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Industry Associations:
Brachioplasty
By Dr. Mark P. Kohout Published: 11/03/2010
Brachioplasty
If you are considering surgery we want you to be thoroughly informed about this procedure. Reading this information is the first step. However, a personal consultation with your surgeon is the best way to obtain any additional information you need.
What is Brachioplasty?
Batwings, arm flaps or just loose arms skin…. Call
them what you will, there is no doubt that loose
skin in the upper arm is considered unattractive.
No age group is immune to this problem and
even if the skin is firm, some people simply have
too much tissue in the upper arm. The thickness
or circumference of the upper arm can be well
out of proportion to the rest of the body.
It makes fitting clothes difficult and wearing
short sleeved shirts, shirts or singlets becomes
very awkward f not impossible. You become
self-conscious and it can affect your self-confidence.
There are several different problems that I see.
The first is the young woman who has the
out-of-proportion arms that won’t fit into the
short-sleeved shirts. They have good, firm skin
and no looseness in the skin. All they want is to
bring the arms into natural proportions so they
are not restricted in what they can wear. This
problem is relatively easy to deal with as it can be
corrected well with simple liposuction. The tiny
5mm incisions are placed discretely in the armpit
crease and will become virtually invisible in a
short period. This procedure can be performed
in day surgery with usually no more than a day’s
worth of downtime.
The second is the middle aged person, both
male and female, who are starting to show signs
of advancing age and they want to turn back
the clock a few years. These patients generally
have a combination of moderate thickening of
tissue in the upper arm ad moderately loose skin.
Depending on the amount of skin looseness,
the incision to remove some of the skin can be
completely hidden in the armpit crease or it may
have to extend a short distance down the arm.
Again, this procedure is very reliable and produces
excellent results to a point where wearing of
T-shirts is no longer an embarrassing chore.
Depending on the extent of the incisions, you
may need a few days off work although it can still
be performed as a day surgery operation.
The third type of problem I will see is the patient
who has lost a significant amount of weight
and can be of any age and either sex. Major
weight loss will result in stretching of the skin
and skin redundancy when the weight has been
lost. Generally, these patients suffer from major
embarrassment and will now show their arms at
all. In this situation, the incision usually has to
extend down the inside of the arm to the elbow.
The hairline scar is a small price to pay for a
thinner, well-contoured arm which will look
great even in short sleeves. This procedure can
be performed in day surgery also although some
patients choose to stay in hospital overnight. The
recovery time is around a week before you can go
back to work (depending on your job)
Initial consultation
During the initial consultation, you may be asked
to point out exactly what you would like to see
improved. This will help your plastic surgeon to
understand your expectations and determine
whether they can be realistically achieved.
You will be asked about your medical history
including previous operations, past and present
medical conditions and current medications. In
order to provide you with the best information
and safest options, it is important that you give
your surgeon complete information. The medical
conditions that may increase risks of surgery
include high blood pressure, thyroid problems,
diabetes and bleeding problems.
Your plastic surgeon may examine your arm
while you are standing as well as lying down. Your
skin tone and the degree of loose skin in the arm
region will be assessed. Your surgeon also will
evaluate the amount of excess fat in your arm.
Preoperative photographs may be taken during
your initial consultation or a subsequent visit.
Your surgeon will discuss with you the details
of the operation and the possible risks and
complications associated with the procedure.
Preparation for surgery
The goal of your plastic surgeon and the staff
is to make your surgical experience as easy and
comfortable for you as possible.
Smokers will be asked to stop smoking 3
weeks before surgery. Aspirin and some
anti-inflammatory drugs used for the treatment
of arthritis can cause increased bleeding, so you
should avoid taking these medications for 2 weeks
before surgery. Arm lift is usually performed in
a hospital under general anaesthetic and you can
expect several days’ stay.
The day of surgery
Your surgeon will mark your skin before the
operation and if you have not already done so,
you will need to sign the consent form for your
operation. Medications are administered for your
comfort during the surgical procedure. During
the anaesthetic, various monitors are used to
check your heart, blood pressure, pulse and the
amount of oxygen circulating in your blood.
Your operation
Because of individual factors, not everyone will
achieve the same results from arm lift. You’re plastic
surgeon will select the surgical technique that
he or she feels will obtain the best outcome for
you. Incision lines will fade over time but will be
permanently visible. Arm lift incisions usually can
be placed in locations concealed by bathing suits
and undergarments.
Arm lift can be combined with other procedures ,
such as liposuction of the flanks, outer arms and/
or arms.
Where will the incisions be?
The usual placement of the incisions follows the
armpit crease, around the junction of the inner
arm and the armpit. The exact incision will vary
somewhat according to the shape of your arm.
Depending on the amount of tissue you have, the
scar may be limited to the armpit only or it may
extend some way down the arm. This may be
half-way down, or as far as the elbow. The exact
extent of the incision will be decided between
you and your surgeon.
Sometimes liposuction may be used alone, or in
conjunction with arm lift, to remove arm fat.
How long does the operation
take?
The operation takes 1 to 3 hours, depending on
the extent of each operation.
