Back rolls — the folds that sit across the upper and mid back, often made obvious by a bra band — are one of the least discussed results of major weight loss and one of the more visible. They are usually skin, not fat, which is why they do not respond to exercise and why liposuction alone rarely helps.
The operation removes them directly, and it accepts a scar across the back in exchange.
Why they form
Skin across the back is thick and, once stretched, retracts poorly. After substantial weight loss the underlying volume goes and the envelope stays, settling into horizontal folds. A bra band compresses one of them and makes it look like a defined roll, which is why patients often describe it as a bra roll.
They also sit awkwardly with other procedures: an upper body lift addresses the trunk, but a roll high on the back may remain unless the plan includes it.
How it is treated
| Approach | What it involves | When it applies |
|---|---|---|
| Direct excision | The roll is removed and the scar placed in the fold, where a bra band covers it | A discrete roll with good skin above and below |
| Upper body lift | A circumferential excision addressing the back, flanks and chest wall | Looseness continuing around the trunk |
| Extension of a breast procedure | The lateral scar from breast surgery is continued onto the back | Where the roll runs continuously from the breast towards the back |
| Liposuction | Reduces bulk before or during excision | An adjunct, rarely the whole answer after weight loss |
The scar
It runs horizontally across the back, positioned to sit where a bra band or the waistband of a garment covers it. Back skin is thick and under tension, so scars here tend to widen more than abdominal scars do. Dr Kumar will mark it on you and show you where it will fall before you consent.
Prineo and Micropore stay on the wound for six weeks and a compression garment is worn for the same period. Dr Kumar reviews his surgical patients for twelve months and manages scars at every visit.
Combining it
Back roll excision is often done with breast surgery or as part of an upper body lift, because the incisions and the recovery overlap. Combining usually costs less than separate operations, since you pay for one anaesthetic and one hospital stay — but it makes a bigger single operation and not everyone is a candidate. Dr Kumar operates at Westmead Private Hospital and will tell you what he is prepared to do in one sitting. See staged body contouring.
Medicare
Item 30169 covers removal of redundant non-abdominal skin for functional problems following significant weight loss. Functional problems means recurrent rashes or skin breakdown in the fold, or interference with daily activities, rather than appearance. A circumferential procedure may fall under item 30179. More about costs.
Recovery
Two weeks off work, a gradual return over the following four, and full clearance at around twelve weeks. Drains are used. Sleeping is the awkward part for the first fortnight — you will be advised to sleep on your side or propped rather than flat on your back.
Complete abstinence from all nicotine, not just smoking, is required for eight weeks before and after body contouring after weight loss. There is background on weight stability and timing at My Weight Loss Journey.
Common questions
Will exercise get rid of them? Building the back muscles can improve the look of a fuller back. It does not shrink stretched skin.
Can liposuction alone work? Only where the roll is genuinely fat with good skin, which is uncommon after major weight loss.
Is the scar hidden? It is placed where a bra band covers it, but back scars widen more readily than abdominal ones. That is the honest trade.
Can it be done with breast surgery? Frequently, and that is often the most efficient plan.
How do I know what I have? Examination, or send photos first if you are travelling.
Next step
Bring a GP referral — it is required to see Dr Kumar — and ask for a plan covering the whole trunk rather than one area. He consults at Westmead, Penrith and Orange. Call 1300 267 726. More about body lift and body contouring after weight loss.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
