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  • What is Brachioplasty?

    An arm lift, also known as brachioplasty, is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. With age, upper arm skin can become loose and flabby. Cosmetic surgeons will discuss brachioplasty with patients who want to tighten this skin and look as good as they feel. In some cases your surgeon may suggest that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

  • Candidates for Brachioplasty

    Patients who are GOOD candidates for an arm lift:

    – Adults of any age whose weight is stable and not significantly overweight
    – Healthy individuals who do not have medical conditions that could possibly increase the risk of surgery
    – Patients who do not smoke
    – Patients who are emotional and mentally stable with a positive outlook with realistic goals for what an arm lift can accomplish
    – Patients who are committed to a healthy lifestyle with the proper nutrition and fitness program

    Patients who are NOT A GOOD candidate for an arm lift:

    – This surgery is not suitable after a mastectomy (breast removal) for breast cancer or operations in the axilla lymph nodes. Those with multiple infections of the sweat glands may also not be candidates for brachioplasty. This is because there may be problems with draining the fluids from your arms as a result of your previous surgery. If you were to have another operation, your arms could swell very badly and this may be permanent.
    – Having a brachioplasty is not an alternative to losing weight. Most surgeons will suggest alternatives to surgery for patients who are more than 15 percent over their ideal body weight.
    – If the patient is in the middle of losing weight, it is best to first lose the weight before having this surgery.
    – Patients who easily develop keloid scars might not be a suitable candidate for this surgery, as the scars could have the potential of being unsightly.

  • Your Consultation

    During the initial consultation, RVB will ask for a complete medical history and will conduct a careful examination to evaluate your overall health. Patients are asked to stop taking all medications that may increase bleeding including aspirin, Plavix, NSAIDs (anti-inflammatory medication such as Advil, Ibuprofen, Naproxen) and herbal supplements like Vitamin E and Gingko Biloba. Patients also need to be good general health and should have a full physical before the procedure to make sure their blood pressure is controlled.

    Patients need to refrain from smoking – as the nicotine in tobacco products decreases the oxygen that is carried in your blood flow to your skin to help heal the surgical incision. Patients who smoke have delayed healing and increased wound complications.

  • The Brachioplasty Procedure

    The arm lift procedure involves an incision from the underarm area extending along the inside of the upper arm. The incisions are closed mostly with dissolvable sutures and more than likely the patient will have drains to help reduce the amount of edema or swelling that might occur. The entire procedure of an arm lift takes approximately an hour per arm. The surgeon makes zigzag, elliptical or triangular incisions along the inner surface of upper arm. The space contained between the incisions is exactly the area of skin that would be removed. If the patient needs to have fat reduced in the upper arm area, liposuction is used. The underlying supportive tissue is tightened and reshaped with internal sutures. Overlying skin is smoothed over the new contour of the arm with excess skin reduced. Dissolvable sutures are used to close the incision and either fibrin tissue glue or stitches will be used to close the outer portion. If sutures are used, these will be removed within one to two weeks following the brachioplasty procedure. A pressure compression garment or elastic bandage is applied to promote healthy healing.

    What types of Brachioplasty are available?

    A brachioplasty procedure can be performed in four different ways:

    – Mini or axillary brachioplasty
    – Full or standard brachioplasty
    – Extended brachioplasty
    – Liposuction

    Depending on how much skin laxity is present will determine which method would be the most effective procedure.

    Mini – Limited – Axillary Brachioplasty
    – The mini or axillary brachioplasty procedure may be performed when there is small amount of skin laxity – and the hanging skin is located within two inches from the armpit. In these cases an incision is made with in the arm pit and along the arm pit crease. Liposuction is sometimes performed during this procedure for additional contouring of the arm.

    Full or Standard Brachioplasty
    – A full brachioplasty is necessary when there is too much excess skin and fat through out the arm. An incision is made along the inner portion of the arm from the axillary area to the elbow and excess skin and fat are removed. The incision is well hidden and will not be visible with the arms at the side in the resting position. However, there will be some scar show with wearing a sleeveless dress or top (when moving the arms). A “T” shaped scar is usually visible afterwards. Liposuction is sometimes added for helping with contouring the arms. Although Liposuction is not an essential part of a brachioplasty, some surgeons use this to help dissect and separate the deep tissue from the skin flaps.

    Extended Brachioplasty
    – An extended brachioplasty or arm lift has the incision extending from the elbow to the armpit and along the outer sides of the chest to the level of the horizontal bra strap. The extended brachioplasty enables the reduction of the upper torso (chest area) and bra strap area so that the patient can fit better with certain clothing. A “L” shaped scar us usually visible afterwards.

