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Liposuction of the Arm Concurrent with Brachioplasty in the Massive Weight Loss Patient: Is It Safe?
Abstract
Background:
Brachioplasty continues to be a sought-after procedure among the massive weight loss population. Residual adiposity of the upper arm can make this procedure more difficult. The authors sought to determine the safety of arm liposuction outside the region of excision with concomitant excisional brachioplasty.
Methods:
Data were analyzed from a prospective registry of massive weight loss patients who underwent brachioplasty alone or with concurrent arm liposuction. Variables examined included age, sex, body mass index, method of weight loss, medical comorbidities, and smoking status. Outcomes included complications such as seroma, wound dehiscence, infection, hematoma, lymphedema, and need for revision. Multivariate analyses were performed to assess outcome measures.
Results:
One hundred forty-four patients (139 women and five men; mean body mass index, 29.6 ± 4.1 kg/m; mean age, 46 ± 10.7 years) underwent brachioplasty. Sixty-four patients had concomitant arm liposuction at the time of brachioplasty. The remaining 80 patients underwent excisional brachioplasty alone. Despite significantly higher operative body mass indices among those undergoing concurrent liposuction, no significant differences in complication rates were seen between the liposuction and excision-alone cohorts for seroma (19.1 percent versus 23.1 percent), wound dehiscence (7.9 percent versus 2.6 percent), infection (4.8 percent versus 6.4 percent), hematoma (3.2 percent versus 0 percent), or lymphedema (3.2 percent versus 1.3 percent). Revision rates were similar between the two groups (9.5 percent with liposuction and 8.9 percent without liposuction).
Conclusion:
Liposuction can be performed safely and effectively outside the region of excision at the time of brachioplasty without the need for prior debulking or staged arm-contouring procedures.
Clinical question/level of evidence:
Therapeutic, III.
... 3 However, their technique was limited because of its complications, especially the unacceptable cicatricial contractures that developed mainly in the axilla, less definition of arm contouring, and scar widening. 1,[3][4][5][6][7][8] Many modifications have been developed since then to limit those side effects through changing scar shapes or sites or minimizing and limiting the scar to the axilla. [9][10][11][12][13][14][15][16] However, none of those techniques has proven to be satisfactory for correcting lipodystrophy, as all were only excision operations. ...
... Plastic and Reconstructive Surgery • February 2021 mid arm, but the pitfall was that it could not treat the resulting inferior redundancy. Bossert et al. 8 reported that liposuction can be performed safely and effectively outside the region of excision, but they performed only posterior arm liposuction using a single port at the elbow. This study reports circumferential arm liposuction followed by brachioplasty in the same operative session. ...
... The initial brachioplasty has the drawbacks of not addressing the lipodystrophy and has complications of visible, hypertrophic scars; wound dehiscence; seromas; lymphedema; and nerve injury. 3,8 Multiple modifications of scar placement and scar shape changes have been developed; mini brachioplasty techniques have also been developed. [9][10][11][12][13][14][15][16] Although these modifications have succeeded in limiting scar healing complications and reduced neurovascular injuries, the problem of lipodystrophy is still not solved. ...
Background:
Excess fat and skin in the upper arms have become troublesome with aging and especially after the advancement in methods of weight reduction. Arm contouring procedures can be divided into three groups: those dealing with skin redundancy, those dealing with the lipodystrophy, and a combination of both. This study tries to find an answer to the debate about the safety of simultaneous circumferential liposuction and brachioplasty.
Methods:
Sixty-two patients (49 women and 13 men) were operated on by simultaneous circumferential suction-assisted lipectomy followed by brachioplasty. Preoperative and postoperative arm circumferences and outcomes (including complications and patient satisfaction) were evaluated starting at least 6 months after the procedure.
