Brachioplasty / Arm lift

Definitions and principles

When the skin on the inside arm loses its elasticity, brachioplasty, or an arm lift, can be performed.

The operation is appropriate when there has been a clear slackening of skin due to age or significant weight loss.

This operation is preferably performed after weight loss: it is of no use to surgically tighten the skin if excess skin is created after the operation through weight gain.

The 3 techniques to lift the inner arm

The operation consists of removing excess skin caused by a slackening of the skin on the inside arm, whether or not it is caused by excess fat, by:

• a scar placed in the armpit crease. This is a technique used on limited skin excess, since it only acts on the upper arm
• a longitudinal scar on the inside arm . This technique is effective along the whole length of the slackened skin, but the scar is in a visible position
• a scar under the armpit and a short vertical scar on the inside arm . This is a combined technique used on intermediary cases

The arm lift is highly solicited by patients but is limited, since the scaring factor often dissuades patients when a vertical scar is necessary.

The surgeon begins the operation with liposuction that enables fat to be removed where necessary, but also allows a pseudo-protrusion of tissues with no lymphatic lesions. Then the lift is performed.

Two principles are respected, regardless of the technique:

• respect of the large lymphatic trunks to avoid secondary lymphatic effusion (seroma).
• closing up of all dead space using padding to limit haematomas and tension on the scars which can cause skin suffering and slackening.

The technique of arm lifts with a horizontal incision in the armpit

The incisions are made in the axillary creases (horizontally under the armpits). The excess skin is removed and the tissues are concentrically brought towards the axillary creases. Other than moderate effects, the technique has the disadvantage of poor long-term stability due to tensions caused after the operation by raising the arms.

The technique of arm lifts with a longitudinal incision on the inner arm

Excess fat and skin are corrected by making a single incision on the inner arm between the armpit and the elbow. This technique is stable, but has the disadvantage of leaving visible scarring. Furthermore, there is a risk of secondary expansion of the scar that can require further surgery after 8 months to leave a thin scar.

Combined arm lift technique

In addition to the incision in the axillary crease, a short vertical incision (10cm) is made that runs down the inner side of the arm. Excess skin is removed and the tissues are concentrically brought towards the axillary hollow for the upper part and horizontally for the lower part. This is a compromise: whilst the effectiveness remains limited, scarring is much fainter than with a scar running to the elbow.

Operation

Practical recommendations prior to the operation

Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. It is imperative that all aesthetic operations be foregone if you are ill or, for women, if you are pregnant on the day of the operation.

Due to the risk of necroses it is imperative that a patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….No progestin treatments (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms and scar inflammations.

It is imperative that you neither drink nor eat for the 6 hours prior to the operation.

The operation will be cancelled if preoperative advices are not adhered to : assessment, fast, stopping smoking…

When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE.

Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)

Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up. Do not shave your armpits before coming for the operation (risk of germs if there are micro-cuts, therefore a risk of infection during the operation.)

Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.

Anaesthetic and hospitalisation

The operation is performed at the clinic and lasts for 1 to 2 hours. It can be carried out:

• either without hospitalisation under assisted local anaesthetic
• or by spending one night at the clinic and with a general anaesthetic

Going home

– When the operation is carried out as an out-day surgery

You will usually leave a few hours after the operation. However, in certain cases (nausea, stress…) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants, do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.

You should arrange for someone to be with you at home. In fact, you should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).

Before leaving home prior to the operation, ensure that you have prepared everything for your return:

– Prepare a light meal

– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.

– When the operation is performed with hospitalisation

Bring clothing that is easy to put on for when you leave the hospital. In theory, you will be able to leave the clinic the day after the operation.

Next steps

It should be noted that due to traction on the scar, it will be difficult to lift the arms following the operation and this should be avoided for 15 days to 1 month. Any brusque movements that could stretch the scar should also be avoided.

For the first few days at home you must relax as much as possible and avoid any over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.

You must not smoke for 15 days in order to facilitate the healing process and reduce the risks or necrosis.

Note down the telephone number of the office, 01 45 53 27 17 from France, 33 1 45 53 27 17 for international call and the number of the clinic near your home telephone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if for you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.

Leave from work: 1 week depending on your professional activity
Stitches absorbable
Bruises 15 to 20 days
Swelling is at its height on the 3 rd or 4 th day after the operation then fades progressively
Scars take 6 to 9 months to whiten
Exercise It is necessary to wait for 4 to 6 weeks after the operation before resuming any sporting activity again that requires sideward arm movements and thus would pull on the scars

Risks

In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.