    Liposuction
    -The only time liposuction is a better choice is when there is a lot of fat, but the skin is tight. It is not a choice if your problem is due to loose skin. An arm lift is the best choice when the skin is loose.

  • Risk

    Short-term Side Effects after Brachioplasty Immediately after surgery some patients will have a feeling of tightness in the upper arm as the area swells due to the trauma of surgery. Some patients may develop swelling and some tingling of the hands as well. Most of these symptoms resolve with time.

    Risks and Complications of Brachioplasty

    The following complications can occur with an arm lift procedure:

    – Bleeding or hematoma
    – Infection
    – Seroma or fluid accumulation
    – Phlebitis – swelling of the hands
    – Delayed or poor wound healing
    – Skin loss or necrosis
    – Motor or sensory function
    – Blood clots – deep vein thrombrosis
    – Excessive or widened scars
    – Skin discoloration
    – Change in skin sensation – numbness
    – Sensation of arm tightness
    – Allergic reaction
    – Anesthesia risks

    Bleeding or Hematoma
    – Hematoma or excessive bleeding occurring with a brachioplasty is rare, however; they can happen. If a hematoma occurs, it needs medical attention immediately and may need to be surgically drained. Excessive bleeding or a hematoma increases when the patient tends to get physically active after the surgical procedure, or if medication is taken that can contribute to thinning the blood pre and post operative. The use of post operative drains help reduce the chance of a hematoma from forming.

    Infections
    – The risk of infections increases through the proximity of the natural crease in the axillary area. Scars and incisions are to be kept clean and the patient needs to make sure they take all of the antibiotic prescriptions. If the infection gets bad, sometimes surgical drainage can be necessary.

    Seroma or Fluid Accumulation
    – Seromas are fluid collections that can arise after surgery along the incision line. Drains are used to help combat this complication. Because of the location of the lymphatic system – seromas and swelling is very common with this type of surgery. Wearing the compression sleeve garment helps to prevent a seroma.

    Phlebitis
    – Phlebitis (inflammation of the vein) may result from an intravenous (into the vein) or intramuscular (into the muscle) injection. Phlebitis can result in painful swelling of the hand or arm that may be prolonged. Treatment may require medication or even hospitalization. Phlebitis can occur in the leg and thigh veins. This is extremely rare.

    Delayed or Poor Wound Healing
    – As in any cosmetic surgery procedure, the quality of healing is not known in advance. Immediately after the surgery, an incision can inflame or weep requiring wound healing treatments that can often be a long road. Keeping the wound clean is paramount along with the patient stopping smoking. Delayed wound healing may increase the risk of infection, extrusion, and necrosis. Depending on the type of surgery or the incision, wound healing times may vary. Smoking may interfere with the healing process. Nicotine is the root cause of the decreased blood supply in that it causes constriction of the capillaries and small blood vessels that feed the skin with its required oxygen.

    Necrosis – Tissue Death and Skin Loss
    – In any surgery that involves the skin, there is always the risk of skin loss secondary to compromised blood supply. Tissue death or skin loss is uncommon, but the chances of this are increased after a seroma, hematoma, or infection. While rare, significant loss of skin could require hospitalization and skin grafting.

    Motor and Sensory Function
    – The nerves that operate your arms/hands are located near armpit area. While very rare, those nerves could be damaged causing permanent disability and sensory changes to the affected arm or hand. An important sensory nerve (“medial antebrachial cutaneous nerve”) runs down the inside of the upper arm. It is important for the surgeon to avoid injuring this nerve, which might cause a painful neuroma.

    Deep Venous Thrombosis – Cardiac and Pulmonary Complications
    – Surgery, especially longer procedures may be associated with the formation of blood clots in the venous system. Pulmonary complications may occur secondarily to both blood cloths (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life threatening or fatal in some circumstances.

    – Air travel, inactivity and other conditions can increase the incidence of blood clots traveling to the lungs – which can be life threatening.

    Make sure you discuss with your surgeon any past history of blood clots, swollen legs or the use of high estrogen birth control pills or hormone replacement therapy which can contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia – even with a patient without symptoms.

    If you experience of the following symptoms contact medical attention immediately: – shortness of breath
    – chest pains
    – unusual heart beats

    Excessive or Widen Scars – Hypertrophic or Keloid Scars
    – All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and the deeper tissues. Scars can become hypertrophic or possibly keloid, which can be unattractive. Scar appearance may also vary within the same scar, such as “bunching” due to the amount of excess skin. Scars may be asymmetrical (appear different between the right and the left side of the body). Also, there is the possibility of visible marks in the skin from sutures. In some cases a scar revision may be necessary. With the brachioplasty procedure, patients are made aware that they are trading one problem of loose and lax skin for the possibility of visible scarring.

