Managing back rolls after major weight loss.

Scottsdale – The back in men and women can become a serious cosmetic problem with major weight gain. When the patient undergoes major weight loss after bariatric surgery, the deformity may worsen. Plastic surgery of the upper back and rolls is becoming more important as the population of patients desiring plastic surgery after major weight loss continues to grow.

A scientific article published in the Aesthetic Surgery Journal, highlights the importance of appropriate diagnosis and treatment options to achieve the best results from plastic surgery. The article is a featured plastic surgery operative technique for plastic surgeons.

The well-written article comes from the Plastic and Reconstructive Surgery Section of the Johns Hopkins University Bayview Medical Center. What the author expresses in the article, is that excess fat in the upper back and rolls, should be managed differently when compared to the situation of deflation that has occurred in the area after major weight loss. When this occurs, the patient is left with excess skin and rolls.

When a cosmetic surgery patient presents with fat in the upper back and rolls and has good quality skin, liposuction is the best technique for management. Importantly, the fat of the back is noted to be more fibrous than in other body regions, while the skin is noteworthy for having a thicker dermis. Because of the fibrous component of the back fat, the area is more resistant to traditional liposuction. It is suggested that power-assisted lipo or ultrasound-assisted lipo might be better at releasing the trapped fat cells and make the removal of the subcutaneous fat easier. This approach is usually sufficient to achieve an improvement in the contour of the back without creating residual skin deformity.

On the other hand, with the development of major weight loss, the plastic surgery patient is left with a significant amount of excess skin and less fat volume. The management of the area is therefore turned to excisional techniques. The most common approach is the use of a procedure called the upper bodylift. This plastic surgery operation involves the excision of the extra skin and subcutaneous tissue. It is usually carried out separately after the patient has undergone a lower bodylift, breast lift, with or without breast implants, or arm lift.

In women, back roll management may be combined with an auto-augmentation of the breasts and breast lift. The author also suggests that a reverse tummy tuck is a possibility during back roll surgery. In the major weight loss patient, surgery begins with the patient in the prone position or while the patient is laying head down on the operating table. The back rolls are treated in order to remove the top layer of skin. Once this is accomplished, the entire roll is elevated and rotated towards the front of the body and breasts. The area in the back is closed and the back roll removal completed. After the patient is turned head up on the table, the breast lift procedure starts in the same fashion. The breast is contoured to reduce the saggy appearance and then the back roll is used to augment the volume of the breasts, creating a larger cup. At this time, the author suggests performing the reverse tummy tuck. The tummy skin is lifted and similarly sutured in a less saggy position. It is important to note that transfer of the back roll tissue to the breasts may not be possible in patients with diabetes, smoking history, and advanced age.

In men, there is no need to augment the breasts to increase volume. Therefore, once the back rolls are excised the tissue is discarded. A complete excision of the extra breast tissue can be combined as a single-stage operation. In both men and women, it is possible to also perform the breast surgery and back roll surgery in two separate operations.

My view on Plastic Surgery.

My take on this plastic surgery operation: Plastic surgery after major weight loss is becoming more popular. This article does an excellent job at demonstrating the versatility of the bra roll technique the article uses. Bra roll transfer in women has the ability to increase the size of the breast cup, supplement volume for breast reconstruction and reduce the excess skin the develops in the back after the loss of the weight.

Please note that transfer of back roll volume to the breasts may not be an option for patients with diabetes, cigarette smoking, and advanced age. I suggest caution should be used in patients with previous back liposuction. All the conditions, decrease the blood nutrition and oxygen supply that gets to the back roll flap. Performing a reverse tummy tuck should also be carefully evaluated and discussed before surgery. Many plastic surgeons believe the risk of disturbing the natural junction between the breasts and tummy is too high to justify this as a routine part of surgery.

Liposuction is still the best option for patients with fat rolls in the back, good skin tone and no excess skin. When a cosmetic surgery patient presents to consult about a comprehensive upper body procedure, the options for women should include:

1. Breast lift or reduction performed in a single operation.

2. Breast lift with auto-augmentation and back roll reduction in a single surgery.

3. Breast lift with breast implants and back roll reduction in a single operation.

4. Breast reduction, breast lift with or implants and posterior arm tuck.

I have found that practicing plastic surgery in Scottsdale, more patients request breast implants than auto-augmentation when undergoing breast lift. Additionally, many Scottsdale cosmetic surgery patients request silicone breast implants, to establish a natural feeling result. The size of the breast cup requested is usually much larger than recommended, and probably much larger than the back roll flap can accomplish. The recommendation for a certain breast implant size is based on the desire to achieve a long-lasting breast lift. The reality is that, in major weight loss patients, the larger the breasts, usually the faster and harder they fall down after breast surgery. Patients are made aware of this fact before surgery.