Many women are uncomfortable wearing form-fitting clothes because the skin either above or below the bra line creates rolls detracting from the aesthetics of the female back. Unfortunately this can occur at any age.Spanx may hide the problem, but who wants to wear tight undergarments during the warm weather months.
Causes: The skin of the back and shoulder must accommodate the wide range of motion of the shoulder girdle. When the arms are raised above the head, the skin in the posterior upper armpit region must stretch to avoid restricting this movement. Over time our skin begins to enlarge and increase in surface area, particularly in the posterior –axillary fold region tapering towards the tip of the shoulder blade. The skin lower in the armpit region and sides along the ribs does not require expansion, but a transitional line of fold can develop and become more pronounced with gravity causing a landslide effect on the skin above. The appearance is made worse with a restrictive band of the bra traversing this region thus forming the dreaded “bra strap fat roll”.
Anatomy varies greatly depending on skin type and quality, body mass index (BMI), and age. In some cases, skin folds are very tight without a great deal of excess fat, but the skin is the issue. People with greater BMI scores may have a great deal of fat deposited in this region. The other extreme is the massive weight-loss patient who has very little adiposity but has a great deal of inelastic deflated skin, which hangs over the bra. Each of these types of patients requires different treatments to achieve a pleasing result.
Treatment options: If you have slight increases in fat deposits in your back with deep tight folds, the treatment of choice is suction-assisted lipectomy or liposuction. This will allow a re-draping/distribution of skin to tighten over the back and conform to the new contour.
For the massive weight-loss patient or the person who has a large amount of loose- hanging skin with or without added fat volume, a skin resection technique is often incorporated with an arm lift to correct hanging skin of the upper arms as well. My incision of choice is a vertical resection of skin along the posterior axillary line angle, which is easily concealed.
If bra line skin or fat excess is detracting from the overall aesthetics of your back, you need a qualified plastic surgeon to thoroughly evaluate your situation to determine the right treatment option to feel more confident in your own skin.