    Skin Discoloration and Swelling
    – Bruising and swelling normally occur after the brachioplasty procedure. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling (including the forearms and hands) and skin discoloration may persist for long periods of time and in rare cases – may be permanent.

    Changes in Skin Sensation or Numbness
    – Itching, tenderness or exaggerated responses to hot or cold temperatures may occur after brachioplasty. Usually this will resolve itself during the recovery period, but in rare situations may become a chronic condition.

    Sensation in Arm Tightness
    – After the arm skin is lifted, there can be a sensation of the arm skin being tight. Usually this feeling will subside over time. Additional surgery may be required to correct this problem.

    Allergic Reactions
    – Allergies to surgical tape, suture material and glues, blood products, topical preparations or injected agents can occur. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during the surgical procedure and or prescription medications. Severe allergic reactions may require additional treatment.

    – Allergic reactions to suture material can be common. Sutures that spontaneously poke through the skin, become visible or produce irritation requires medical attention with the removal of the dissolvable stitches. This is also known as “spitting a stitch”.

    Reaction to Anesthesia
    – Fortunately most “bad reactions” to anesthesia are not life-threatening. However, all forms of anesthesia including the different forms of local, can carry a risk of an allergic reaction. Anesthesia exposes the body to controlled levels of toxic chemicals in order to make sure there is no pain felt during a surgical procedure. The main goal of anesthesia is to either stop pain temporarily or to induce a semi-conscious or unconscious state. Even though anesthesia carries a risk, the benefits outweigh any potential disadvantage.

    – The most important factor is making sure that whoever administers the anesthesia are board certified in anesthesiology. By doing this, you reduce the risks of any complication that might arise during surgery. All body functions and chemistry are monitored during your surgery to ensure a safe procedure.

    – The most common reaction or danger of having anesthesia is an allergic reaction to one of the medications used. This is addressed immediately by the attending anesthesiologist by monitoring your vital signs. If an allergic reaction occurs, your anesthesiologist is equipped to handle this immediately. Severe allergic reactions during anesthesia are fortunately rare.

    It is very important to tell your anesthesiologist every medication you take on a regular basis, so that he can prevent any potential problem during surgery.

  • Recovery

    The recovery period for a brachioplasty ranges from one week for a mini or a limited brachioplasty to three weeks for a full brachioplasty. During the first two weeks, most surgeons want the patient to elevate their arms above their heart to help reduce the chance of swelling. While each patient is unique with their own recovery time, most are back to full activities within three to four weeks post operative – and back to their normal exercise program by six weeks. Wearing the compression garment for the first couple of months following surgery will help the skin contour to its new shape.

    Your surgeon might have placed surgical drains to help reduce edema from building up after the procedure. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. You will need to monitor the out put of the fluid in these drains for the surgeon. The surgical dressing may look extensive after the brachioplasty because of the compression garment. The compression garment does protect the incisions after the surgery and helps the skin to retract back to its new contour and shape. Limiting any physical exercise is going to be beneficial for the patient, especially any lifting. Elevation with pillows will help increase comfort.

FAQs

  • Where are the scars going to be located?
    - Depending on the actual type of brachioplasty that will be performed - the scar is normally placed inside the inner side of the upper arm - beginning at the axillary area (underarm) to the elbow). If a limited or a mini brachioplasty is indicted, the scar will be much shorter. All surgery requires a scar and all scars take time to soften and fade. The final appearance of the scar will not be seen for at least a year or two after surgery. In the beginning, the scar may appear red and raised for the first few months following the surgery.
  • Are drains going to be used with the brachioplasty?
    Drains are sometimes are used after this type of surgery.
  • Drains are used for two reasons:
    - One is to remove fluid such as serum or blood that would otherwise collect under the skin.
  • - The other reason is to pull the skin against the underlying tissue to allow it to stick in placeIf you have drains when you leave the surgery center you will be given instructions on their care before you go home
  • What are the advantages of brachioplasty?
  • Brachioplasty Advantages:
    - Directly removes excess skin and fat of arms
  • - Firms and tightens arms
  • - Tones and defines arms with liposuction
  • What are the disadvantages of brachioplasty?
  • Brachioplasty Disadvantages:
    - Brachioplasty scars tend to be some of the more noticeable scars left after cosmetic plastic surgery. The scars tend to widen and stay more red than typical scars. Still many patients find this an acceptable trade-off in order to rid themselves of all the loose skin
  • - Severe swelling or edema
  • - Bleeding and or hematoma
  • When can I start exercising again?
    - Approximately one to two weeks are necessary to resume daily activities, and approximately four to six weeks (sometimes longer) to resume most sports activities.
  • Will my arms start to sag again?
    Generally not, but with substantial weight gains and losses, there could be a partial recurrence of laxity to the area.