hanging skin. This will ease the pressure on your pubis and should improve your sensitivity. It will also make it easier to exercise and lose weight. When you reach your goal, you probably will require a revision to a formal TT for the best possible cosmetic result.

Many of my patients do not wait until their weight goal to have PS, because the hanging skin becomes such a problem for them.

[Dr. Schulman 2]

Earlier I had discussed an "upper body lift" that will help with the back rolls and underarm rolls....."banana rolls".

Here is a link to a picture of a recent patient who had this procedure.

[Lap_dancer 8]

It sounds like a breast reduction is appropriate for you. Your breasts are about 50% fat and 50% breast tissue. As you lose weight, you will lose fat...but not breast tissue. This explains why you have seen some improvement with your weight loss, but not much. A breast reduction will help ease your discomfort and will help speed your weight loss (think about how much easier it will be to get around and exercise). Just keep in mind that you may require a revision in the future depending on your additional weight loss.

Regarding you stomach, you may consider a panniculectomy to remove the hanging skin. This will ease the pressure on your pubis and should improve your sensitivity. It will also make it easier to exercise and lose weight. When you reach your goal, you probably will require a revision to a formal TT for the best possible cosmetic result.

Many of my patients do not wait until their weight goal to have PS, because the hanging skin becomes such a problem for them.

Thank you Dr. Schulman. This makes so much sense to me!

[BRANDYK 0]

Dr S,

Will the upper body lift also help the upper stomach (between the belly button and breasts)? The reason I ask is when I gained weight, it all went to my upper stomach and my lower belly has always been flat as a board. Now the skin on my upper stomach is saggy, but my lower is still just fine. Can my doc pull that skin tight too when he does an upper body lift/breast lift?

[Dr. Schulman 2]

Dr S,

Will the upper body lift also help the upper stomach (between the belly button and breasts)? The reason I ask is when I gained weight, it all went to my upper stomach and my lower belly has always been flat as a board. Now the skin on my upper stomach is saggy, but my lower is still just fine. Can my doc pull that skin tight too when he does an upper body lift/breast lift?

The area between the belly button and the breasts is improved during a TT (not a panniculectomy). There is a procedure called a "reverse TT" that pulls everything up, instead of down. This can work, but it involves an incision that goes completely across theupper abdomen, under the breast fold (think of a breast reduction incision that connects to the other breast). This tends to make a very bad scar in the middle (thick and raised). It also tends to pull the breasts down, more than it pulls the abdomen up.

I know this sounds confusing, but my point is that a reverse TT does not work as well as a traditional TT. An upper body lift is mainly for the back and underarms.