Operation Guide: Auto Augmentation Mastopexy and Brachioplasty Surgery


Dr Bernard Beldholm

Many women are bothered by lax skin after weight loss. Most patients want to fix loose abdominal skin first. However, not everyone is concerned about excess tummy skin. For some women, it is really saggy breasts, droopy nipples and excess arm skin that bothers them most.

If you have loose skin on your breasts and arms, you should know it is possible to correct both in one surgery.

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Combining a breast lift and arm lift

This article explains a combined procedure that lifts breasts and tightens saggy arms at the same time. In this surgical guide, you will learn what happens inside the operating room during Doctor Bernard’s brachioplasty with breast auto augmentation, which is a breast lift (Mastopexy) that uses your own breast tissue to naturally lift your bust after weight loss.

Who is a candidate for a brachioplasty with breast auto augmentation?

This combined surgery is specifically for women after weight loss. If you have the following cosmetic concerns, then breast auto augmentation with arm lifting may be the right choice.

Who needs a brachioplasty?

The ideal candidate has:

  • Loose upper arm skin
  • A modest amount of excess arm fat

Who can have a breast auto augmentation lift?

The ideal candidate has:

  • Deflated breasts
  • Loss of fullness in the upper breast pole
  • Excess fullness in the lower breast pole
  • Nipples that may point downward or sideways
  • No desire to increase bust size

What is an arm lift?

Arm lifting (brachioplasty) is an elective surgery that removes excess arm skin between the elbow and armpit. The result is tighter, slimmer upper arms.

What is auto augmentation breast lifting?

A breast lift can be performed in many ways. Auto augmentation is one of them. In this procedure, the breasts are lifted to a more youthful position using your own natural breast tissue.

The saggy breast tissue is moved up and secured in place with sutures. This restores fullness to the upper part of the breasts, which often looks deflated due to weight loss, past pregnancy, or aging. Auto augmentation can also fix downturned nipples so they point forward.

Unlike a traditional breast lift (mastopexy), the auto augmentation lift retains all of your natural breast tissue. No underlying breast tissue is removed, so you won’t go down a cup size like you might after a traditional breast lift.

Breast auto augmentation vs breast lift with implants

Many patients who have a traditional breast lift also add implants to make their breasts fuller. Breast implants increase bust size. They can fill and lift empty breasts as well.

However, implants are not your only option. Auto augmentation moves the sagging breast tissue to the upper area of the breast, no implant needed.

Auto augmentation is a natural alternative to a breast lift with implants. It is ideal for women who want an improved breast shape and restored upper breast volume without changing their bra cup size.

Let’s look at some reasons women choose auto augmentation instead of a breast lift with implants:

Not everyone is a good candidate for implants

Women who have lost a significant amount of weight are not always the best candidates for implants. Obesity causes the breast tissue to stretch extensively. Both the skin and underlying tissues become loose and empty after weight loss. That is a problem because implants need support from the internal breast tissue to hold the implant in place. Without it, the implant can slide freely in the cavity, more or less.

Without support, implants can shift out of position. They can hang to the side when lying down. They can become displaced.

Poorly supported implants can even flip upside down. With round implants, implant flipping is not a problem. With anatomical implants (aka “tear drop” or “gummy bear implants”), that results in a major cosmetic deformity.

Not all breast lift patients want to increase bust size

Unlike a breast lift with implants, the auto augmentation breast lift does not add volume. Instead, it uses the existing breast tissue to change the shape, profile, and projection of the breasts. The upper breasts appear to gain volume by moving the sagging breast tissue upward. However, your cup size remains the same.

Some women prefer natural breasts

Some women are turned off by the idea of man made implants. The thought of having a foreign object surgically placed in their chest does not interest them. Auto augmentation is a natural way to lift breasts and restore upper pole volume.

Breast implants need replacing

Finally, breast implants need to be replaced eventually. They are not lifetime devices. When it comes time to have the implant replacement surgery, there is downtime, inconvenience, and hospital costs.

If you don’t want to worry about an implant replacement surgery some day, you might consider auto augmentation. Replacement is not necessary when you are reconstructing the breast mound using your own breast tissue.

Some women need two breast lift surgeries, unless they have auto augmentation

If you’re considering a traditional breast lift with implants, this might give you pause: If you have severe breast sagging and your breasts are a C cup or bigger, you might need a two-stage operation. The first operation lifts the breasts. The second operation adds the implants. Understandably, many women do not want to have two surgeries.

