Although weight loss contributes positively to general wellbeing, one of the likely but negative consequences of losing a lot of weight is that the body can deflate like a balloon, resulting in unwanted loose, saggy skin, which can cause tremendous cosmetic deformity as well as pain and discomfort caused by the skin folding and rubbing on itself. The psychological effect of this new physical state of profuse loose skin is often more disturbing and traumatising for the patient than when they were large and overweight.

Body contouring surgery after weight loss encapsulates a range of surgical procedures aimed at improving and restoring the body’s normal shape and contour by removing the excess skin. Common procedures that fall into this category include tummy tucks, lower body lifts, breast lifts, and arm and thigh lifts. They generally involve removal of large areas of skin, and therefore, extensive scarring is one of the trade-offs that patients need to except. Scars will generally fade however, and are usually placed strategically to minimise their visibility.

In approaching this growing group of patients, my first question will usually be aimed at identifying the area/s on the body which concern the patient the most. This then allows me to give priority in terms of planning and staging surgery. When a patient has several areas that need addressing, one needs to consider whether they can be all treated at the same setting, or whether treatment should be more sensibly broken up into multiple procedures, staged over a period of time. In making this decision, the surgeon and patient need to consider healing factors, recovery, and safety.

Body contouring is considered major surgery, and is not without its risks, which is often potentiated by this group of patients’ pre-existing state of poor nutrition and other health issues. In preparing for this type of surgery, it is best that the patient has reached and is stable in their goal weight, lives an active healthy lifestyle, and has eliminated risk factors such as smoking. They should maintain a positive mindset during recovery, and be focused and motivated by the final outcome, which will close the final chapter in their weight loss journey.

Dr Ray Goh, Valley Plastic Surgery. 12^th March 2019.

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In Breast Augmentation, this means that the surgeon must understand and determine the kind of result the patient is hoping for, in terms of breast shape and size. After surgical goals have been established, it then becomes easier for both surgeon and patient to work through the type and size of implant, pocket placement, and surgical technique to be applied in order to achieve the best result.

To make it easier in my consultations, I like to think of the goal (or final result) from breast augmentation as broken into four categories. Most patients will fall into one of these goals:

1. “You’ve got breasts”
   This is a small and subtle increase in size. You do not want anyone to know that you have had breast augmentation, and people around you may not notice the change.
2. “Nice breasts”
   This is a natural result, with a gentle slopping upper pole, and a round lower pole. There is often little hint to others that your breasts have been surgically enhanced.
3. “Are they real?”
   The breasts are large, but may still be accepted as just falling within what nature can endow. There is fullness and roundness in the upper pole and sides.
4. “They are not real”
   Size rules here – as big as can be done – the breasts are disproportionally large compared to your body. Patients in this category wish to have the “fake” look.

Remember, for each patient, there is a safe range of implant shapes and sizes that can be used to augment the breasts. Once you venture beyond this safe range, the risks of future complications such as displacement and capsular contracture dramatically increases. The final result gained from breast augmentation is a very subjective matter. The eventual size of implant used is often chosen by the patient; however, it is the surgeon’s role to guide the patient in making this decision based on the patients wishes and their breast anatomy.

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