After surgery
When surgery is completed, you will be taken
into a recovery area where you will continue to
be closely monitored. You will have a firm arm
bandage or a compression garment, which you
will have to keep on for 3-6 weeks after surgery
as instructed by your surgeon.
You will feel drowsy for several hours after the
procedure and you will remember very little of
this time.
Any surgical drains probably will be removed
within a few days following surgery, at which
time your dressings may also be changed or
removed.
How will I look and feel
initially?
It is important to realise that the amount of
time it takes for recovery varies greatly among
individuals and also depends on the extent of the
operation.
The stitches are usually hidden beneath the skin
so that no sutures need to be removed following
surgery.
You will notice swelling and bruising, which is
to be expected. The bruising and much of the
swelling will disappear over a period of weeks.
However, it may be months before all swelling
subsides and you see the final result of your arm
lift. You may also notice some numbness over
portions of the arm area, and this may persist
for several months. Incisions will initially be red
or pink in colour. They will remain this way for
many months following surgery and may even
appear to worsen before they finally begin to
fade.
Some numbness around the suture line may
persist for months after surgery. The arm skin
may feel quite tight for some time but this
feeling will gradually lessen and relax. This s due
to strong stitches holding up the arm skin and
keeping it anchored to the strong tendons around
the armpit.
When can I resume my normal activities?
You may be able to return to light work
anywhere from one to three weeks after surgery.
In many instances, you can resume most of your
normal activities, including some form of mild
exercise, after several weeks. You may continue to
experience some mild, periodic discomfort and
swelling during this time, but such feelings are
normal. Severe pain should be reported to your
doctor.
Results of your surgery
Since the healing process is gradual, you should
expect to wait at least several weeks to get an
accurate picture of the results of your surgery.
Incisions will fade over a number of months.
Unless you gain or lose a significant amount of
weight or become pregnant, your arm should
remain firmer and flatter for many years.
However, gravity and the effects of ageing will
eventually take their toll. If, after a period of years,
you become dissatisfied with the appearance of
your arm, you may choose to undergo a second
procedure to restore a more youthful arm
contour.
Risks and possible complications
of surgery
Fortunately, significant complications from
arm lift surgery are infrequent. Every year, many
operations are performed with no major problems
and good results. However, everyone considering
surgery should be aware of both the benefits
and risks. The subject of risks and potential
complications of surgery is best discussed on
a personal basis between you and your plastic
surgeon. A number of measures will be in place
to minimise the following risks:
• Bleeding may occur. At worst, this will
require return to the operating theatre to
evacuate the blood clot and to stop the
bleeding.
• There will be bruising after surgery. This
usually settles after approximately 2 weeks.
• Wound infection may complicate
the operation in approximately 5% of
operations. The infection is usually treated
with antibiotics, oral or intravenous,
depending on its severity.
• Dehiscence or reopening of the wound
may occur in about 1-5 percent of
operations. This usually happens as a result
of infection and is managed by treating
the infection.
• Collection of blood or fluid under the
operated skin. Because arm lift is usually
an extensive operation, blood can collect
under the repositioned arm skin. This
usually happens within the first 24 hours
after surgery. Rarely, it may require return
to the operating theatre. More commonly,
fluid collects under the skin without any
obvious ill effects. Removal of this serum
is a painless process but may require
several visits to the plastic surgeon’s office.
• Skin loss in the highest extent of
the repositioned arm skin occurs in
approximately 2% of operations. This
complication is more common in smokers
and it is therefore very important that you
stop smoking at least two weeks before
surgery. Skin loss is also more common in
medical conditions such as diabetes.
• Fat underneath the skin may not survive
surgery and oily discharge may persist
from the wounds for some weeks after
surgery.
• Arm lift may result in long scars. Wide,
lumpy or irregular scars may occur due
to the tension on the tissues after surgery.
Revisionary surgery is sometimes helpful
in certain instances where incisions may
have healed poorly.
• The scar, which is designed to lie in the
creases along the top of the arm, may
descend in to the upper arm under the
action of gravity. This means that the
scar may, with time, no longer be hidden
within creases and may be more visible.
• There may be numbness in the upper
part of your arm skin after surgery. This
usually recovers with time.
• Blood clots in arm veins may cause arm
swelling. The clots may travel to the lungs
causing severe breathing difficulty and,
rarely, death. With adequate precautions,
which are routinely taken, including
medications, compression stockings and
early mobilisation, these complications are
uncommon.
You can help to minimise certain risks by
following the advice and instructions of your
plastic surgeon, both before and after your
surgery.
Maintaining a relationship with
your plastic surgeon
Should there be any questions regarding arm
lift; be sure they are answered in advance.
Well meaning friends are not a good source
of information. Find out everything before
proceeding with the operation - a well informed
patient is a happy one.
After surgery, you will return to your plastic
surgeon’s office for follow-up care at prescribed
intervals, at which time your progress can be
evaluated. Post-operative photographs will form
a part of the evaluation of your result. Once the
immediate postoperative follow-up is complete,
many surgeons encourage their patients to come
back for periodic check-ups to observe and
discuss the long-term results of surgery.
Please remember that the relationship with your
plastic surgeon does not end when you leave
the operating room. If you have questions or
concerns during your recovery, or need additional
information at a later time, you should contact
your surgeon.
