This is a 62 year old patient who had lost over 100 pounds through multiple bariatric surgeries.  As seen in her before photos, she presented with laxity of the skin envelope of her breasts and abdomen.  Though she also had laxity of the posterior trunk, she opted to just proceed with an extended abdominoplasty (rather than circumferential) combined with liposuction of the flanks at this stage and will have a posterior skin excision at a future date.  I performed a superior pedicle mastopexy (breast lift) and used 345 cc smooth round moderate projecting implants (Natrelle) to achieve a more youthful looking breast with natural-looking upper pole fullness. Her mid-section was completely transformed by first performing liposuction on her flanks to remove 650ccs of volume from her right side and another 650ccs were removed from the left.  I then made a low-transverse incision to excise this patient’s previous Pfannerstiel incision and then elevated the flap at the level of her navel.  Her navel was then incised and the flap elevated further up to the xiphoid process (the cartilaginous section at the lower end of the sternum, which is not attached to any ribs, and gradually ossifies during adult life.)  After placating the abdominal wall, I excised redundant skin of her anterior thighs in addition to the redundant skin of the mons-pubis.  In all, 1477 grams of tissue were removed from her abdomen and 147 grams of tissue was removed from the right breast and 167 grams were removed from the left.