Can combining a breast reduction incision up to an arm lift incision address some upper back laxity? (Photos)

Question

I have had a significant amount of weight loss (33% of my original weight) and I have a lot of loose skin. I want to have a breast reduction done ideally at the same time as an arm lift. I have seen some individuals with these scars combined and their back appear improved as it pulled it up. What is this called? Can this improve the loose skin on the back? I am aware an upper back lift would address it completely, but the scar across my back is not something I really want - I’m looking for better, not perfect. Thanks!

J. Timothy Katzen, MD, FACS · Answer

Hello Mataztinkerbell, Thank you for your question regarding whether you can combine a breast reduction incision with an arm lift incision to address some upper back laxity.  Thank you for your history and your pictures.  First, let’s analyze your pictures.  You have cutis pleonasmus (excess skin), dermatocholosis (loose skin) of the outer breasts or breast roll.  
There are two ways to remove fat from the side of the breasts: the vertical torsoplasty or horizontal torsoplasty.  A horizontal torsoplasty is also called a braplasty, bra straplasty, upper back lift, bra lift, or upper body lift.  A vertical torsoplasty is also called an hourglassing procedure.  Based on your back pictures, you would do best with a horizontal torsoplasty.  However, if you cannot handle the horizontal torsoplasty scar, don’t have the procedure.  instead have the vertical torsoplasty.  
An incision is made from the armpit and extends down the side of the chest in the mid-axillary line during a vertical torsoplasty.  An initial vertical incision is made in the front.  Then, tissue dissection is carried out on the back.  The lateral breast skin and adipose tissue are drawn forward.  A substantial portion of excess lateral breast skin and fat, resembling a football, is excised.  The vertical torsoplasty incision is located in the midaxillary line and usually can be concealed by holding your arms at your sides.  The vertical torsoplasty is completed in approximately two hours and is performed under general anesthesia.  Typically, drains are maintained for 7 to 10 days.  You must allocate yourself a two-week recuperation period.  Prolonged use of a medical-grade compression garment for a minimum of six weeks is advised to reduce edema, pain, and scarring.  The longitudinal brachioplasty and/or breast reduction are frequently combined with the vertical torsoplasty.  Typically, the vertical torsoplaasty incision connects withthe brachioplasty (arm lift) in the axilae.  The vertical torsoplaasty incision connects with the breast reduction in the lateral bra line.  Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say.  I hope I have answered your question regarding whether you can combine a breast reduction incision with an arm lift incision to address some upper back laxity.   If you have any more questions regarding back liposuction, back lift, vertical torsoplasty, hour-glassing procedure, horizontal torsoplasty, bra strap plasty, breast reduction, or braplasty, contact an experienced plastic surgeon.  Since the torsoplasty is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the vertical and horizontal torsoplasty.  Do your research.  Make sure they have performed at least 100 torsoplasty surgeries and have the before-and-after pictures to prove it.  Carefully examine their before-and-after photos and review their RealSelf profile.   If you cannot find an experienced torsoplasty plastic surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (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 RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Gary M. Horndeski, MD · Answer

Your back laxity exists in 2 dimensions: horizontal excess and vertical excess. By combining a vertical incision, which is an extension from the horizontal incision of the breast reduction, to the horizontal incision of the arm lift, the vertical component will pull some of the back horizontal excess. However, it will not move the vertical excess. The breast reduction technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This will pull some of back excess as well. At the same time, an arm lift can be done. I usually use liposuction with the arm lift to remove the fat as well as help with dissection. It is possible to connect both incisions at the same time.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

However, it is not as effective at treating back laxity as a transverse excision of skin. In your photos you have your elbows parallel to your shoulders, effectively reducing skin redundancy and you still have skin redundancy. In your situation, do not expect complete tightening of your back skin.  You would also need liposuction to reduce volume and mass of the area in addition to skin excision.

Harry T. Haramis, MD, FACS · Answer

Combining breast reduction with arm lift is common, the scars can be connected, usually around the arm pit and lateral breast.

Usually, some Vaser liposuction of the bra/ back area at the same time will improve results.

An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Zoran Potparic, MD · Answer

It is possible to do all of these surgeries at the same time. Arm lift is frequently combined with breast reduction/lift in patients like you. However, in order to remove back skin there will be a scar extension across your back on both sides. This can be done in two separate surgeries as well. In person consultation with a board certified plastic surgeon is recommended. Good luck.

Can combining a breast reduction incision up to an arm lift incision address some upper back laxity? (Photos)

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