A brachioplasty is a surgical procedure to remove loose skin and excess fat deposits on the upper arm. This can be caused by age, as the upper arm skin becomes loose and flabby, or may simply be a feature of natural fat distribution and surplus arm skin (often caused by weight loss).
Brachioplasty procedures tackle these conditions to leave a tight and smooth skin appearance by using one, or both, of two key surgical techniques; liposuction and skin excision.
There are two aspects to the problem of the upper arm, the relative amount of excess fat and the excess skin. These problems have two surgical solutions, which are often combined. At the two extremes, there are patients with large arms with surplus fat, who are treated very satisfactorily by liposuction. Unobtrusive stab incisions are made in the armpit and on the back of the elbow. We then need a skilled and obsessional surgeon to very carefully remove the fat in a smooth manner from all the way around the arm. There are other adjacent areas that we often treat at the same time, and in particular fat around the shoulder, armpit, adjacent back and so-called tail of the breast. This is fat that bunches up particularly when wearing a bra, below the front of the armpit. In addition, we also carry out liposuction of forearms and make particular note of the fat on the back of the elbow. All of these areas can be treated in the same session.
This liposuction carried out on its own is particularly useful when the skin is still relatively elastic and will therefore be more commonly carried out in younger patients. At the other extreme, we have skinny patients who simply have a lot of loose skin hanging down embarrassingly as ‘Bingo Wings’. Retraction of the skin after liposuction would not be adequate, and in any case, there is little or no fat to remove. In this case, the solution is skin reduction, and can only be carried out by removing a long ellipse of skin all the way from the back of the elbow, along the line between the inside and back of the arm, curving into the armpit. Positioning of the scar to make it the least obvious is important.
The scars themselves take some months to settle in. There are surgeons who offer to tighten the skin with an excision of skin confined to the armpit. The skin then is pulled up towards the armpit like pulling up a sock. Unfortunately, this does not work for the vast majority of patients. The excess skin is around the circumference of the arm and not along
the length. In patients who have had extreme weight loss, perhaps after bariatric surgery, there is surplus skin
everywhere and the arm reduction can be incorporated into reductions of skin of the back, flank and
There are many patients who do not fit into these two groups. They have both excess fat and excess
skin. Liposuction alone will not tighten the skin sufficiently. In these cases a combination of liposuction and excision of skin and fat is carried out. Experience and careful planning is required to produce a symmetrical result. We have all seen patients who have had unequal amounts of skin and fat removed with unnatural shaped arms, of unequal size. There are even occasions were patients have required to have skin put back, using skin grafts.
How the operation is performed
Before surgery the surgeon will measure up the arms to assess how much fat and/or skin needs to be removed. The arms are then photographed, with the skin markings, in various positions, front and back. The procedure can be carried out under local anaesthesia, but more usually under our form of general anaesthesia called T.I.V.A. (Total Intravenous Anaesthesia). There is an electroencephalogram called BIS which helps maintain your consciousness so that you are unaware, but only just asleep. You therefore wake up very quickly without sickness, when the procedure is completed.
The arms are bandaged after surgery to reduce bruising and you will feel stiff and mildly uncomfortable as you bend your arms. Most of the sutures used are dissolving to avoid stitch marks, but there may be a few to remove, particularly in the armpit, a week after surgery. Bruising lasts about 3 weeks.
+ Bleeding - is uncommon, which would cause swelling and pain. Rarely if skin is excised, a haematoma occurs and would need to be surgically released, or aspirated.
+ Infection - of any surgical wound is possible and usually treated with antibiotics.
+ Sensation change – temporary numbness after liposuction is normal, and occasionally there will be some permanent numbness and a change in sensation along the stitch line.
+ Asymmetry – Arms are never quite symmetrical but the risk of any significant asymmetry is greatly reduced by careful surgical technique.
+ Dissatisfaction – The result of surgery will always be subjective and patients can never know before surgery whether a result, which is considered good by others, including the surgeon, may not be adequate for themselves. The risk of this is reduced by careful discussion with the surgeon pre-operatively, but is never quite eliminated.