Results:
Only two patients (3.2 percent) developed small areas of wound dehiscence that healed after repeated dressing and an extended period of compression garment use. One patient (1.6 percent) complained of hypertrophic scarring, which was managed by local compression and silicone sheets. The average reduction in mid arm circumference was 9 cm (range, 5 to 14 cm). Approximately 95.2 percent of the patients in the study are highly satisfied, and 4.8 percent reported a mild degree of satisfaction.
Conclusions:
Simultaneous circumferential arm liposuction followed by brachioplasty addresses both the lipodystrophy and arm ptosis in a single hospital admission. This combination does not increase the complication rate. The results are highly satisfactory to the patients. According to the results of this study, circumferential arm lipobrachioplasty is considered to be a safe, efficient, reliable, and feasible procedure.
Clinical question/level of evidence:
Therapeutic, IV.
... Although brachioplasty is widespread, the risk of postoperative complications such as hematomas, lymphedema, or skin sensitivity disorders still remains high because the surgical area has vascular, nerve, and lymphatic structures. [6][7][8][9][10] Thorek [11] was the first author to describe brachioplasty as a surgical procedure to improve arm shape; over the years, many other surgeons have been looking for techniques to correct skin deformity, achieve good aesthetic results, and at the same time reduce the incidence of postoperative complications. [12][13][14][15][16][17] Since the introduction by Illouz in 1980, [18] liposuction has been frequently combined with body contouring techniques. ...
... Despite its diffusion, this procedure is full of pitfalls because nerves, blood vessels, and lymphatics of the arm are located just beneath the area of resection so complications such as hematoma, seroma, or paresthesia are common. [6][7][8][9][10] One of the main problems is scar location and quality. ...
... [27] Recently, two studies evaluated the safety of these combined procedures. Gusenoff et al. [28] stated that brachioplasty could be safe if combined with other procedures, and Bossert et al. [9] found that the complication rate of the patient who underwent brachioplasty with medial scar alone was the same as that of the patient who underwent brachioplasty and liposuction of the posterior arm (outside the brachioplasty excision site). In our study, we found that the incidence of complications was significantly lower in the LAB group than in the standard technique group (9% vs. 60%, P < 0.01). ...
Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.
... Previous studies have reported complication rates ranging from 25% to 56%, although the definitions of complications have been variable. [6][7][8] While body mass index (BMI) has been described as major risk factor for complications in brachioplasty and body contouring surgery as a whole, other risk factors such as diabetes, age, gender, and facility in which the procedure was performed have either not been evaluated or have been disparate in previous studies. 6,7,9,10 Furthermore, brachioplasty has been deemed safe to be performed in conjunction with procedures such as liposuction, abdominal contouring, and lower body contouring but these studies agree that no definite conclusions can be made due to small study samples. ...
... [6][7][8] While body mass index (BMI) has been described as major risk factor for complications in brachioplasty and body contouring surgery as a whole, other risk factors such as diabetes, age, gender, and facility in which the procedure was performed have either not been evaluated or have been disparate in previous studies. 6,7,9,10 Furthermore, brachioplasty has been deemed safe to be performed in conjunction with procedures such as liposuction, abdominal contouring, and lower body contouring but these studies agree that no definite conclusions can be made due to small study samples. [6][7][8][9] Utilizing the CosmetAssure (Birmingham, AL) insurance database, our study aims to accurately describe the incidence of major postoperative complications in patients undergoing brachioplasty; evaluate risk factors associated with developing complications; identify the most common combined procedures with brachioplasty; compare outcomes in brachioplasty alone or with concomitant cosmetic procedures; and assess changes in brachioplasty patient profile over a 5-year period (2008 to 2013). ...
