Introduction

Liposuction of the upper back is very important in body contouring surgery. Even considering that this region is loose skin, allowing free movement of the torso and arms, it shows good index of retraction after liposuction. We must inform patients in advance about this feature of the skin, so they do not feel that this is loose skin sagging caused by liposuction. The skin resection is limited to people with thinner skin and with excess skin hereditary characteristic. Especially after the age of 46, when the first signs of skin aging. Liposuction alone resolves the vast majority of cases.

Anatomical Aspects

The back and its extension towards the breast is a region of the body with its own characteristics in liposuction.

The thickness and the ratio between the lamellar and areal layers in the thin individual oscillate from 0.3 to 0.5 cm for the lamellar layer and 1.0 to 1.2 cm for the areolar layer, and may reach 0.5 to 0.8 cm for the lamellar layers and 1.5 to 2.2 cm for the areolar layer in obese individuals.

However, for morbid obesity these values may be higher, highlighting the increase in the lamellar layer.

In liposuction the dense connective tissue is very important because it is thicker in the upper back region, especially in the grooves formed by the excess skin that can result from both genetic inheritance (Fig. 15.1), obesity (Fig. 15.2A and D), sagging senile (Fig. 15.3A, B) or post liposuction (see Fig. 15.2 C and F).

FIG. 15.1 Constitutional skin flaccidity (genetics). The whole liposuction of the upper back was made through a minimal incision in the posterior axilla (arrow). Pre- and postoperative views.

FIG. 15.2 Good skin retraction (A, B, D, E) shown. Thin and senile skin (C and F) may present residual skin protuberance.

FIG. 15.3 Resection of senile skin flaccidity.

Another important feature is the loose connective tissue (Fig. 15.4B) that grips the skin and subcutaneous muscle (aponeurosis) in this region making it easier to rip of the whole skin and subcutaneous tissue without detaching it surgically during resection flaps (Fig. 15.4C and D).

FIG. 15.4 (A) Liposuction before skin resection. (B) Skin resection. (C) Excised skin. (D) Suture made (posterior view).

Surgical Treatment

Planning – Demarcation

Liposuction of the upper back can be performed only by minimal incisions of 5 mm at each subsequent level of the armpits (see Fig. 15.1A and C).

Where it is planned, resection of skin incisions may be made in the flaps (see Fig. 15.4).

The upper line of resection of the back is marked by pulling down the skin of this region and marking ± 2 cm above the submammary horizontal extension of the line (Fig. 15.5E and 15.8F).

FIG. 15.5 Constitutional skin excess exacerbated by obesity (A–F). The sequence shows the demarcation of the back skin resection and associated mammaplasty.

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