Brachioplasty (Arm Lift)

Brachioplasty surgery is surgery to remove the excess skin and fat from the upper arms (so called “bingo wings”) that develops with ageing or significant weight loss. It tightens the remaining skin and improves the contour of the upper arms. Afterwards many people are much more comfortable wearing styles of clothing and sportswear that expose the upper arm due to the improved shape. 

Indications for Brachioplasty:

• Loose skin on the upper arms
• Loose skin and fatty tissue on the upper arms
• Bulky upper arms due to excess fat 

Limitations of Brachioplasty: 

• Brachioplasty does not treat the forearm. It primarily addresses the upper arm area.
• A scar along the inner side of the arm is necessary to perform brachioplasty surgery. Often this needs to run into the axilla or armpit to gain the optimal result. Milder cases may be suitable for short scar brachioplasty or in select cases liposuction alone. If this scar is an issue for you, then you should not have brachioplasty surgery.
• Significant changes in weight can affect the long term results of brachioplasty surgery. Therefore if you are considering brachioplasty surgery after weight loss, it is best to be at a stable weight with no further changes in weight planned before undergoing the surgery.

Brachioplasty Procedure:

Pre and post surgery clinical photographs of your arms will be taken. Brachioplasty surgery is usually carried out under general anaesthesia (while you are asleep) with an overnight hospital stay. The surgery usually takes between 1.5 and 2 hours. If drains are used, they are removed the next morning before you go home. You will be asked to wear a support bandage or garment for 4 to 6 weeks afterwards.

Liposuction:

If required, liposuction is usually done first before the skin excision procedure. In select cases where the skin tone is good and the issue is excess fat alone, liposuction may be the only technique needed for treatment This is not common and usually liposuction is carried out in addition to the main skin excision procedure.   It is carried out through very small incisions where fluid is infiltrated and then a suction cannula is used to remove the fat. A narrow metal tube (suction cannula) attached to a suction pump is inserted through the very small skin incisions and used to remove the unwanted fat by moving it through the area to be treated under the skin. Most surgeons inject a local anaesthetic and adrenaline solution beforehand to help reduce pain and bleeding. Power or suction assisted liposuction is normally used.

Brachioplasty:

Brachioplasty surgery is done via an incision running down the inside of the arm from inside the axilla or armpit to just above the elbow. The excess skin and fat are removed and the remaining tissue and skin are sutured back together improving the contour and shape of the upper arm. The tissue is not pulled overly tight as this gives an unnatural appearance and can cause problems with a stretched scar or it may be too tight for the internal tissues of the arm and can cause problems with a sharp cut off appearance between the area of surgery and the elbow/forearm area which are not involved in brachioplasty surgery. The upper arm contour needs to blend naturally into the forearm for the best appearance afterwards.

Short Scar Brachioplasty:

In some people, the amount of excess skin is mild. They may be suitable for a short scar version of the brachioplasty procedure where a transverse scar at the junction of the upper arm and the axilla is used for the surgery or a shorter version of the main procedure scar. It is important to understand that not as much tissue removal or not as significant a tightening or contouring effect can be achieved with a short scar brachioplasty.

Combination Surgery:

 Brachioplasty is often combined with other body contouring procedures such as breast reduction or mastopexy (breast lift) surgery.

Post-Operative Course:

You will have bruising and swelling in your arms afterwards which will peak at day 2 to 3 and slowly resolve over the weeks following this. Most of this will go in the next 4 to 6 weeks but swelling can persist for up to six months. You will have a scar running down the inside of your arm to the elbow and in to the axilla (armpit). You often have some temporary numbness of the overlying skin.

You will need to wear a compression garment for 4 to 6 weeks postoperatively. This helps to provide support to the skin and to keep swelling controlled.

Recovery:

Most people return to work after about 2 weeks depending on the nature of their work. Exercise or strenuous activities need to be avoided for 6 weeks post surgery. Light activities can be resumed within 2 weeks and normal activities are usually unrestricted after 6 weeks.

Complications:

While most brachioplasty surgeries go very smoothly and patients are delighted with the results, as with any procedure there are some risks associated with brachioplasty.

• Swelling and bruising. This will peak around day 2 to 3 post surgery and will gradually reduce after that. Most of the swelling is usually gone by 6 weeks but occasionally lasts longer than expected.
• If you have a tendency to bruise or bleed easily or take medications such as aspirin that make you more prone to bleeding, this may be a higher risk for you. It may be necessary to stop some medications in advance of surgery. Occasionally there is more bleeding than expected from the incisions or bleeding under the skin forming a haematoma. A return to theatre may be needed to deal with this.
• If an infection occurs, you will be treated with antibiotics and occasionally a return to theatre is needed to washout or further treat the wound.
• Slow healing. This may be due to one of the problems mentioned in this section such as infection or sometimes some areas are slower to heal than others or due to overdoing it after surgery. This is usually managed with dressings in the clinic.
• Suture spitting. The sutures used are normally dissolvable. Sometimes parts of these sutures can take longer to dissolve than anticipated and can cause some irritation and spit out. Any remnants can be removed in the outpatient clinic and the area should heal well after that.
• Poor scar formation which may be tender, raised, lumpy, stretched, red or slow to settle
• No-one is perfectly symmetrical and we all have differences between the two sides of our body. These differences persist after surgery but are usually small enough that they are not overly visible and do not require any treatment. Occasionally further treatment is required to address a significant asymmetry following brachioplasty surgery.
• Clots in the legs (deep vein thrombosis) can form due to the length of surgery and reduced mobility after the procedure. They can sometimes travel to the lung (Pulmonary embolus (PE)) and this can be very serious. While in hospital, you will receive blood-thinning injections and be asked to wear compression stockings. You should continue to wear the stockings for 2 weeks after discharge from hospital.
• Numbness or sensitivity of the skin of the arm and forearm due to bruising or damage of the sensory nerves in the area. This is usually temporary but can persist.
• Seroma. After surgery, the body naturally produces a certain amount of fluid as part of its reaction to surgery and attempts to heal the area.  Sometimes this fluid can build up underneath the skin after the drains have been removed and require drainage in the clinic with a fine needle. This may need to be repeated until it stops being produced.
• Visible scarring. While every effort is made to place the brachioplasty scar in as inconspicuous a location on the inner arm as possible, the scar will run the length of the inner upper arm and may be visible from certain angles and in certain styles of clothing.
• Bulge at the elbow just below the operated area resulting in a visible “cut-off” point between the reshaped upper arm and the unoperated forearm
• Lymphoedema where fluid drainage channels in the arm are disrupted by the surgery and therefore the arm tends to swell to a varying degree
• Disappointment with the result. Sometimes after undergoing brachioplasty surgery, patients are disappointed with the result. This may be due to one of the problems described above occurring or due to unrealistic expectations of the surgery e.g. mild asymmetries, visible scarring or less than expected definition of the arm area. It is important that you discuss your expectations in advance of the surgery so that you can understand what to expect from the surgery and so this situation is avoided as much as possible. (Additional costs may be incurred for further procedures.)

Longevity of Procedure:

Brachioplasty surgery has a high success rate and is considered an excellent procedure for contouring the upper arms. The improvement in your arm contour is apparent early on although it is 6 to 12 months before the final result can be seen. The results are usually very long-lasting.

The natural ageing process of the body continues regardless of surgery and so may over time alter your body shape leading to recurrence of loose skin. Significant changes in weight can also affect the longevity of brachioplasty surgery.

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