Who should not have breast auto augmentation?

Not everyone is a good candidate for auto augmentation breast lifting. Some patients do better with implants.

For one thing, not everyone needs a breast lift. If sagging breasts are not your concern, then you don’t need breast auto augmentation. If you simply want to increase bust size, then implants or natural breast fat injections may be a better choice.

You also need to have enough lower pole breast tissue to reshape the upper area of your breasts.

Pros and cons of arm and breast lifting

Perky breasts and tight arms are on many women’s wish list after losing weight. While these benefits can be life changing, one of the drawbacks of an arm lift with breast auto augmentation is the scars. You will have an arm lift scar and scarring on your breasts.

Surgical scars fade with time in most cases, but they never fully disappear. Patients that choose to have an arm lift, breast lift, or both should be willing to accept the scars and feel the benefits of tighter arms and lifted breasts outweigh the scar.

Auto augmentation can fix sagging breasts and nipples; it doesn’t add volume like an implant. It will, however, increase upper breast fullness by moving the excess lower breast tissue upward. This can give your breasts a dramatically improved appearance with better lift and projection.

Another factor to consider is the revision rate. Nearly 20 to 30 percent of auto augmentation patients need a minor revision surgery. This is done to fine tune the results of the initial surgery. That must be considered before you decide to go ahead with the procedure. You need to be comfortable with the fact that you might have to come back to the operating room six to 12 months later.

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Operation Guide: VASER arm lift and auto augmentation breast lift

Learn how Dr Bernard Beldholm performs an arm lift and auto augmentation breast lift to restore a youthful look to your upper body after weight loss.

Phase 1: Surgery Preparation

Pre-operative markings

While you are awake and standing upright in the anesthetic bay at the hospital, Doctor Bernard will draw markings on your arms and breasts. The markings help to plan the operation.

Auto Augmentation Breast Lift Surgery Preparation Pre-operative Marking by Dr. Bernard Beldholm

The arm markings will extend from the elbow, past the armpit and down toward the sides of the breasts. Doctor Bernard will place the scar as discreetly as possible. Ideally, the scar will not be visible while you stand with your arms at your sides.

In a traditional brachioplasty, the incision ends at the armpit. This procedure uses an elongated incision since he operates on both your arms and breasts. He will then draw anchor-shaped markings on your breasts to plan the breast lift.


Anaesthetic will be supplied through an IV and you will drift off to sleep. You will not feel pain during the surgery. A licensed anaesthetist will monitor your vitals during the surgery. You will also have a breathing tube placed to assist with breathing.

Positioning you on the operating table

You will lie on your back for the operation. Your arms will be raised above your head and bent at 45 degrees. Your hands will be secured to arm bars.

Phase 2: Arm Lift

Doctor Bernard will perform the arm lift before addressing your breasts. An arm lift removes excess skin from elbow to armpit. Doctor Bernard will also use VASER lipo to melt excess fat if you need it.

VASER for arm fat reduction

VASER defines your upper arms by removing fat. It offers precise fat removal. Many surgeons consider VASER the gold standard in surgical fat removal. VASER is a three-step process.

Wetting solution

A liquid mixture of adrenaline and local anaesthetic will be applied to your subcutaneous arm tissues. Dr Beldholm uses a large amount of fluid since it assists with hydrodissection of your tissues. This makes it easier to remove your excess arm skin later in the procedure.

Fat melting
Arm Lift Suction assisted lipectomy

Doctor Bernard will insert the VASER probe into the fatty arm tissue. He will work the probe in a back-and-forth motion to melt the fat. The VASER probe vibrates at a high frequency to emulsify the fat until it is liquefied.

Arm fat removal

Next, he will remove the fat with machine-powered suction. Unlike traditional liposuction, the machine uses gentle suction to remove the fat. Therefore, there is less inflammation, bleeding, and bruising.

Your arms should appear noticeably slimmer at this stage. However, they will be quite swollen for the first day. Much of the swelling subsides in 24 to 48 hours. Swelling will continue to decrease in the next few months after surgery.

Adjusting your surgical markings

Arm Lift Adjust surgical markings

After the arm fat is gone, Doctor Bernard will adjust the surgical markings. He plans the arm lift incisions carefully to minimise scarring as much as possible.

Arm lift incision

Arm lift Skin excision

Doctor Bernard will make two long incisions from your elbow to your underarm, using the markings as a guide.

