The purpose of brachioplasty is to remove excessive loose skin and underlying fat, usually from the bottoms of the upper arms.  The intent of surgery is to improve the contour of the upper arms, to tighten the skin and to improve the appearance of the upper arms in clothing.  In any given patient these goals may only be partially met.

Limitations of the Procedure

The correction of soft tissue laxity and excessive fat is generally restricted to the immediate area of this surgical procedure.  If the rest of the arm, particularly in the elbow area and forearm is also heavy, this may not be improved and the balance of the arm may still be less than ideal.  Over time the skin may stretch and some laxity may return.  In addition, with significant weight gain, areas of uneven fat distribution may become apparent in the area of the surgery or immediately adjacent to it.

Alternatives to the Procedure

In some patients suction lipectomy may be utilized instead of direct surgical excision (brachioplasty).  However, a good result from suction assisted lipectomy is dependent upon very good skin tone and the ability of the skin to retract or tighten following liposuction.  In patients who have had considerable weight loss or have very poor skin tone for other reasons, suction lipectomy may not be indicated.  Diet and exercise will reduce the amount of subcutaneous fat and may improve the heaviness of the arms, but they will not generally improve severely loose skin.  This procedure is of no functional benefit and is performed entirely for cosmetic reasons.  Without surgery the laxity of the skin is likely to increase with age.

Surgical Technique / Anesthesia / Recovery

Arm reduction surgery requires an excision which generally extends from just below the underarm to the elbow.  Excessive skin and underlying fatty tissue are then excised and the incision is closed with multiple layers of sutures.  The stitches may be absorbable or may require removal in 7-14 days. The incision is placed so that it is not obvious in short sleeve clothing, but the surgical scar will remain visible permanently.  Initially the scar may be red or purplish and quite obvious.  As the scar matures over the first 6-12 months the scar will fade.  It is typical for incisions in this area to spread as they mature.  Usually the procedure is performed with the patient under general anesthesia although in some circumstances the surgeon may recommend a combination of intravenous sedation and local anesthesia.

Physical exercise is restricted in the upper body and arms for 2-4 weeks following surgery.  It is recommended that you take one week off from work although this may be flexible depending upon the physical requirements of your employment.  You can anticipate visible bruising for 7-14 days following surgery and some degree of residual swelling for weeks following surgery.  Your surgeon may ask that you wrap your arms in ace bandages or some other compression garment for several weeks following surgery.  Blood transfusion is usually not required.

Risks and Complications

The most common complication following this surgery is a collection of blood or tissue fluid beneath the incision.  If this produces swelling, tension and pain in the area of this surgery, a small second procedure may be required to remove the fluid.  The incision, as noted previously, will heal with a scar and in some patients the scar may be thickened, red or widened.  Occasionally secondary scar revisions may be required to improve the appearance of the scar, but there is no procedure to completely “remove” the scar.  Contour irregularity, small bulges, wrinkles in the skin, dimpling or overall disproportion of the circumference of the arm may be apparent after surgery.  Small secondary procedures may help improve this, but such changes may be permanent.  There may be delayed or incomplete wound healing which may require special dressings or secondary surgical procedures.  In very rare instances superficial numbness surrounding the incision or even extending into the lower forearm may exist after surgery.  This is usually temporary, but in some cases may be permanent.

Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon.