Brachiaplasty What is a Brachiaplasty? As we age, or after losing a lot of weight, it is common to develop an
overhang of skin from the upper arms. Unfortunately no amount of exercise can improve the loose skin and this “bat wing” appearance can only be removed through surgical excision. What does the surgery involve? Any excess skin and fat is removed from the upper arm in one of two ways,
depending on your needs and scar preference. If you have minimal excess, then a small horizontal incision can be used hidden in the armpit. As this only allows minimal pull, only a moderate improvement in shape is possible.
However, the scar can only be seen on very close inspection. For those who wish a dramatic improvement, then a longitudinal scar from armpit to elbow is required. The scar is placed so that it will not be visible when your arms are by your side. This allows a large amount of excess skin to be removed, with
the inevitable trade off of a scar. The scars heal well and fade with time. They will, however, always be detectable. The surgery takes between one to two hours to complete and is usually performed under a general anaesthetic (you will be asleep during the procedure).
The operated area may be swollen for a few days and you will experience some pain. Simple painkillers are all that is normally required, although aspirin should be avoided for the first few weeks following your operation.
Providing all is well, you can expect to go home the day after surgery. What are the risks and side effects of surgery? Having cosmetic surgery can be a very positive experience. Complications are
infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of possible complications. A haematoma (collection of blood in the wound) can occur. This is most
likely to occur within 24 hours of surgery. Large haematomas may need to be drained in the operating theatre, under a general anaesthetic. Infection may occur but again this is rare. Infections can usually be treated successfully with antibiotics.
Everybody heals differently, and this is not always predictable. Poor or delayed healing occasionally occurs. These healing difficulties are exceptionally rare but can range from minor problems (such as small areas of wound separation) to major issues (such as skin loss). People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed
healing. There is alwayspermanent scarring where the incisions are made.
Although these usually fade and soften up to a year after surgery, scars can occasionally thicken and stretch. Darker skinned people have more of a chance of forming thick scars (hypertrophic or keloid scars).
Asymmetry/shape irregularities can occur following this operation. In rare cases, further surgery is needed to correct this. Most patients are not symmetrical before surgery and we would hope to be able to correct some of
these differences. However, it is important to note this before surgery, or you will think that the surgery caused the difference in appearance. The skin excision is performed above a thick layer of tissue called the fascia. The clockwork of the arm is housed below the fascia, so it should not be damaged during surgery. However whenever a cut is made in soft tissue
there is always a small risk of damaging important structures, which could lead to weakness of the arm, large patches of numbness or bleeding. Small areas of numbness are common, as small nerves to the skin have to be divided. This will improve with time and should resolve completely.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would
require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E.). Developing a chest infection is uncommon but more likely to happen to people who smoke.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your
surgeon. Decisions about cosmetic surgery should never be rushed. How do I prepare for surgery? Having had your initial consultation, if you decide to proceed, a mutually convenient date for your operation will be made. Prior to your admission, you
may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests, and heart tracing (ECG) may be taken. You will be given the opportunity to ask
any questions you may have or raise any concerns.
You will be admitted to the hospital on the day of your operation. If you are having a general anaesthetic, you will be asked not to eat anything six hours
before surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation. It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since
they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand. What happens after the operation? Once you have recovered from your anaesthetic, you will be encouraged to sit
up in bed. A small tube (called a drain) may be placed in each arm to drain off blood and
fluid. These tubes would be removed the next day before you go home. You will have a compression dressing put on in theatre. You will be advised to wear the compression dressing day and night for the next three to six weeks
to give support and prevent bruising or fluid collecting. Before you leave the hospital, you will be given a follow up appointment to
see either the surgeon and/or nurse. This is to check on your progress and also the wounds. If any non dissolvable stitches have been used, these will be removed about 10 days after surgery.
What is the estimated time for recovery, absence from work and return to usual activities? Recovery times vary from one person to another so use the times given below as a guide only. If you have any concerns during this period, do contact the hospital team for advice.
In the first two days after your operation, it is important for you to be out of bed and walking every two hours during the day and early evening. Staying in bed too long increases your chances of developing clots in the legs. Gradually increase your activity over the next few days.
If you have visible scars avoid sunbathing for up to a year after the operation and certainly for the first few months. The scars are more sensitive to
sunlight and burn more easily.
Brachiaplasty post surgery timeline 4 to 6 weeks 6 to 9 months You may have
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