In weight loss patients, upper body laxity can present in a vertical direction as back rolls or a horizontal direction as excess tissue under the arm pits. The vertical upper body laxity often presents as hanging tissue drapes extending from the rib cage in front to the vertebral column in the back. Recent studies by Dr. Agha (submitted for publication in Plastic and Reconstructive Surgery) identify up to five typical chest and back rolls in severe cases. The upper back roll extends from the breast tail over the chest toward the vertebral column. Midback laxity can present as one or two rolls. The lower back roll spans horizontally over the lower back and upper buttock at waist-level and extends to the abdominal pannus in the front.
The upper body lift is a procedure to correct for upper body laxity; including that of the chest and back. The mainstay treatment strategy for correction of upper back laxity is “bra-line upper body lift.” This technique involves removal of upper back rolls through incisions that are placed horizontally at the bra level. Although this technique is versatile and effective for severe upper back laxity, bra-line upper body lift can exhibit unsightly back scars.
46 year old patient who weighed 330 lbs. before gastric bypass surgery. After losing 160 lbs., she presented to Dr. Agha for an upper body lift in Newport Beach California, as well as a lower body lift. The patient had a bra-line upper body lift as well as a crescent upper body lift to correct for her vertical and horizontal back laxity.
For milder cases, a “crescent upper body lift” technique will produce effective correction with a well-hidden scar. Developed by Drs. Siamak Agha and Dennis Hurwitz, the crescent upper body lift, employs incisions that are placed vertically from the arm pit to the inframammary fold. Through this incision, mild to moderate cases of upper body laxity can be effectively treated.
Markings for the crescent upper body lift. 43 year old patient of Dr. Agha who weighed 270 lbs. before gastric bypass surgery. After losing 130 lbs., the patient presented to Dr. Agha for an upper body lift as well as a lower body lift.
Same patient as above: before and after pictures after a crescent upper body lift for for mild to moderate back laxity.