Hello, Sa095, in Fayetteville, GA. Thank you for your question regarding a 120 lb. weight loss and what your options are for the side boob area. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. You have cutis pleonasmus (excess skin), dermatocholosis (loose skin), striae (stretch marks), and lipodystrophy (excess fat) of the side boob and lateral torso area. Liposuction only removes fat, not skin. Therefore, liposuction alone will not work. You need excision of lateral boob skin and fat. There are two primary surgical techniques used to remove excess skin and fat from the upper back after massive weight loss or significant skin laxity: the vertical torsoplasty and the horizontal torsoplasty. A horizontal torsoplasty is also commonly referred to as a bra line back lift, bra strap lift, brachioplasty of the back, upper back lift, bra lift, or upper body lift. During a vertical torsoplasty, an incision is made beginning in the armpit and extending downward along the side of the chest in the midaxillary line. The incision extends vertically sometimes to the top of the bra strap, bottom of the bra strap, bottom of the ribs, or sometimes even to the top of the hips. The length of the incision depends on the amount of excess skin and fat. A vertical torsoplasty is often called an hourglass procedure because it narrows the waist and improves the contour between the chest and hips. The skin and underlying tissues are carefully elevated toward the back, allowing the excess lateral chest and upper back skin and fat to be mobilized forward. A football-shaped segment of excess skin and fat is then removed to tighten the lateral chest and improve the contour of the upper torso. The resulting scar lies in the midaxillary line, making it relatively inconspicuous when your arms are at your sides. The procedure is performed under general anesthesia and typically takes approximately two to four hours to complete. A surgical drain is usually placed and remains in position for approximately 7 to 10 days to reduce fluid accumulation during healing. Most patients should plan for about two weeks away from work and strenuous activities. Wearing a medical-grade compression garment continuously for at least six weeks is recommended to minimize swelling, improve comfort, and optimize scar maturation. A vertical torsoplasty is frequently combined with a longitudinal brachioplasty (arm lift), allowing the incisions to connect seamlessly within the armpit for a more harmonious body contour. During a horizontal torsoplasty, also known as an upper back lift or bra line back lift, an incision is made horizontally across the upper back in a location that is typically concealed beneath a standard bra strap. The skin and underlying tissues are elevated, and a butterfly-shaped segment of excess skin and fat is removed. The remaining tissues are then elevated and tightened, lifting the upper and lower back to create a smoother, firmer contour while eliminating redundant rolls of skin and fat. The final scar is designed to remain hidden beneath most bras and swimsuits. The operation is performed under general anesthesia, and two surgical drains are usually placed to minimize postoperative fluid collections. These drains typically remain in place for approximately two to three weeks, depending on your drainage volume. Recovery generally requires two to three weeks before returning to work and routine daily activities, although strenuous exercise and heavy lifting should be avoided for approximately six weeks. A medical-grade compression garment is recommended during the healing period to reduce swelling, improve comfort, support the surgical repair, and help achieve the best possible cosmetic outcome. Based on your photographs and physical examination, you are an excellent candidate for a horizontal torsoplasty, as this procedure will provide the greatest improvement in your upper back contour, remove excess skin and fat, and create a smoother silhouette. However, it is important to understand that a horizontal torsoplasty results in a permanent scar that extends across the upper back. If you feel that you would not be comfortable with this scar, then you should not undergo a horizontal torsoplasty. In that situation, a vertical torsoplasty may be a better option because its scar is positioned along the side of the chest and is generally concealed when your arms are resting at your sides. However, remember that a horizontal torsoplasty will yield better results than a vertical torsoplasty in your case. Both the vertical and horizontal torsoplasties are highly effective procedures for treating excess upper back skin and fat following massive weight loss, bariatric surgery, pregnancy, or age-related skin laxity. The ideal procedure depends on your anatomy, skin quality, aesthetic goals, and your willingness to accept the location and length of the resulting scar. During your consultation, your plastic surgeon will review your examination findings, discuss the advantages and limitations of each technique, and determine which procedure will provide the safest operation and the most aesthetically pleasing, long-lasting result. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. Good luck. I hope I've answered your question regarding a 120 lb. weight loss and what your options are for the side boob area. I hope I have answered your question regarding combining vertical and horizontal torsoplasty versus back liposuction. If you have any more questions regarding back liposuction, back lift, vertical torsoplasty, hourglassing procedure, horizontal torsoplasty, bra strap plasty, or bra plasty, 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 pictures and check their reviews on RealSelf. 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.)
