Do I need a bra line back lift? What kind of tummy tuck would I need? (photos)

Thank you for your question regarding what to do with your back and abdomen. Based on your pictures and history, I would suggest an extended horizontal tummy tuck.  During the extended horizontal tummy tuck, the excess abdominal fat and skin removed.  Also, the abdominal muscle is tightened from the pubic region to the rib cage. Your results would be a flat tummy without any skin or fat rolls. Also, I would suggest the incision to be carried over your hips to reduce excessive skin and fat that hangs over the hips. In regards to your back, I would highly suggest a horizontal torsoplasty or bra-straplasty or braplasty. During this procedure, an incision is made across your back and a butterfly shaped area of back skin and fat is removed. Some other plastic surgeons also call this an upper body lift. It can be combined at the same time as your extended tummy tuck or can be done 3 months later. Since this is a complex procedure, please seek a board certified plastic surgeon. Your extended tummy tuck would take approximately 3-4 hours to perform under general anesthesia.  Your bra-straplasty should take 3-4 hours under general anesthesia. Again, these procedures can be combined. If you combined the procedures, plan on a 2-3 week recovery. If you decide to do your tummy tuck, first plan on a 2-3 week recovery. If you decide on the horizontal torsoplasty performed alone, plan on a 2-3 week recovery. Thank you for your questions regarding a tummy tuck, extended tummy tuck, horizontal torsoplasty, bra-straplasty, and braplasty.  I specialize in torsoplasties.  If you have any more questions regarding the horizontal torsoplasty, bra-plasty or a bra strap-plasty. please contact my office.  Since the horizontal torsoplasty is a very technically procedure, please seek an experienced, board certified plastic surgeon with significant experience performing torsoplasties.   Do your research.  Make sure your chosen plastic surgeon has performed at least 100 torsoplasties.  Make sure they have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

The answer depends on your aesthetic goals. You may benefit from a combination of procedures to address both your abdominal and back concerns. For your abdominal area, a full tummy tuck (abdominoplasty) is often recommended. This procedure tightens the abdominal muscles, removes excess skin, and contours the lower abdomen, helping to create a flatter, more toned appearance. In some cases, a "belt lipectomy" or body lift can also be performed, which addresses not only the abdominal area but also the flanks and lower back, extending the tummy tuck incision to remove excess skin and fat around the hips and back.
In addition to a tummy tuck, your back concerns, especially around the bra line, could be addressed with a "bra-strap lift" or back lift. This procedure removes excess skin and fat from the upper back, targeting areas that may have sagged or accumulated fat. Depending on the severity and location of the back skin and fat, some surgeons may offer to perform this at the same time as the tummy tuck or as a separate procedure. Combining the two procedures may lead to more comprehensive body contouring, but it is essential to consult with an experienced plastic surgeon to determine the best approach for your specific needs and ensure you achieve the most desirable results based on your individual anatomy and goals.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Thank you for submitting your question and photos :)
I would recommend a belt lipectomy / body lift to address the abdomen.  Liposuction may be required to improve your flank and lower back appearance also, however clinical examination would best determine this.
Your upper back region would be suitably managed by a back bra lift. This can be done at the same time however I personally would only support this if my clinical examination suggested that the location of your skin excess (and subsequent scar placement) would not pull too much on the other operative site. It might sound convenient to package the two procedures together so that you only have to go through one recovery period however the conditions have to be right to achieve the best result in both zones.
Assessment by a suitably qualified plastic surgeon will help you determine the best path forward.
Kind regards,
Matthew