Depending on the breast condition in females or the chest condition in males, either skin excess is excised from the lateral chest wall or implants are inserted as the breasts become very empty with the loose skin hanging.
It is my experience that people who have had massive weight loss, are only too happy to accept scars to get rid of the troublesome and lax loose skin. The scars generally heal very well, most patients accepting the scars very well and all being very happy with the final outcome. With massive weight loss, the buttocks are usually very flat and with a lower bodylift a lower augmentation flap of fat is used to gain more buttock fullness. This can be done and is done in most cases.