Breast size and shape often change significantly in both men and women following weight loss. The effects of aging and gravity cause the breasts to sag with time. Massive weight loss greatly accelerates this process. As women advance from their teens to twenties and into their later years, the glandular portion of breast is replaced with fat. Glandular tissue is more firm than fat.

Consequently, even without weight loss, women's breasts become less firm and change shape over time. Women who sustain significant weight loss in the fourth and fifth decades of life can have a marked change in breast size and shape. By this age, a significant portion of the breast's glandular tissue has been replaced with fat and, therefore, marked weight loss will lead to a rapid decrease in the amount of breast tissue. The skin, unable to retract completely, produces severely sagging (ptotic) breasts. This condition is called breast involution.

There are several treatment options for women's breasts following weight loss. If a woman desires larger, fuller breasts but has little sag, an implant alone may be satisfactory. This scenario is not the norm, however. More often, women have concerns about sagging and want to be larger. In this case, a breast lift or mastopexy is needed, in addition to placement of an implant.

There are several options for breast lift as well. For small amounts of sag, a cirumareolar technique can be used, which only involves an incision around the areola. For moderate amounts of sag, a vertical mastopexy can be used. With this technique, there is an incision around the areola as well as an incision extending from the areola to the base of the breast. For severe sagging or ptosis, an anchor type incision may be necessary. The above-mentioned incisions are utilized in addition to one at the base of the breast. For patients not desiring to be larger and who have an adequate amount of breast tissue, a lift without an implant may produce an aesthetically satisfactory outcome.

The problems in men are similar, however the terminology and treatment is slightly different. In the obese state, men tend to have large breasts. With weight loss, some fat and glandular tissue remains. Depending on a man's age, degree of weight loss and other factors mentioned above, he might end up with large breasts relative to his torso, large and/or sagging breasts or satisfactory appearing breasts. Large and/or sagging breasts in men is called gynecomastia.

For men with large breasts following weight loss, liposuction alone may provide adequate treatment. This is not typical, however. Most men who present for treatment have concerns about both size and sag. Some surgeons' preference for this scenario is to do a two-staged procedure. In the first stage, liposuction is performed to remove excess fat and some glandular tissue. Over the next several months, the breast skin will retract to some degree. Three to six months later, the patient is seen to evaluate the situation and determine whether a satisfactory outcome has been achieved.

Delaying a second procedure allows for significant skin retraction to occur. If a skin tightening procedure is desired, it is likely to require shorter incisions. The incisions for a mastopexy in men are similar to women, however there is one additional option. For men with a relatively small amount of breast sag, a skin tightening procedure can be performed from the axillary region or armpit, concealing any scars. Furthermore, because men often have hair on their chests, scars are well concealed and thus better tolerated.

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