How Does an Upper Body Lift Differ From a Lower Body Lift?

The excess skin and fat from extreme weight loss often creates a circumferential hanging effect at many levels of the body. While many think of the body lift as only one contouring procedure, they are only thinking of the lower body lift or circumferential body lift procedure. There is another body lift procedure for the upper body, not surprisingly called the upper body lift.
Like the lower body lift, the upper body lift is a combination of three body contouring procedures. A frontal breast procedure (for both women and men), a side chest wall lift, and an upper back lift. In some cases, the cut out of loose skin may extend into the arms as well. This combined operation leaves long scars around the upper body but are usually a worthwhile trade-off for the dramatic improvement in the shape of the upper body. The resultant scars across the back and on the side of the chest are horizontal, much like the lower body lift. The change is in what occurs across the chest/breast area. Usually I like to keep it in the lower chest/breast crease and make it horizontal also. It can certainly be combined with a breast lift or a gynecomastia reduction if needed. But the one thing you don't want to do is cross the midline/lower sternal area with a scar if you can avoid it. The risk of scar widening is very likely in this area, not to mention being very noticeable particularly in women. Therefore an upper body lift is not always completely circumferential as a lower body lift would be.
Upper body lifts are not as common as lower body lifts because it takes a very extreme amount of weight loss to create enough skin to justify the operation. Usually the patients must have lost 150 to 200 lbs after their bariatric surgery. The upper body lift has its greatest effect in the problematic area of the side of the chest wall and upper back. As a result, it would not be uncommon to just do a partial upper body lift stopping short of the chest/breast area and not crossing the exact middle of the back. Upper body lifts have the same riska and postoperative issues as lower body lifts including poor scarring, small areas of wound separation, and fluid build-up after the drains are removed.

Correcting the Chest Deformity in the Massive Weight Loss Patient

Currently, men make up a minority of patients presenting for body contouring surgery after weight loss. However, their numbers are increasing and they have several different body concerns that women. One of these is that of the chest area. The skin sag and the presence of excess fat under the nipple creates a relatively new type of problem. Some call this chest problem gynecomastia but that is inaccurate. It is really pseudogynecomastia as it has more skin and less actual fat.
Most male chest deformities after weight loss require dealing with the extra skin. Some patients may need liposuction only but this is not common in my experience. When a male patient is motivated to undergo chest reconstruction, they almost always have a significant problem. It usually requires removal of skin and then what to do with the the sagging and often stretched out nipple. The skin part is relatively easy. The overhanging skin (that which sags below the lower chest crease) is horizontally removed with the goal of making the chest flat and keeping the final scar low enough so that it hopefully lies in the natural skin crease at the lower end of the chest muscle.
The more difficult choice is how to manage the sagging nipple. Choosing a new location is based on standard measurements but how to get there is another. The nipple can be removed and replaced like a skin graft or the nipple can be moved while attached to some underlying breast tissue. (similar to how it is done in a female breast reduction. Both methods are reasonable but they have slightly different outcomes. Free nipple grafting gives one the flexibility to place it anywhere on the chest but the nipple will not have sensation and make look a little artificial and stuck-on. (plus there is no guarantee it will survive and it may lose some color after it is healed. ) Pedicled nipple grafts are harder to perform and are more limited in where they can be placed. But they usually look more natural and have better color. In some cases, the amount of sagging chest skin dictates which nipple technique can be used. But in others, it is a matter of the patient's choice and their level of concern about the look of the nipple.
For male extreme weight loss patients, the chest deformity is right up there in concern just behind the abdominal and waistline areas. Men are most interested in how their chest looks in clothes and want a relatively flat appearance in shirts.