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Guide · Recovery
Those who lose a lot of weight lose fat — but not the skin that was needed before. It remains as excess, usually as an apron on the abdomen and as sagging on the chest. Reconstructive surgery removes this excess and reshapes the contour. In this article, Dr. med. Zeynep Potente uses a case from our practice to explain how a vertical and horizontal tummy tuck is performed and why the abdomen and chest are operated on sequentially.
Note: The video shows footage from medical documentation. It serves to inform about the procedure and does not constitute advertising for a specific result. Watch reel on Instagram ↗
Skin is elastic, but only has a limited ability to retract. When there is significant weight gain, it is stretched over years; the elastic fibers in the dermis are permanently damaged in the process. If the underlying volume is lost—often within a few months and by several dozen kilograms after bariatric surgery—the skin does not shrink back to the same extent.
This typically creates an apron of skin on the abdomen that hangs over the pubic area. It is not just a matter of contour: heat and moisture build up in the fold underneath, which promotes skin inflammation. Movement, clothing, and hygiene become more difficult.
The same effect appears differently on the breast. The glandular tissue loses volume, the skin envelope remains—the breast sags, the nipple moves downward.
In a classic Abdominoplasty the incision lies horizontally in the bikini line. That is sufficient if the excess primarily hangs downwards.
However, after massive weight loss, the excess skin is often present laterally as well—meaning the skin hangs in folds at the sides. A purely horizontal incision cannot compensate for this. In this case, an additional vertical incision along the midline is added. This makes it possible to tighten the abdomen laterally and shape a waist.
The price for this is a longer scar: it then runs horizontally across the lower abdominal fold and additionally vertically down the center of the body. This decision is made together before the operation — more tightening always means more scar as well.
In the case shown here, during this step 2800 grams of fabric Removed.
Tummy tuck and Breast lift can generally be combined. After significant weight loss, however, there are often reasons to separate them:
In the described case, there were three weeks between the two procedures. The article shows what a combined lift of the breasts, upper arms, and chest looks like. Body contouring after a 60-kilogram weight loss.
Our female patient had lost a significant amount of weight following bariatric surgery. Her abdomen bothered her in everyday life, and her breasts were noticeably sagging. She came to us with the desire for reconstructive surgery.
In the first step, a vertical and horizontal abdominoplasty was performed with the removal of 2,800 grams of tissue. Three weeks later, the breast lift followed: the nipple was repositioned, and the shape was constructed from the existing glandular tissue—without an implant.
At the time of the photograph, the scars were still red. This is the normal course; the redness fades over months.
Note: This case is an individual example. The course of treatment, incision technique, and result depend on the initial findings, tissue quality, and healing process, and cannot be generalized to other patients.
„As a first step, we performed a vertical-horizontal tummy tuck, removing 2,800 grams of tissue. [...] The scars are still red, but will fade over time.“
— Dr. med. Zeynep Potente, Board Certified Plastic and Aesthetic Surgeon
It is standard practice to let the weight stabilize first — usually for about six months. If we perform a tightening procedure too early, further weight loss can create excess skin again. Protein and vitamin levels should also be within the normal range before the procedure, as they affect wound healing.
Yes. The vertical scar runs along the midline and cannot be hidden by underwear. It is the price for also being able to remove excess skin on the sides and shape a waist. Whether this trade-off makes sense is discussed prior to the procedure.
This is a case-by-case decision. Costs may be covered if the excess skin leads to recurring skin inflammation or other documented complaints. Medical findings over an extended period are a prerequisite. Procedures intended purely for aesthetic improvement are not covered by health insurance.
Often yes. If there is still sufficient glandular tissue available, the shape can be reconstructed from it; the nipple is repositioned in the process. The examination will show whether additional volume is necessary.
In a personal conversation, we will clarify findings, options, and the appropriate path – no obligation. Consultation in Frankfurt, the surgery will be performed in Oberursel.
Medically reviewed by Dr. med. Zeynep Potente · Updated on August 28, 2026
