Upper body lift

A upper body lift is used to improve the body contour by a correction of the entire body circumference. The upper body lift involves circular tightening of the chest and back, in some cases including the upper arms. A body lift is not simply a combination of several skin tightening operations, but rather a comprehensive treatment concept. An upper body lift involves contouring the entire upper body in a single operation, improving the fit of the clothing and facilitating the choice of clothes.

Considerations

When to consider an upper body lift:

• You have excess or loose skin on the breast and back.
• After losing a substantial amount of weight, there remain unattractive fat deposits and folds of skin on the breast and back.
• You have pronounced stretch marks on your breast and back.
• You are willing to accept long scars in order to achieve a better contour and firmer skin of the breast and back.
• Your well-being and self-esteem are negatively affected by the changes on the breasts and back.

An upper body lift involves the removal of excess skin and fat on the upper body, including the breasts, the back and potentially the arms that cannot be eliminated by other means. It is possible to perform the operation at any age, as long as there are no serious underlying medical conditions that might increase the risk of surgery. The prerequisite for an upper body lift is a stable body weight, as strong weight fluctuations may affect the surgical outcome. A desired pregnancy or planned weight loss should be considered before an upper body lift. Severe obesity may be a contraindication for an upper body lift, increasing the risk of surgery and significantly affecting the expected result. An upper body lift is not a suitable method for weight loss, although several kilograms of skin and fat can be removed.

Consultation

A prerequisite to a successful operation is careful planning. This starts with a personal consultation at the AARE KLINIK.

• Communication of wishes and expectations ascertain what you would like to improve.
• Explanation of the possibilities, scope and limitations of the operation.

Examination:

• Medical history is taken.
• The upper body is examined and digital photos are taken.
• The strength and elasticity of the skin, the amount of excess skin and the thickness of the fatty tissue on the breast and back are determined.
• Individual factors and personal wishes help in jointly deciding the choice of the appropriate surgical technique, the position of incisions and the resulting scars.
• In addition to lifting the breast and tightening the back skin the surgery may include in addition liposuction, an augmentation of the breast with silicone implants, autologous fat injection (lipoaugmentation), or soft tissue flaps from the back (dermofat flaps) or an upper arm lift (brachioplasty).
• All risks and possible complications of surgery will be discussed with you.
• Based on this, an individual treatment plan is drawn up and goals of the operation are discussed and defined.
• Risks and possible complications are discussed and documented.

To plan the operation and to make a risk assessment we require:

• Full medical history (pre-existing conditions and previous surgery).
• Current diseases (high blood pressure, diabetes, thyroid dysfunction, etc.).
• Allergies or aversion to medications.
• Any important medical reports (please bring any important medical information).
• If you are intending to lose a significant amount of weight to get pregnant, this should be considered when planning an upper body lift.
• It may be advisable to wait for the stabilisation of your weight or after pregnancy before surgery is undertaken.

Procedure

Individual factors and personal preferences determine the choice of the operation method. The operation begins at the back and continues with the treatment of the breast. Breast correction is similar to a breast lift (mastopexy), but missing breast volume (e.g. after massive weight loss) can be replaced in part by shifting excess tissue from the back (dermoglandular flap), by using silicone breast implants (augmentation mastopexy) or by lipofilling (lipoaugmentation). The incisions are positioned so that the resulting scars can be concealed beneath clothing (bra, underwear), follow natural skin folds or are hidden under the breasts. The exact position of the scars vary between individuals and depends on the preferred style of dress and personal preferences. The incisions are closed with layered suturing techniques in order to achieve an optimal and lasting tightening effect. Drainage tubes are inserted at the end of the operation, to remove blood and wound secretion.

An upper body lift is generally performed as an inpatient procedure under general aesthesia in a private hospital. The surgery usually takes 5–7 hours.

Risks

Upper body lifts are common cosmetic surgeries. Complications, such as infection, healing problems or circulatory disorders of the skin are infrequent when surgery is conducted with the proper procedures and care. However, in individual cases a prolonged treatment or another operation may be required. Every patient should be informed of all the benefits, risks and possible complications involved.

Minor complications and side effects that usually resolve spontaneously include: bruising (hematoma), wound fluid accumulation (seroma) and swelling. Severe hematoma or seroma may require surgical evacuation to prevent further complications, such as delayed healing and infection. Some numbness of the breast and back skin is common after an upper body lift, but is usually temporary and improves with time.
The risk of severe complications such as circulatory disorders of the breast or back skin and wound healing problems along the suture lines is increased in smokers or patients with chronic diseases, such as diabetes. Combined interventions also increase the risk of complications.

General risks

• Haematoma (bruising), bleeding and swelling
• Seroma (accumulation of wound fluid)
• Healing problems or infection
• Wound breakdown/dehiscence (separation of wound edges)
• Injury of nerves or vessels
• Numbness in area of operation (temporary or permanent)
• Circulatory problem in the breast and back skin (skin slough)
• Slight asymmetry
• Unsatisfactory aesthetic result
• Secondary surgery
• Thrombosis or embolism

Overall an upper body lift is a safe procedure when undertaken by an experienced plastic surgeon and patients are mostly satisfied with the results. You can help to minimise the risks by following the advice of your surgeon.

Preparation

Our aim is to make the time before and after your surgery as comfortable as possible. By following a few recommendations you can support our care:

• To aid the healing process, avoid smoking for two weeks before and after the operation.
• Avoid medications that increase the risk of bleeding, like aspirin, non-steroidal anti-inflammatory drugs, as well as vitamins and homeopathic remedies for two weeks prior to the operation.
• Depending on your age and additional risk factors, it might be recommended for you to have an X-ray (mammogram) or ultrasound examination (sonograph) of your breast before and after having the operation.
• This is to rule out pre-existing changes in the breast and, if necessary, allow their removal during the operation and to aid in the detection and assessment of future changes in the breast tissue.
• Having a breast lift as part of an upper body lift does not increase the risk of developing breast cancer.
• Mammograms or breast ultrasound can still be carried out after a breast lift (mastopexy).
• Simultaneous breast augmentation using silicone implants limits the use of mammography after surgery, but other imaging methods, such as sonography and magnetic resonance imaging (MRI) can still be used to examine the breast.
• An upper body lift is mostly performed as an inpatient procedure under general anaesthesia.
• The duration of hospitalisation depends on the extent of surgery and the combination of several procedures.
• Recovery time varies for each individual and also depends on pre-existing conditions and whether complications occur.

Day of surgery

In most cases, an upper body lift is performed under general anaesthesia as an outpatient procedure or with an over-night stay at the AARE KLINIK. In individual cases, when necessary, the procedure can be undertaken in an affiliated private hospital.

• During surgery you will receive various medications for your wellbeing.
• For your safety, your heart rate, blood pressure, oxygen supply etc. are monitored during the operation.
• After the operation, drains are usually inserted to prevent the accumulation of blood and serous fluid in the wound.
• The wounds are dressed and a special compression bra or garment is applied to protect the wound and to reduce the swelling.
• You will be taken to the recovery room, where you will have continued monitoring until you awaken and are able to get up.
• You will be allowed to return home after a few hours.
• If you are an inpatient, you will remain in hospital under surveillance until the following day.
• Already on the day of the surgery you should get up regularly for a few minutes in order to minimise the risk of thrombosis.
• The level of pain after an upper body lift is usually not severe and can be compared with muscle soreness.
• You are advised to take mild pain relief that reduces swelling and should be continued for several days after surgery.
• In case of an ambulatory procedure, you should have someone to care for you continuously for 24 hours postoperative.
• We also provide the option of an over-night inpatient stay at the AARE KLINIK in a single room with a personal nurse care, if needed.

After surgery

• It is important to realise that recovery from an operation varies for every individual.
• You should rest in the first days after an upper body lift.
• Do not raise your arms above shoulder height, or move them excessively and do not lift heavy objects.
• As a rule, you should sleep on your back for several days.
• Only take the prescribed painkillers and avoid any medication that contains aspirin or other blood-thinning substances.
• Wear the compression bra or garment continuously day and night over a total period of 4-6 weeks.
• In the first 2–5 days after the procedure, a feeling of tension and light pain will be felt in the region of the surgery.
• Breast and back skin may feel temporarily numb and hypersensitive. This is usually temporary. However, it may take weeks or months, in some cases even longer to return to feeling completely normal.
• Slight swelling and bruising in the area of surgery usually subsides within 2–3 weeks.
• Typically you will be back on your feet a couple of days after surgery and be able to resume your daily activities.
• Drains are removed in the first days after the operation, after which you can take showers again.
• Full baths and excessive heat (e.g. sauna), however should be avoided for several weeks until swelling has receded.
• Most sutures will dissolve by themselves and do not need to be removed.
• Non-dissolvable sutures are removed after one week.
• After removal of the sutures, we recommend the start of an intensive skin and scar care with rehydrating creams and light massage.
• In individual cases it may be useful to have special treatment with silicone gel or silicone pads over a period of 2–3 months.
• The fresh scars should be protected from UV radiation for at least six months, in order to prevent increased pigmentation.
• Physically demanding activities and sport should be avoided for several weeks.
• After surgery you will be examined at the AARE KLINIK at regular intervals, so that the healing process can be assessed until the final result is achieved.

Outcome

• Swelling and bruising may remain for some time after surgery.
• The healing process is gradual and it takes several months before the final result can be conclusively determined.
• Scars might be red or appear darker pigmented for several months, but this colour will fade with time.
• Sometimes scars appear even worse after a few weeks before they heal becoming flatter and paler.
• Scars are easy to conceal under clothing.
• Swollen (hypertrophic) scars may require treatment with special silicone pads and cortisone injections.
• An upper body lift improves the contour of the entire upper body, lifting the breast and tightening the back skin.
• At the same time, an upper body lift dramatically changes your appearance, making you look slimmer.
• It may sometimes take a while until you become accustomed to your new appearance.
• Without the loose skin and heavy breast physical activities and sports are easier and more pleasurable.
• After an upper body lift, women often feel more self-confident and find it easier to wear certain clothes.
• The result of an upper body lift is usually long lasting.
• Gravity, the aging process, weight fluctuations, pregnancy and lifestyle continue to affect the outcome over time.
• If you are unhappy after a few years, another breast or back lift can be performed.

Costs

An upper body lift is usually an aesthetic procedure, in which case the costs have to be carried by the patient. In exceptional cases, where there is functional impairment, (e.g. chronic skin infection or back pain) the surgical correction is medically indicated. In these cases, the treatment costs may be covered by health insurance after a prior cost estimation is given. A normal body weight, demonstrably failed non-invasive treatments, including long-term physical therapy, and an expected weight reduction of more than 500 grams per breast are prerequisites for a medially indicated surgery. The decision for, or against reimbursement depends on the recommendation of the medical officer in each individual case.

If the intervention is based on a combination of medical and aesthetic indications, then the costs related to the medically indicated aspects will generally be covered by health insurance.

The costs of an aesthetically motivated upper body lift are variable and mainly depend on the complexity of the operation and the facility in which the surgery is performed (hospital or AARE KLINIK). A more accurate cost estimate can therefore be made only after a personal consultation.

The costs are composed of:

• Surgical fee (including consultation and post-operative care)
• Anaesthesia fee
• Technical infrastructure costs (AARE KLINIK/hospital)
• Inpatient hospital costs
• Compression bra/garment
• Medication
• Diagnostics (laboratory, ECG, scans, etc.)

Meet PD Dr. med. Oliver Scheufler

Dr. med. O. Scheufler, specialist in plastic, reconstructive and aesthetic medicine and author of this website, is pleased to be at your service for a personal consultation. Besides his main work at the Aare Clinic, PD. Dr. Scheufler is also scientifically active and has habilitated at the University Hospital of Basel. He was therefore awarded the title of assistant professor by the University of Basel. In addition, he was honored by Duke University (USA) as a Visiting Professor. So do not hesitate to contact him if you wish a professional consultation!