General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics

Infections

Risk of infections rises through the proximity of a natural crease. Therefore you will be asked to keep scars clean and to respect antiseptic and antibiotic prescriptions. In case of infection, a surgical drainage may be necessary.

Haematomas

Haematomas are a very rare complication but need to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.

Healing problems

As in any plastic surgery operation, the quality of healing is not known in advance. Immediately after the operation a scar can inflame or weep, requiring specific local treatments that can often be long. Respect of advice concerning cleanliness, stopping smoking and attendance of monitoring sessions will be decisive. In the mid-term, a scar can sometimes develop poorly: thicken, expand, form keloids. This principally depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)

Risks from anaesthetics

Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.

(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)

Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues

The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up are evoked prior to any aesthetic operation.

Arm lift – specific issues:

Imperfection of results

There is the risk of insufficient or asymmetric results especially for patients with bad quality skin and notably for people who were previously overweight whose skin tends to become slack as of the day after the operation.

Touching up

As we have just mentioned, the skin of people previously overweight has the characteristic of slackening quite soon after the operation. Thus, touching up or even repeat operations are not out of the ordinary. Some patients, though luckily few, need to have the operation repeated twice in order to achieve a satisfactory result (body lift, arm lift, inner thigh).

Sensitivity

The operation can lead to usually temporary problems (3 to 6 months) with regards to sensitivity.

Possible complications

Thrombo-embolic problems

These troubles are the most dreaded complications, even if they remain extremely rare. The phlebitis can sometimes lead to pulmonary embolisms which can be fatal ( 1 in 10 000).This risk increases with long haul flights too soon after the operation and by certain pathologies. This is why an anaesthetic consultation and the respect of preventative measures will be decisive: respect of potential anticoagulant prescriptions, halt of all progestin and hormonal treatment… Furthermore, if the anaesthetist feels that the patient should be rejected his decision is definitive. If in doubt during the post-operative period, a blood test can be performed to measure the D-Dimères and research impending thrombo–embolic problems.

Lymphatic effusions

Effusions may require draining. They usually dry with no further consequences, but can persist for several months. Preservation of the thick lymphatic trunks thanks to a superficial dissection reduces this risk.

Necroses

Extensive necroses are very unlikely thanks to the closing up of all dead areas using padding to reduce tension on the scars, a source of skin suffering, but it should be pointed out that the risk does exist and increases considerably due to cigarettes.

Marginal necroses are, however, less common, especially when the skin is of poor quality. They usually lead to a localised slackening of stitches due to the post-op tension (notably when the combined technique is used at the T intersection between the axillary and longitudinal scars.) These necroses require specific treatment that is often long. They are ultimately touched up later.

The result

Two to three months after the operation, a first evaluation of the result is possible. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.

Usually an appreciable aesthetic result is achieved with real psychological benefits and in cases where there is a clear excess of fat, the patient’s comfort is also greatly improved (rubbing disappears and it is easier for the patient to dress themselves).

The final appearance of the scar depends on the reaction specific to each patient and the cessation of smoking is a key factor in the healing process.

By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.

References:

Specific information delivered on this website is based on Doctor Le Louarn’s practice and on his scientific work :

PASCAL J.F., LE LOUARN C.: Brachioplasty
Aesthetic Plast Surg. 2005 Sep-Oct ; 29(5) : 423-9
http://www.ncbi.nlm.nih.gov/pubmed/16151657

Regarding arm lift surgery, the following publications and works can also be listed (this list is obviously non exhaustive and may be amended):

1 – ALI A., SOLIMAN S., CRAM A. : Brachioplasty in the massive weight loss patient
Clin Plast Surg. 2008 Jan ; 35(1):141-7
http://www.ncbi.nlm.nih.gov/pubmed/18061808

2 – EL KHATIB H.A. : Classification of brachial ptosis: strategy for treatment
Plast Reconstr Surg. 2007 Apr 1 ; 119(4):1337-42
http://www.ncbi.nlm.nih.gov/pubmed/17496609

3 – LOCKWOOD T.: Brachioplasty with superficial fascial system suspension
Plast Reconstr Surg. 1995 Sep ; 96(4):912-20
http://www.ncbi.nlm.nih.gov/pubmed/7652066

4 – BAROUDI R. : Body sculpturing
Clin Plast Surg. 1984 Jul ; 11(3):419-43.
http://www.ncbi.nlm.nih.gov/pubmed/6147222