Sir:
Comprehensive body contouring surgery after massive weight loss includes the upper torso. A common approach for treating skin laxity combines a reverse abdominoplasty with a transverse excision of excess mid-torso and back skin, leaving a circumferential transverse scar. Although the back scar can usually be hidden along the bra line, avoiding it would be preferable. For mild to moderate skin laxity of the back, we have designed an excision pattern in the shape of the letter J for the left anterolateral torso and a mirror J for the right side (Fig. 1). The excision pattern is framed at the posterior axillary line and recruits the back tissue excess anteriorly. The final scar is well hidden at the axillary line, avoiding the circumferential scar. This is a case series report of patients treated over the past 2 years.
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Fig. 1: A 39-year-old woman underwent brachioplasty, J torsoplasty, and spiral flap augmentation.
The operation is performed entirely in the supine position with the arms abducted 90 degrees onto arm boards. A curvilinear crescent-shaped excision is designed extending along the inframammary fold to the lateral chest and then ascending through the posterior axillary line. When treating lower back rolls, the apex of the crescent excision is directed inferiorly. In women, the back advancement flap is suspended to the serratus muscle just lateral to the breasts. In men, the back advancement is sutured to the anterior chest skin, thereby further tightening chest skin over the pectoralis muscle.
The J torsoplasty was performed successfully in 30 consecutive patients (19 women and 11 men). The technique was combined with breast mastopexy in 19 cases, breast self-augmentation (using the spiral flap) in 18 cases, brachioplasty in 19 cases, and gynecomastia correction in nine cases. The contour of the upper torso was improved by reducing the lateral rolls of the back while hiding the scar at the midaxillary line. The complications are listed in Table 1. The most frequent complication was minor axillary dehiscence (13 patients). No significant correlation was found between the combination of procedures and the complications. The complications were treated with conservative measures. Scar revision was performed along three of the J excisions because of residual pleating of gathered back skin. A representative case is presented in Figure 1.
Table 1: All Complications
The J torsoplasty modification of the upper body lift satisfactorily corrects mild to moderate back deformity associated with massive weight loss in both sexes. More importantly, it avoids circumferential scars across the back, with acceptable morbidity.
Julio A. Clavijo-Alvarez, M.D., Ph.D., M.P.H.
Division of Plastic and Reconstructive Surgery, University of Pittsburgh
Dennis J. Hurwitz, M.D.
Private practice, Pittsburgh, Pa.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
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