Brachioplasty surgery is performed to reshape the underportion of the arm between the shoulder and elbow. The surgery removes excess skin and fat, giving a more toned appearance. It is most commonly performed in women over the age of 35 and in patients who have undergone significant weight loss. Exercise can be used to tone the arm muscles, but it will not address droopy skin. Individuals who have excessive fat in their upper arms without lax skin can achieve great brachioplasty results with liposuction alone, but in most patients excision of skin is also required.
The surgery takes 1-3 hours and can be done as day case or overnight-stay surgery under general anaesthesia. Liposuction is used in addition to the excision of skin to help achieve optimal contour outcomes and to retain veins and lymphatic channels that run within the arm tissue. The scar is placed on the inner aspect of your arm. The location of the scar should be confirmed with your surgeon before the operation, as its location can be varied according to your preferences - some people prefer it to be located more towards the back of the arm, others prefer it to be at the front of the arm.
If you have undergone significant weight loss it is worthwhile having your nutritional levels checked prior to surgery as you may have some nutritional deficiencies (iron levels, Vitamin D) that would be best corrected prior to an operation in order to optimise your healing. Smokers are requested to cease smoking 3 weeks prior to surgery and not to smoke for at least 3 weeks after surgery. Smoking impairs wound healing and increases the risk of complications and poor scarring. You must not consume aspirin or other blood thinners for 10 days prior to the surgery, as these medications increase the risk of bleeding and bruising.
Post operative recovery
The scar is the major downside of the surgery, so I take as much care as possible to minimise the appearance of this scar. The eventual scar outcome is a mixture of surgical technique, genetics, post operative complications and the post operative scar management. I can control the surgical technique, such as closing the wound without tension and avoiding trauma to the tissues. You cannot control your genetics, so if you or your relatives have a tendency towards hypertrophic or keloid scarring you should take this into consideration when contemplating surgery.
The likelihood of post operative complications (such as infection, haematoma or skin necrosis) can be minimised by selecting a careful and experienced surgeon to perform the procedure, and by following your pre and post operative instructions. Your post operative instructions will instructions about dressings and your compression garments, as well as a post operative scar management regimen, which includes silicone gel sheeting, massage and other topical therapies. The compression garments and silicone gel sheeting is provided in your surgical package.
After surgery you should:
- take the antibiotics and pain medications that have been prescribed for you
- avoid strenuous exercise and heavy lifting for 4 weeks
- wear your compression garment for at least 4 weeks after surgery and follow the post operative scar management regimen recommended to you
- maintain a stable, healthy weight.
Your scar will continue to mature and fade for 1-2 years after surgery.
What can go wrong (complications)?
- allergic reactions to anaesthesia or skin preparation solutions or dressings
- contour asymmetry
- changes in skin sensation
- changes in shape or appearance of the arm, and of the axillary (armpit) hair
- delayed healing
- uneven or unsightly scarring
- swelling and/or lymphoedema
- recurrent skin laxity
- haematoma (blood clot under the skin)
- skin necrosis
- wound breakdown
- distortion of the armpit skin
- need for secondary surgical correction
- deep vein thrombosis or pulmonary embolism
- seroma requiring drainage
It is important to have realistic expectations about wound healing and post operative scarring with brachioplasty. A study published in Plastic and Reconstructive Surgery in 2014 of 44 brachioplasties performed by two experienced surgeons had a complication rate of 50% and a scar revision rate of 21%. There were no returns to the operating theatre for serious problems such as infection or bleeding, but 14 of 44 patients required wound dressings after an area of wound splitting (wound opening), 1 patient developed a seroma, and 9 patients underwent scar revision within one year for widened or hypertrophic scarring. The post operative regimen that we recommend that you follow is designed to minimise the likelihood of these complications. Reference: Knotts CD, Kortesis BG, Hundstad JP. Avulsion brachioplasty: technique overview and 5 year experience. Plast Reconstr Surg 2014 Feb; 133(2):283-8
What are the costs of brachioplasty?
The surgical quotation that you will be provided with at your consultation includes:
- the surgeon's fee
- the anaesthetist's fee
- the hospital and theatre fee
- compression garment(s)
- scar management products
- the cost of your post surgical appointments
In this video YouTube user Kellawanda describes her brachioplasty surgery recovery at 17 days after surgery:
Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.