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 Liposuction
of the female back can produce dramatic improvements. The fat on
the back can be subdivided into several important areas:
- Infra-scapular
fat (female flanks) is located above the waist and below the
shoulder blades. This is the unsightly fat that bulges just
below the bra strap.
- Posterior
axillary fat is located on the upper-outer back near the
armpit.
- Posterior waist
fat is located above and posterior to the hips.
- Lumbo-sacral fat
pad is located in midline of the lower back, just above the
tailbone.
- Buffalo hump
consists of fat located on the upper back near the neck.
Infra-scapular Back
Infra-scapular back is the area on the back just below bra. The
fat in this area is a single subcutaneous layer, without a
well-defined deeper fat compartment. When a tight bra is worn,
this area tends to bulge-out more prominently. Some women have
an inherited tendency to collect fat in the infra-scapular back
area. With increasing degrees of obesity the infra-scapular back
can accumulate so much fat that the skin and subcutaneous tissue
can bunch-up forming parallel rolls of fat. Tumescent
liposuction with microcannulas can remove this unsightly
localized "bra-fat" and provide dramatic aesthetic improvement.
Infra-scapular Back Fat is Fibrous
Infra-scapular back fat is fibrous. Fatty tissue contains fat
cells and fibrous connective tissue that hold the fat cells in
place. The fat on the infra-scapular back seems to contain a
higher proportion fibrous tissue than the fat in other areas of
the body. The highly fibrous nature of fat in the subscapular
area makes liposuction a challenge. This densely fibrous tissue
is nearly impossible to penetrate with large cannulas. However,
with the use of microcannulas and tumescent infiltration, this
area can be successfully treated. The greater the fibrous
content of a fat compartment, the greater the resistance to the
penetration by a cannula, and the more difficult it is to
achieve a satisfactory degree of liposuction. The initial use of
smaller microcannulas, followed by gradually using larger
microcannulas, permits more thorough liposuction. Microcannulas
with an inside diameter between 1.2 mm and 2.2 mm, can penetrate
this fat more easily and permit improved cosmetic results.
Previous Large Weight-loss Affects Results
With weight loss by dieting, the fat cells become smaller but
the fibrous tissue remains. Thus after a large weight loss, the
remaining compartment of fat will be relatively more fibrous.
Consequently, when treating patients with rolls of fat on the
back, liposuction is relatively easy if the patient is near her
maximum all-time weight. For another patient of the same height
and weight who has lost a considerable degree of weight,
liposuction of the same area is much more difficult. For mildly
obese patients who do not have excessively fat back, liposuction
can also provide significant improvement. If a patient gains a
significant amount of weight after liposuction of the back, then
some of the cosmetic benefit of liposuction may be lost.
Hyperpigmentation of Incision Sites
The skin on the back is especially susceptible to
liposuction-induced hyperpigmentation of the skin surrounding
incision sites. The number of incisions placed on the back
should be minimized. Trauma to the skin near an incision site
can result in a dark mark known as post-inflammatory
hyperpigmentation.
Microcannulas are better than larger cannulas for avoiding
unnecessary trauma to the skin near incision sites on the back.
Also, hyperpigmentation at incision sites for liposuction seems
more likely to occur on the back than do incisions located more
laterally toward the sides. Thus, when doing liposuction on the
back, surgeons will often place incisions sites as far laterally
as is practical.
Risks of Excessive Liposuction
Because there is no deep compartment of fat on the back, but
merely a thick layer of dermal fat, some surgeons have a
tendency to do excessive superficial liposuction and injure the
skin. The consequence of excessive liposuction that injures the
under-surface of the skin is a permanent discoloration of the
skin known as erythema ab liporaspiration. See figure 10. An
injury to the skin caused by overly aggressive liposuction can
also cause full thickness necrosis of the skin (the skin dies)
that ultimately results in an ugly scar.
Postoperative Care
Postoperative care after liposuction of the back merely requires
adequate coverage with super-absorbent pads, held in place with
an appropriate torso compression garment. A high degree of
external compression is not necessary for liposuction of the
back. The motion of the torso during respiration, and other
normal daily activities are sufficient to completely expel the
residual blood-tinged anesthetic solution from treated areas
overlying the rib cage. The application of absorptive
compression sponges is accomplished in a fashion quite similar
to applying absorptive compression sponges to the abdomen, or
breasts.
Lumbo-Sacral Fat Pads
The relatively small fat deposits on the lower back are easily
removed by liposuction. Caution should be used in the
preoperative physical exam of this area. A focal lipoma or hairy
birth mark may indicate the presence of a defect in the lower
spine. If in doubt, an x-ray of the area should be obtained.
Buffalo Hump
Increasing obesity, is often associated with an increasingly
prominent accumulation of fatty tissue on the mid upper back.
This area is known as the Cervico-Dorsal Hump or the Buffalo
Hump. Liposuction of the dorsal hump is easily accomplished and
patients are uniformly delighted with the results.
Posterior Waist
Posterior waist usually contains a significant fat deposit,
however, it is often overlooked when the hips are treated by
liposuction. |
