Arm Lift after Massive Weight Loss
Dr. Peter Fisher can provide you with an arm lift after massive weight loss at his San Antonio, TX, practice to help you look lean and fit during this healthy new time in your life. Please contact us today to schedule a consultation.
Brachioplasty over the past six years has increased ten -fold. The major reason for this is the increased number of patients undergoing bariatric procedures. Commonly performed with Mastopexy (breast lift), an arm lift surgery is done as an outpatient procedure. It involves the removal of skin and fat essentially using two techniques:
Under the Arm, or Posterior Incision
This runs along the underside of the arm, from anywhere near the lateral aspect of the breast to the elbow and extremely rarely to the wrist. This procedure is performed for the considerably better scar it leaves as compared to other types of arm lifts.
- The dissection is posterior to the antibrachial cutaneous nerve, thus virtually no chance for injury to it and the very unwanted side effects of numbness and burning that go with it,
- An incision that generally heals better, thus leaving a better scar than the anterior technique.
- Because the skin and fat is removed from the front and back of the arm, there is no added weight for gravity to pull on and therefore less recurrence of the problem. The skin that is being stitched together is of similar consistency leading to the better scar.
- The scar can be seen from behind when the patients arms are by their side.
Inside the Arm, or Anterior Incision
This incision leaves a scar in the hair bearing portion of the arm and side of the chest. It can only be used in minor cases when the excess skin is confined to the medial third of the arm.
- When the arm is by the patient’s side, the scar cannot be seen.
- When the patient’s arms are up for any reason, the scar is visible
- The scar in this position frequently widens and can stay red and angry looking for years.
- It is harder to maintain the result long term because a flap of skin and subcutaneous fat is rotated from under the arm around to the front, allowing gravity to pull down on it.
*Note from Dr. Fisher: These pros and cons are my own findings from 24 years in practice and from evaluating multiple journal articles and photos from them. My obvious bias is toward the posterior incision.
Techniques have changed somewhat to deal with the differing presentations of skin laxity and their extremes. This has become a much more extensive procedure with these deformities sometimes extending to the wrist on one side and onto the lateral chest and back areas on the other side in some patients.
Extension can be in one of two directions. Either toward the side of the chest (most commonly), or towards and all the way down to the wrist (5% of my practice).
As mentioned earlier, there are two reasons to extend the incision towards the side of the breast. One is because of continued excess skin from the arm along the side of the breast and the other is for loose excess skin of the upper outer back. Both will result in a J shaped incision which runs from the armpit along the outer aspect of the breast to the inframammary (crease at the bottom of the breast) crease. This incision will join an incision that is usually made when and if a breast lift has or will be performed. If the upper outside loose skin of the back is extensive then a T incision in the middle of the J portion will need to be made that runs towards the middle of the back in the bra line.
In approximately 5% of my patients an extended incision is continued down to the wrist along the inside (ulnar) aspect of the forearm. This is usually done at the patients request and if I agree that an acceptable result can be obtained.
It is essential to stop all kinds of female hormones at least two weeks prior to any surgery. These include BCP’s and any other estrogen and progesterone combination pre and post-menopausal.
Other medications to stop include all non-steroidal anti-inflammatory meds and vitamin E.
Patient is seen pre-operatively in the office for photos, prescriptions, markings and to answer any final questions.
A brachioplasty is performed last if other procedures are being done at the same time. Under general anesthesia the markings are reinforced and infiltrated with marcaine and epinephrine. If performed with liposuction, a wetting solution is infiltrated into the areas that will be suctioned.
The area of fat under the area to be excised and any adjacent areas of excess fat are then suctioned. Then, the anterior incision is performed along its entire length. The skin and any remaining underlying fat is dissected backwards close to the underlying muscle. The posterior incision is then made and all the excess skin and fat removed.
Incisions are closed with one layer first and the two arms are then checked for symmetry, shape as well as making sure the correct amount of tissue has been removed. Drains are rarely used. A final layer of buried skin suture is run. Antibiotic ointment, non-stick gauze and kerlix wrap are then placed.
Two layers of suture are placed, all dissolving and buried. No drains are used. If done by itself or with a breast procedure then the patient is discharged home after an appropriate time in the recovery and post-recovery rooms. If performed with a more extensive procedure then the patient is kept in the hospital. Drains are almost always not used.
The patient may shower two days after surgery. Antibiotic ointment and non-stick gauze applied daily for about a week. There are no restrictions to lifting and or using your arms to lift yourself. A post-operative return appointment is usually made for five to seven days after your surgery.
Dr. Fisher has been available to answer all of my questions and provide me with not only professional medical expertise, but also a much appreciated level of personal empathy. I would 100% recommend Dr. Fisher to anyone who is considering plastic surgery.Brandi