Liposuction of the Upper Back
Article by S. Larry Schlesinger, MD, FACS
Honolulu Plastic Surgeon
From Lipoplasty Magazine, 1992, Vol. 9 No. 3
At times female patients complain about festoons of fat hanging over the halter top or brazier straps on their backs. Historically, the upper back is an area not often considered for liposuction. It is considered a difficult area to suction since it is very vascular and bleeding is copious. In addition, there is only a single layer of fat and some surgeons have warned that suctioning could create ripples in the skin surface.
Illouz, 1990, refers to the upper back as a non-forgiving area to suction since there is only a superficial layer of fat present. Other areas with localized fat deposits are felt to be easier to treat since a bulge can be removed and the remaining superficial layer of fat hides any latrogenic defects.’ However, have not found this to be a problem and have experienced pleasing results while suctioning the back over the last six years.
To perform liposuction of the upper back, I first mark the patient while she is standing with her halter top on to note the offending bulges. Then I make two or three vertical midline incisions that measure an eighth to a quarter of an inch in length. Both sides can be suctioned through these incisions with 2.4,
3.0 and 3.7 mm cannulas varying in length from 17 to 21 cm. An alternate incision site is the posterior axillary line.2
I suction in a crisscross or grid pattern across the entire upper back down to what would be considered the lumbar roll inferiorly and to the lateral extent of the breast anteriorily. It is important to realize that if only the lumbar roll is suctioned, and not the upper back, then an unattractive bulge may protrude around the halter top. (Fig. 1)
Once suctioning is completed, the wounds are sutured with subcuticular 4/0 Vicryl and covered with steri-strips. Reston foam and a pressure garment are then applied and left on for 72 hours. Then the Reston foam is removed and a pressure vest is worn for only one week .3
I find there is minimal postoperative swelling and rarely is there any significant postoperative bruising even though the intraoperative bleeding is often brisk. In addition, patients rarely complain of any significant postoperative pain. They heal very well with minimal scarring. (Figs. 2 and 3)
Jose Guerrerosantos, of Guadalajara, Mexico, has suggested that using liposuction cannulas alone to pierce the transverse fibrous bands in the back will relax these bands and result i elimination of the festooning effect and lead to a smoother back surface. He has demonstrated through anatomical dissection the existence of these fibrous bands .4 The technique I have performed over the past six years is virtually the same as described by Dr. Guerrerosantos. Knowing about the existence of these fibrous bands gives the surgeon a better understanding as to why this surgery is effective and why crisscrossing through these bands is essential for successful results.
One admonition is that this area has a plethora of perforating musculocutaneous blood vessels from the latissimus dorsi to the skin. This area when suctioned will often bleed profusely leading to a potentially excessive intraoperative blood loss. Therefore, I recommend that the upper back not be done in conjunction with any other surgery of a significantly vascular area such as breast reduction, abdominoplasty or browlift during which a patient might lose a great deal of blood.
1 Illouz, Y.G.: Study of subcutaneous fat. Aesth Plast Surg 14:165-177, 1990.
2 Grazer, F.M.: Upper trunk and extremities; breasts and adjacent areas. In Grazer, F.M. (ed), Atlas of Suction Assisted Lipectomy in Body Contouring. New York: Churchill Livingston, 1992, p 139.
3 Schlesinger, S.L., Kaczynski, A.J.: Use of Reston Foam in Liposuction. Aesth Plast Surg, In press, 1992.
4 Personal communication, Jose Guerrerosantos, MD, 1990.