Brachioplasty

The least-invasive manner to contour the upper arms is to simply remove extra fat via liposuction. However, traditional deep liposuction often leaves sagging and wrinkled skin. An alternative to this is Circumferential para-Axillary Superficial Tumescent (CAST) liposuction, which maximizes the skin retraction.{{cite journal | title=CAST Liposuction: An Alternative to Brachioplasty |author1=Mark D. Gilliland |author2=Andrew T. Lyos | journal=Aesthetic Plastic Surgery |date=November 1997 | volume=21 | issue=6 | pages=398–402 |doi= 10.1007/s002669900144|pmid = 9354600|s2cid=25034543 }}

Under the right conditions such as adequate skin elasticity and minimal excess skin, the surgical incision for the brachioplasty can be placed under the arm. This allows for easy concealment of the scar. Minimal incision brachioplasty includes lipoplasty of the upper arm, wide-axillary and upper-arm skin excision, and dermal suspension of the upper-arm skin to the axillary fascia.{{cite journal | title=Minimal-Incision Brachioplasty: A First-Choice Option in Arm Reduction Surgery | author=Richards, Mark E. | journal=Aesthetic Surgery Journal |date=July 2001 | volume=21 | issue=4 | pages=301–310 | doi= 10.1067/maj.2001.117695| pmid=19331908 | doi-access=free }}

The typical brachioplasty involves removing excessive loose skin via surgical excision, leaving a significant scar along the bottom of the upper arms.

If there is also a significant amount of loose skin that goes from the upper arms and continues along the chest wall, an extended brachioplasty may be called for. In an extended brachioplasty, the incision and excision of skin continues along the upper arm onto the area under the arm along the chest wall.

This method is used for patients with an enormous amount of soft tissue excess. Fish-incision brachioplasty uses mathematical measurements and anatomic marking that allows the preoperative marking of the incision in the shape of a fish.{{cite journal | url= http://www.jprasurg.com/article/S0007-1226(05)00145-1/fulltext | title='Fish-incision' brachioplasty |author1=Rajiv Y. Chandawarkar |author2=James M. Lewis | journal= Journal of Plastic, Reconstructive & Aesthetic Surgery |date=May 2006 | volume=59 | issue=5 | pages=521–525 |doi= 10.1016/j.bjps.2005.04.035 |pmid= 16749198}}

This technique is used to decrease the post- operative seroma formation and nerve injury. In this method liposuction is done for the arm with excessive liposuction under the area of excision to make it paper thin. Only the skin over the marked area is excised followed by invagination of the tissue and closure with dermal to dermal sutures and skin edge closure.

In this procedure anchoring of the arm flap to the axillary fascia is secured along with strong superficial fascial system repair of incisions. This method reduces the risk of widening or migration of scars and unnatural contours.{{cite journal | title= Brachioplasty with superficial fascial system suspension | author=Lockwood, Ted | journal=Plastic and Reconstructive Surgery |date=September 1995 | volume=96 | issue=4 | pages=912–920 |doi= 10.1097/00006534-199509001-00022| pmid=7652066 | s2cid=40670220 }}

This technique uses a mold to mark the incision in an italic double S-shape for better incision control, symmetrical and smaller scars. This method has often been used in association with other brachioplasty procedures.{{cite journal | title= Brachioplasty technique with the use of molds |author1=de Souza Pinto, E.B. |author2=Erazo, P.J. |author3=Matsuda, C.A. |author4=Regazzini, D.V. |author5=Burgos, D.S. |author6=Acosta, H.A. |author7= do Amaral, A.G. | journal= Plastic and Reconstructive Surgery | date=April 2000 | volume=105 | issue=5 | pages=1864–1865 | doi= 10.1097/00006534-200004050-00039}}

Although the long term results may not be as significant as surgical excision, there are other options to improve skin laxity and fatty excess of the upper arms without the need for a visible scar. The most common treatment is liposuction with possible laser, ultrasound or sub dermal helium plasma.{{cite journal | title= Aesthetic Nonexcisional Arm Contouring | author= Ibrahiem SMS | journal=Aesthetic Surgery Journal |date=June 2020 | volume=42 | issue=7 | pages=463-473 | doi= 10.1093/asj/sjac031| pmid=35170726 }}

Some of the possible complications associated with brachioplasty include:{{cite web | url= http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Brachioplasty_arm_lift_surgery | title=Complications of brachioplasty surgery | publisher= Better Health Channel | accessdate=15 September 2015}}

• Risks of anaesthesia, including allergic reaction
• Surgical risks such as bleeding or infection
• Blood clots that may cause potentially fatal cardiovascular complications, such as heart attack, deep vein thrombosis or stroke
• Collapsed lung
• Fluid build-up under the wound
• Tissue death along the wound, or skin loss
• Sensory nerve damage, which may cause prolonged or permanent numbness in the upper arm or even in the forearm
• Prolonged swelling
• Damage to underlying tissues such as muscles
• Asymmetry (unevenness) of the skin
• Unsightly, inflamed or itchy scarring
• Further surgery to treat complications.

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Category:Plastic surgery