Definition and Overview

Back lipectomy is a surgical procedure wherein excess tissues, specifically fat and skin, of the back are removed. Target areas are usually the flank (love handles) and the lower or upper back. It is typically performed on both sides to achieve more symmetrical results.

Although back lipectomy removes excess fat, it is not an alternative to proper diet and exercise. Rather, it is used to improve the shape of the patient’s body particularly those who have lost a lot of weight and have an ongoing exercise regimen and diet.

Who Should Undergo and Expected Results

Obesity is a serious medical condition that is becoming increasingly more common. With this condition, there is an accumulation of excessive body fat resulting in negative effects on a person’s health. Obesity puts an individual at risk for a number of medical conditions, including diabetes mellitus, heart disease, arthritis, and obstructive sleep apnoea, among others. A body mass index of more than 30 kg/m2 is generally defined as obese although in some Asian countries, a lower value is used. An estimated 600 million adults are obese and more and more children are now also diagnosed with the condition. The initial treatment involves conservative measures particularly lifestyle modification that focuses heavily on diet and exercise. Several medications, such as orlistat, have also been approved for use. The most effective treatment, however, remains to be surgical. Bariatric surgery is associated with permanent weight loss and decreased rates of related medical conditions and mortality.

Unfortunately, even if these treatment measures result in long-term weight loss, excess tissue can remain in certain areas of the body such as the back. This is where back lipectomy comes in. Back lipectomy can be performed to eliminate excess fat that does not go away, even with aggressive conservative treatment. Aside from the removal of fatty deposits and excess skin, the procedure also enhances the shape of the back, making it tighter and providing contour.

How is the Procedure Performed?

Back lipectomy is usually performed under general anaesthesia and on an outpatient basis, which means that the patient can go home on the day of the surgery. The procedure may be performed alongside other cosmetic surgical procedures, such as an abdominoplasty, better known as a tummy tuck, to achieve more aesthetically pleasing results.

Prior to the actual procedure, excess skin and tissues are marked, the target area is cleansed, and anaesthesia is administered. Small incisions are then made and a cannula, an instrument attached to a vacuum, is inserted underneath the skin to reach the subcutaneous tissues and fat. The surgeon then scrapes the fat cells off and the vacuum suctions it out of the body.

In some patients, the excess skin does not have to be removed, as skin is elastic and can retract. However, in cases wherein elasticity has been lost, excess skin may be excised to achieve a smoother appearance.

After the surgery, drains are usually placed to remove residual fluid and patients are advised to wear some form of elastic support, such as an abdominal binder. Although the patient is sent home after the procedure, restriction in certain activities is advised for several days. Recovery is expected to be nearly complete after two weeks, and patients can resume their regular activities by then.

Possible Risks and Complications

Back lipectomy is associated with some risks, which include the following:

  • Swelling and hematoma – These are expected but typically subside on their own after some time
  • Pain – This can occur but is generally temporary, and can be controlled with pain medications
  • Numbness - There is usually some degree of numbness, which can persist for several weeks
  • Scarring - The incision sites will develop scars, but these typically fade as healing progresses. Depending on how much skin is removed, scars may be extensive.
  • Skin complications
  • Infection and skin dehiscence
  • Skin necrosis – This is a rare complication, but may also happen. It can be treated with antibiotics and prolonged wound care.
  • Seroma formation - Seromas are the accumulation of liquefied fat that form in the subcutaneous area. They develop when the drains inserted become clogged and the residual fluid cannot be removed. Small seromas usually do not require treatment and get absorbed by the body but bigger ones may need intervention, such as aspiration.
  • Asymmetry - After the procedure, the contour of the back may not be symmetric. Irregularities can develop due to several causes, such as uneven removal of fat or loss of skin elasticity. Healing may also not be completely symmetrical. In these cases, an additional procedure may have to be performed to retouch or improve the appearance of the back.


The risk for complications tends to be higher when more areas are treated and more fat is removed.

References:

  • Coleman WP III, Flynn TC, Coleman KM. Liposuction. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 156.

  • Farrior EH, Park SS. Liposuction. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head and Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 31.

  • Kenkel JM, Stephan PJ. Liposuction. In: Neligan PC, ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 24.

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