... 6,7,9,10 Furthermore, brachioplasty has been deemed safe to be performed in conjunction with procedures such as liposuction, abdominal contouring, and lower body contouring but these studies agree that no definite conclusions can be made due to small study samples. [6][7][8][9] Utilizing the CosmetAssure (Birmingham, AL) insurance database, our study aims to accurately describe the incidence of major postoperative complications in patients undergoing brachioplasty; evaluate risk factors associated with developing complications; identify the most common combined procedures with brachioplasty; compare outcomes in brachioplasty alone or with concomitant cosmetic procedures; and assess changes in brachioplasty patient profile over a 5-year period (2008 to 2013). This prospective, multicenter study is the largest investigation to date to evaluate outcomes of brachioplasty. ...
Background:
Brachioplasty is a popular procedure to correct upper arm ptosis. However, current literature on complications and risk factors is scant and inconclusive.
Objectives:
Using a large, prospective, multicenter database, we report the incidence of major complications and risk factors in patients undergoing brachioplasty.
Methods:
Patients who underwent brachioplasty between 2008 and 2013 were identified from the CosmetAssure (Birmingham, AL) database. The primary outcome was the occurrence of major complication(s), defined as complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the procedure. Risk factors including age, gender, body mass index (BMI), smoking, diabetes, combined procedures, and type of surgical facility were evaluated using univariate and multivariate analysis.
Results:
Within the 129,007 patients enrolled in CosmetAssure, 2294 (1.8%) underwent brachioplasty. Brachioplasty patients were more likely to be older than 50 years (50.1%), obese (36.3%), diabetic (5.5%), but less likely smokers (5.5%). Major complications occurred in 3.4% brachioplasties with infection (1.7%) and hematoma (1.1%) being most common. Combined procedures, performed in 66.8% cases, had a complication rate of 4.4%, in comparison to 1.3% for brachioplasties performed alone. Combined procedures (RR = 3.58), males (RR = 3.44), and BMI ≥ 30 kg/m(2) (RR = 1.92) were identified as independent risk factors for the occurrence of any complication. Combined procedures (RR = 12.42), and the male gender (RR = 8.89) increased the risk of hematoma formation.
Conclusions:
Complication rates from brachioplasty are much lower than previously reported. Hematoma and infection are the most common major complications. Combined procedures, male gender, and BMI ≥ 30 kg/m(2) are independent risk factors for complications.
Level of evidence:
2 Risk.
... 34 Liposuction has been reported as a bridge to future skin excision, 37,38 to facilitate skin excision by liposuctioning under the skin to be excised, 39 or to provide additional debulking by conservative liposuction adjacent to the skin excision site. 40 To our knowledge, circumferential limb liposuction in combination with immediate skin excision has not been reported, in either healthy aesthetic patients or in lymphedema patient. Unexpectedly, when liposuction and skin excision were simultaneously performed, as in the mLIPO group, the incidence of wound-related complications decreased. ...
... The complication profile of the mLIPO group compares favorably with the published outcomes for brachioplasty and thighplasty in healthy aesthetic surgery patients in nearly all parameters measured. 37,40 In other words, the complication decreased when more invasive surgery was performed in a higher-risk lymphedema patient population. We hypothesized that the favorable outcomes of mLIPO in the lymphedema patients, who theoretically were at higher risks for complications due to their compromised soft tissue quality than those without lymphedema, suggested feasibility of such technique in healthy aesthetic patients also. ...
Liposuction is the treatment of choice for solid predominant extremity lymphedema. The classic lymphedema liposuction technique does not remove skin excess created following bulk removal. The skin excess is presumed to resolve with spontaneous skin contracture. We investigated the technique of simultaneously performing liposuction with immediate skin excision in patients with solid predominant lymphedema and compared the outcome with that from the classic technique.
Methods:
Modified liposuction with skin excision (mLIPO) and standard liposuction without skin excision (sLIPO) were offered to patients with solid predominant extremity lymphedema. Skin traction of 4 cm and undulating skin mobility constituted positive "flying squirrel" sign. Patients with negative "flying squirrel" sign were excluded. mLIPO patients underwent skin excision. Surgical outcomes and postoperative complications were compared.
