Impact and Predictors of Surgical Outcomes in Mastopexy after Massive Weight Loss

Post-massive weight loss (MWL) patients present unique anatomical challenges for mastopexy, including diminished parenchymal support and poor skin elasticity. Regional data on mastopexy outcomes in Saudi Arabia remain limited despite the increasing demand for postbariatric body contouring.

This retrospective comparative study reviewed 89 patients who underwent mastopexy between May 2021 and May 2025 at King Abdulaziz Medical City, Riyadh. Patients were categorized into post-MWL (n = 33) and non-MWL (n = 56) groups. Demographics, operative techniques, complications, revision rates, and satisfaction outcomes were analyzed. Logistic regression was performed to identify predictors of complications and dissatisfaction.

Baseline characteristics were comparable between groups, except for prior gastric sleeve surgery, which was more frequent among post-MWL patients (66.7% versus 16.1%, P < 0.001). The inverted-T incision was the predominant approach in both groups. Implant augmentation was more common in the post-MWL cohort (33.3% versus 17.9%). Overall complication rates were similar between post-MWL and non-MWL patients (27.3% versus 21.4%), although infection was significantly higher in the post-MWL group (12.1% versus 1.8%, P = 0.04). Revision rates were comparable (9.1% versus 7.1%), and satisfaction remained high in both groups (87.9% versus 89.3%). Multivariable analysis identified no independent predictors of complications or dissatisfaction.

Mastopexy after MWL achieved early complication and satisfaction outcomes comparable to those of non-MWL patients. These findings suggest that appropriate technique selection, including parenchymal support and careful pedicle planning, can support favorable early outcomes in post-MWL mastopexy.