Removing the excess arm skin

Doctor Bernard will then resect your excess arm skin and discard it. The VASER fat reduction from earlier helped to partially dissect the tissues, making it easier to remove the loose skin.

Closing the incision

He will apply sutures immediately. Dissolving sutures are placed in the upper layers. These sutures will take between 90 and 180 days to dissolve naturally. The deep permanent suture will not need to be removed.

The closure is tight initially since your arms will be swollen at first. Once the fluid dissipates in a day or two, your tissues will relax. Swelling continues to subside over the next few months.

Repeats all steps on the other arm

After one arm is finalised, Doctor Bernard will repeat the same process on your other arm. The arm lift takes approximately one to two hours to perform. Due to the VASER, you won’t need to wear surgical drains.

Phase 3: Auto Augmentation Breast Lift

After your arms are finished, Doctor Bernard will perform an auto augmentation mastopexy to lift your breasts and correct nipples that point downward.

Positioning you on the operating table

Your arms will be released from the arm bars and lowered to your sides.

Breast lift incision and dissection

Auto Augmentation Breast Lift Breast lift incision and dissection by Dr Bernard Beldholm 1024x576 1

The incision is similar to the anchor-shaped incision in breast reductions. However, unlike a breast reduction which removes underlying tissue, auto augmentation retains all your natural breast tissue so you won’t lose any volume. After making the incisions, he will elevate and resect the excess breast skin, then dissect the subcutaneous tissue.

Breast reshaping

Auto Augmentation Breast Lift Breast reshaping by Dr. Bernard Beldholm

Doctor Bernard will reposition your breast tissues, moving the saggy tissue in the lower breast pole up higher on the breast mound. The goal is to create a rounded teardrop shape with more fullness at the top than before. To keep the tissues in place, he will apply sutures. Your areola will be raised so it is centered on the breast mound with forward projection, correcting a droopy appearance.

Closing the breast incisions

Auto Augmentation Breast Lift Closing the breast incisions by Dr. Bernard Beldholm

He will redrape the skin over your breast and close the incisions with dissolving sutures.

Repeats all steps on the other breast

Doctor Bernard will repeat the same steps on your other breast. He will aim for a symmetrical, lifted result. Breast auto augmentation usually takes one to two hours.

Breast symmetry check

Auto Augmentation Breast Lift Breast symmetry check by Dr. Bernard Beldholm

While you are still under anesthesia, the operating room staff will lift you to an upright seated position. Doctor Bernard will perform a symmetry check.

Phase 4: Finalising Your Surgery


Doctor Bernard will apply sterile dressings. Bandages help prevent contamination and support the incision as it heals.

Compression garments

Gentle compression reduces swelling, improves skin retraction and relieves tension on your incision as it heals. You will wear the compression garments for several weeks according to the aftercare instructions that Doctor Bernard will provide before you go home. Most patients can return home the same day. In some cases, an overnight hospital stay may be required.

Scar care

Surgical scars are unavoidable. To promote scar fading, Doctor Bernard will provide you with scar aftercare instructions. Silicone scar strips and scar moisturising gel helps to initiate scar fading. He will instruct you on when to begin scar therapy after surgery.

It can take one year or longer for scars to fade. Laser Genesis is a nonsurgical treatment that can reduce scar redness. If you have a history of poor scarring, let Doctor Bernard know during your consultation.


Ptosis should no longer be a problem in your arms and breasts after surgery. Your arm skin should appear tighter and firmer. Breast auto augmentation results in improved breast symmetry. Your breasts should look more lifted and perky. Your nipples should be raised to a more central position and point forward. Your upper breast pole, which lacked fullness, should have more volume. The breasts should take on a more aesthetically pleasing shape and profile after surgery.


Some patients will need to come back six to 12 months later for minor surgical revisions. It may be necessary to revise the scar or make adjustments to the areola. A 20 to 30 percent revision rate is considered standard for this procedure.


If you want to tighten loose arm skin and lift sagging breasts after weight loss or pregnancy, you may be a candidate for an arm lift (brachioplasty) combined with a natural breast lift (auto augmentation mastopexy).

Auto augmentation is only suitable for patients who have enough natural breast tissue to reshape the breast mound. If not, you can have a traditional breast lift (with or without implants).

Many women are interested in breast auto augmentation because it is a more natural alternative to breast lifting with implants.

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30 Belmore Rd
Lorn NSW 2320


This website contains adult content. You must be 18 years or over to read. All surgery carries risks. You should seek a second opinion before proceeding. Results vary from patient to patient. See our disclaimer.
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