Brachioplasty

A brachioplasty, or arm lift procedure, is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. It reshapes and provides an improved contour of the upper arms and connecting chest wall. A beautiful arm has always exuded a sense of fitness and anatomic prowess. From the early works of the Renaissance to our new popular culture, a fit arm has been an important part of the quest for beauty and health. In the literature of plastic surgery, the first description of brachioplasty was by Correa-Iturraspe in the Argentinian Medical Press in 1954.

The main indications for a brachioplasty is either massive weight loss or excess skin in the upper arms. The extent of the lipodystrophy or excess skin then determined the types of brachioplasty that these patients need.

The dramatic differences in body habit and weight loss translate to myriad presentations in arm recontouring. The extension of excess arm skin and lipodystrophy also carried toward the lateral chest wall and upper body. Some of these patients had a combination of brachioplasty and thoracoplasty. Some also had upper body lifts as a part of the constellation of strategies aimed at their upper truncal recontouring.

From this diverse group, four types of brachioplasty were determined and classified. Type I patients had very little excess skin, most of it occurring in the upper arms. These individuals were candidates for the less commonly used minimal incision brachioplasty. These patients had minimal lipodystrophy. Type II patients had moderate excess skin in the upper arms and underwent a standard brachioplasty. This was a common group that presented with the arm as their central complaint. Many of the non-weight loss patients fell into this category. Type III patients had both excess skin and lipodystrophy, and majority of this group had a combination of brachioplasty and suction-assisted lipectomy (SAL). Most of these patients also had involvement to some extent of the lateral chest wall. Many of the patients that did not have optimal weight resolution were in this category. Type IV patients had not only excess arm skin and lipodystrophy, but also significant involvement of the lateral chest wall and upper body. This group had a combination of brachioplasty along with thoracoplasty and/or an upper body.

There are a number of ways in which the skin and fat excess can be managed. It usually involves a combination of surgery (conventional and extended brachioplasty) and liposuction

Below is a picture demonstrating the incision that most often will be utilized.

If there is a lot of excess skin and adipose tissue the excision will continue along the latera aspect of the chest.

Planning your surgery

Our initial consultation is very important. We will need your complete medical and surgical history and a list of all medications so as to determine your fitness for surgery. Thus check your records before so as to provide the information. Be sure to inform me if you have any allergies, taking any vitamins or herbal formulation, drugs, smoking, poor healing of wounds, bleeding tendencies or a personal or family risk of deep vein thrombosis.

You should carefully discuss your goals and expectations with me and make sure that you we have a mutual understanding of the expectations.

The Surgery

The operation may takes 2 to 3 hours depending on additional procedures.

The incisions will be marked before the operation.

The procedure will be performed under general anesthetic. Mild liposuction of the arms will be performed followed by excision of excess skin and fat.

Drains will be left in both arm which will remain until it drains less than 30 ml in 2 consecutive days.

The incisions will be closed with absorbable sutures and a bandage applied.

After the surgery

The immediate postoperative care includes placing specific dressings on the skin and compressive garments. Patients are instructed not to bend at the elbow for the first 24 hours and are highly encouraged not to engage in any strenuous activity for the first 2 weeks after the operation. Swelling is certain and are instructed to avoid wearing rings or any compressive ornaments for the first 2 weeks after the operation.

Regular postoperative visits start a regimented program of scar care. For the first 2 weeks, the scar is covered with Steri-Strips. This is then replaced with Micropore brown tape for another week.

At this point, a rest period from any coverage will determine the integrity of the scar and lack of any wound separation or eschar formation. Once this is determined the scar protocol is started. It is recommended that the patient continue with the scar regimen for at least 4 months after the procedure.

Stretching the arm into a full arm raise and manual massage are also important instructions that are given to patients postoperatively.

Pain, swelling and bruising will persist post operatively and will gradually resolve over the following 2 weeks. You will be given antibiotics and analgesia to take home and use as instructed.

Puckering and irregularities of the scars are common and will gradually disappear over the ensuing months.

If you experience any severe or worsening pain or any loss of function please contact your surgeon immediately.

Your new look:

Complications associated with brachioplasty.

The most significant compilations are: an ugly, visible scar ; permanent numbness of skin of the arm and lymphedema or swelling of the arm requiring extensive physiotherapy .Below follows a list of some of the more frequent complications associated with brachioplasty:

Local Complications:

-Pain and Bruising

-Swelling

-Infections

-Seroma

-Hematoma

-Wound separations

-Lymphoedema

-Loss of sensation

-Poor scarring and widening of the scar

-Puckering of the surgical scar.

Systemic complication…. your body

-Fluid and electrolyte abnormalities

-Deep vein thrombosis

-Post operative lung complications

Long term and cosmetic complications… the way it looks

-Poor scarring

-Over Correction / under correction

-Slight asymmetries

-Visible Scar

-Loss of sensation

-Scar Contracture

-Need for secondary surgery

Patients with significant deformity due to excess fat and skin have a high likelihood for the performance of a second procedure, as all the anatomical deformities are impossible to correct in a single procedure.

In Conclusion.

Healing is a gradual process, and scars may appear pink for up to six months after surgery. Please avoid sunlight (any UV radiation) during this time. Eventually the scars will fade to a thin invisible white line. You will have a more youthful appearance and in many patients the results are permanent.

Brachioplasty is a major surgical procedure with the complications of visible scars and loss of sensation on the medial aspect of the upper arm. All things considered many a patient have expressed immense satisfaction with their new frame in fitted clothing.