Body Contouring - Brachioplasty (Arm Lift)

A brachioplasty or upper arm lift, is an operation performed to improve the shape and contour of your arm from armpit to elbow. The operation can remove excess skin, unwanted scars, stretch marks and fat. There are a variety of different brachioplasty procedures and depending on your particular problem(s), and the operation will be individualised and tailored to suit you.

Brachioplasty is usually performed under general anaesthesia and usually requires an overnight hospital stay. A wedge or ellipse of skin and fat is excised from the inner arm leaving a scar that can run from axilla (in the armpit) to elbow. The scar can sometimes be shorter if you need a mild lift only. It can also be longer and incorporate the removal of lateral chest fullness – e.g. in massive weight loss patients. In addition liposuction can be performed to the arm, which is used to de-fat the area being treated before the skin is excised. This technique helps to minimize damage to superficial nerves and lymphatics.

What can be expected at the initial consultation?

At the initial consultation you will be assessed as to whether you are a good candidate for brachioplasty. Your arms will be carefully examined to assess the amount of excess skin and fat. Your general fitness for the procedure will be evaluated and the potential for problems sought. It is important to know about past medical problems, medication that you are on, and whether or not you smoke.

Your reasons for wanting the procedure will also be discussed. It is important that your expectations concerning the outcome of the procedure are realistic. If they are, you can expect to be happier with the result.

Once you have been fully assessed, an operative plan tailored to your individual needs will be formulated. The incision to be used, the amount of skin and fat to be excised, and whether liposuction will be used as an adjunct will be discussed with you.

Do not be hesitant to ask questions, now or at any other time.

Medical aids or health insurance companies do not usually provide cover for this kind of surgery although occasionally a motivation can be done especially if you have lost large amounts of weight.

Preparing for Surgery

Ideally surgery is performed when you are fit and healthy. No special diet or exercise program is required prior to a brachioplasty, but you should be close to your ideal weight. It is a good idea to have a good fluid intake for a few days before your operation. You should not have been on a long-haul flight for 2 weeks prior to surgery.

It is advisable to stop smoking at least 6 weeks prior to surgery and not to smoke until your wounds have healed - usually about 6 weeks after the operation. It is well known that there is a higher frequency of complications in patients who smoke. In ex-smokers although the risk of complications is lower, it never reaches the levels of those who have never smoked.

On the morning of surgery you should wash well. Do not shave your axillary hair specifically. Prior to surgery, the incision lines will be marked with a pen in your room. Ms Grob usually takes photographs for your records immediately before surgery.

The Surgery

Surgery will be performed in an operating theatre under general anaesthesia. A brachioplasty takes between one and three hours. Following surgery the wounds are closed with dissolving sutures, and drains may well be left in place for a day. Dressings will be applied, and an elasticated garment will be needed. A Tubigrip is usually placed over the dressings for the first few weeks, but Ms Grob recommends MACOM garments to be used for six weeks or more after the surgery. These can be purchased over the internet with delivery time about 48hrs.

What can be expected after the operation?

Following the operation you should be relatively pain free, although you may feel some discomfort with movement. You will be given analgesic tablets to take regularly. Daily showers are encouraged. Someone will need to drive you home and help around the house for a few days. You will be given painkillers to take home with you. The drains, if needed, are usually removed before you go home.

How long does it take to get back to normal?

Healing is a variable process and it may take you 4 weeks to feel like your old self again. People vary enormously in their recovery period.

The scars are healed by six to eight weeks, but continue to mature for up to 18 months to 2 years, by which stage they should be thin, fine, inconspicuous lines. It must however be remembered that much of wound healing is out of the control of the surgeon, and abnormal unsightly and uncomfortable scars can occur. Massage of the scars with an aqueous cream helps, but should only be started after 1 month.

Bruising takes about 2 weeks to settle. Swelling can take up to 12 weeks or longer to settle. To help diminish swelling and bruising Tubigrip support should be worn for 24 hours a day.

Mobilisation should be gentle, but begun early. Vigorous exercise should be avoided for six weeks, until you feel comfortable – your body will tell you if you are pushing it too hard. Do not drive until you really feel well – usually 2 weeks. Shower daily to stay clean.
Depending on the procedure you have, you may be able to begin work after about 1 week (liposuction), and 2-4 weeks for a full brachioplasty. It is advised that you are able to fly short haul 2 weeks after the operation and that you can fly long haul 4-6 weeks post-operatively.

What are the risks?

When performed by a qualified plastic surgeon, brachioplasty is normally safe and the results predictable. Nevertheless, as with any surgery, there is always a possibility of complications, including the following:

Bleeding (early or late) (<5%) which can lead to blood collections (haematoma). These may require drainage with a syringe or, rarely, repeat open operation.

Seroma refers to the accumulation of serous fluid (a pale straw coloured fluid) that leaks out from damaged capillaries and lymph vessels. Sometimes a seroma requires repeated drainage with a needle and syringe. This is usually relatively painless and is done in the outpatient rooms.

Prolonged swelling: This may include disruption to some of the lymphatic channels along the inner arm. This condition is called “Lymphoedema” and may require prolonged elasticated support. Fortunately this is uncommon (<5%) and also mild.

Wound healing problems and infection (<2%) at the operative site.

Sensory alterations in the area: Numbness occurs in nearly all patients because small skin nerves are cut during the surgery. It is usually transient. Can take up to 2 years to resolve. Occasionally sensation abnormalities can be permanent and also affect the forearm as cutaneous nerves that supply sensation to the skin of the forearm pass through the operated area and can be damaged during surgery.

Loss of tissue (necrosis) - Usually small and treated with dressings. May need return to theatre for removal of tissue. Fortunately this is rare (<1%).

Unsatisfactory scarring: Usually not keloid, but scars can stretch or become raised and red and uncomfortable. This may require further treatment in the form of massage, creams, steroid injections or even revisional surgery.

Asymmetries or irregularities in contour, the commonest being dog-ears at the ends of the scars. These may require simple revision under local anaesthesia.

General surgical complications such as deep vein thrombosis (“clot in leg”). This is a rare but serious complication of surgery and anaesthesia, where a blot clot forms in the veins, usually the legs and may migrate to the lungs (pulmonary embolism) interfering with their normal function resulting in possible life threatening consequences. Early mobilization, staying well hydrated, using compression stockings, and Heparin injections all lessen the risk.

Problems with anaesthesia, drugs, etc. These should be rare and the risks will be explained to you by your anaesthetist.

Prolonged recovery if any of the above occur.

Dissatisfaction with the surgery.

Will the new look last?

Brachioplasty produces excellent results for patients with hanging upper arm skin and fatty excess. In most cases the results are long lasting (10 years or more), especially if after the operation you avoid weight gain, follow a balanced diet and exercise regularly.

Checklist before coming into hospital

• Make sure I know all the medications you are taking before surgery.
• Do not take any Aspirin or blood thinning drugs (which include some homeopathic supplements) for at least 2 weeks prior to surgery. Paracetamol is safe.
• Oral contraceptives can increase the risk of Deep Vein Thrombosis or Pulmonary Embolism. The contraceptive "pill" should ideally be stopped a month prior to surgery but please use some alternative form of contraception.
• It is advisable not to smoke six weeks prior to surgery and until complete healing has taken place. Nicotine reduces oxygen levels required for wound healing.
• Please have a shower in the morning of surgery and do not apply deodorant or any other products (e.g. body lotion, perfume etc.)
• Please do not have anything to eat (including chewing gum) 6 hours prior to surgery. You are able to drink still clear water up to 2 hours prior to your admission.