This article presents our evolved surgical approach to upper body, breasts, and arms after massive weight loss, which frequently complements lower body oblique flankplasty with lipoabdominoplasty. Deflated breasts need to be lifted, augmented, and securely shaped. Surrounded by chest and back skin rolls, the breast footplate usually descends. From this neighboring epigastric and lateral thoracic excess skin, spiraled deepithelialized skin flaps reshape and raise the breasts. Except in cases of severe skin laxity, the transverse bra line approach has been replaced by J torsoplasty for improved esthetics.