Background: Besides a tummy tuck there are numerous different types of body lifts that are far less known. One uncommon but most well known of these more obscure types is the back or bra line lift. This is a horizontal excision of tissue across the back for excessive tissue which typically presents as oblique rolls. By removing a horizontal strip of back tissue along the bra line the rolls are reduced or eliminated by lifting them up to close the excision site. The scar line is usually acceptable since it should be ‘hidden’ under the bra line.
Besides removing loose back tissues the horizontal backlift provides good access for rib removal body contouring. The lower ribcage can be readily accessed for bony removal. The wide open access also provides a great opportunity to trim the wide and broad latissimus dorsi (LD) muscle which contributes to torso widening. A long and wide strip of the lateral border of the muscle can be removed from both sides to add to the rib removal effect.
Case Study: This patient presented for secondary body contouring with a prior history of breast reduction and bra line lift scars. She also had a history of a tummy tuck. Despite these prior surgical efforts she had residual loose upper abdominal skin above the belly button and loose lower back tissue below the bra line. She was interested in further body contouring efforts including rib removal.
A circumferential body lift was planned (upper abdominal lift anteriorly and a secondary backlift posteriorly. Through the backlift rib removal was planned.
In the supine position under general anesthesia the lower end of the horizontal backlift markings was incised and the back flap raised down to expose ribs #11 and #12. The ribs were circumferentially dissected out and removed.
When removing ribs it is important to try and preserve the intercostal nerves along their inferior edge. Exparel-soaked gel foam sponges are placed into the rib removal space for postoperative pain control and the serrates muscle closed over it.
Then a 2 to 3cm long strip of the LD muscle can be taken from its outer border along as much of its length as can be seen.
The backlift is then completed and closed using quilting sutures so drains were not needed.
The patient is then turned over so the anterior part of the body lift can be completed. (upper abdominal lift)
Backlifts do provide good access to perform rib removals whether it is a horizontal or vertically oriented type excision.
Key Points
1) The horizontal backlift provides convenient access for rib removal for lower torso/waist narrowing.
2) Rib removal can be combined with an upper circumferential body lift. (horizontal backlift + upper abdominal lift)
3) The horizontal backlift also provides great access for LD muscle reduction which is a helpful adjunct for torso narrowing.
Dr. Barry Eppley
World-Renowned Plastic Surgeon