Thank you for your question regarding what to do with loose skin around the lats. Congratulations on your weight loss. This is a common problem for patients who have undergone massive weight loss. The only way to remove the skin is to have the skin excised. Liposuction will not remove the skin. It only removes fat. In your situation, I would suggest a torsoplasty. A torsoplasty is a plastic surgery procedure that removes excess skin and fat from the torso. There are two types of torsoplasty horizontal torsoplasty and vertical torsoplasty. I would suggest, in your case, a vertical torsoplasty. In a vertical torsoplasty, an incision is made from the armpit down the side of your torso. A large elliptical area of skin and fat is removed. The result is a scar that goes down your side that is usually hidden when your arms are at your side. The only disadvantage of this procedure is that the nipple is pulled to the side or laterally. During the procedure, the nipple must be relocated as a sliding or free graft. Your plastic surgeon will discuss this with you at length. Another option is a horizontal torsoplasty. In a horizontal torsoplasty, the incision starts underneath the breast and extends across your back. The disadvantage of this procedure is that there is a noticeable scar across your back. In women, this scar is easier to hide. In men, this scar is more challenging to hide. Either way, I do not think you need a horizontal torsoplasty. In my opinion, you need a vertical torsoplasty. Thank you for your question regarding what to do with loose skin around your Latissimus Doris after massive weight loss. I specialize in reconstructive plastic surgery after weight loss. If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research. Make sure they have performed at least 100 panniculectomies or circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, panniculectomy or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)