Results:
The study enrolled 15 and 26 patients into the sLIPO and mLIPO groups, respectively. mLIPO patients demonstrated statistically significant decrease in seroma/hematoma, contour irregularity, and skin necrosis, while experiencing increased procedural satisfaction.
Conclusions:
Skin excision following liposuction for solid predominant lymphedema is safe. It decreases postoperative complication and improves surgical outcome.
... Table 2 shows that most of the patients have a pre-bariatric surgery BMI less than 30 kg/m 2 ; nevertheless, this does not relate to the number of complications compared with patients with a greater 10,20 This remains controversial because other studies report a close correlation between a high BMI and the number of complications. 21 The most common complications in post-bariatric body contouring surgery are wound dehiscence followed by seromas. The wound dehiscence rate described is more than 22% to 30% of the cases. ...
... The same author in a different study demonstrated that liposuction associated with brachioplasty does not increase the complication rate compared with brachioplasty with no liposuction. 21 Several authors have demonstrated that abdominal surgery associated with liposuction does not increase the risk of complications, which is consistent with this work. 28,29 Smoking was not associated with increased complication rate, which remains a controversial issue in the literature. ...
Introduction:
Over recent years, body contouring procedures in postbariatric patients have been in exponentially growing demand resulting in high complication rates rendering a variety of ciphers in the literature.
Objective:
The purpose of this study is to determine the complication rate in patients who have undergone body contouring surgery after bariatric surgery between June 2012 and March 2015 at Hospital de San José.
Methods:
A cohort study including 153 individuals who underwent a total of 198 body contouring procedures after massive weight loss following bariatric surgery was conducted. Data on variables, such as complication rate according to the type of body contouring surgery, major and minor complications, weight of resected tissue, or intraoperation time, among other variables, were analyzed.
Results:
A total of 198 procedures were performed in 153 patients. The mean (SD) age of the patients was 43.93 years (9.4 years). Of 198 procedures, 110 (55.5%) had complications. The rate for major complications was 13%, and for minor complications, 87%. Complication rates according to the type of operation were as follows: circumferential abdominal lipectomy, 55.7%; extended abdominal lipectomy, 53.7%; cruroplasty, 69%; breast surgery, 57%; and brachioplasty, 40%. Patients who presented with bleeding enough to require transfusion (P = 0.000) and with weight of the resected tissue greater than 2700 g in abdominoplasty (odds ratio, 3.26; 95% confidence interval, 1.48-7.1) had a higher complication rate. There were no thromboembolic events among this population.
Conclusions:
The overall complication rate was 55.5%. The great majority were minor complications. The thromboprophylaxis regimen used was 100% effective.
... Data extracted from each paper included source, number of patients, maximum BMI, preoperative BMI, weight change, and information regarding a number of complications including: seroma, hematoma, dehiscence, infection, necrosis, deep venous thrombosis (DVT) or pulmonary embolism (PE), lymphedema, and death (Table 1). 1,2,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Complications were extracted as the number of (14), Infection (22) complications occurring and were converted to percentage in the total patient population, rather than number of complications per total complications. As seen in a previous meta-analysis published by Carloni et al, data pertaining to risk factors for the development of postoperative complications, including BMI indices, were often inadequate. ...
... 28 Other articles share conflicting views. 9,29 In recognition that clinically important complications are those which lead to functional impairment, readmission, or return to the operating room (OR), the PBCCRS requires stratification of complications by management. With this method of reporting, one can determine how often clinically relevant complications are occurring at their individual institution, and how one's institution compares to others across the country and world. ...
Background
Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report.
Objectives
We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications.
Methods
The authors reviewed the literature for the terms “body contouring,” “MWL,” and “complications.” Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring.
Results
Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance.
Conclusions
Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
... The literature is mainly concerned with scarring, fibrous bands, and sensory disturbances. 3,7,9,18 The safety of liposuction of the arms along with brachioplasty has been debated in the past. Although Bossert et al 18 asserted the safety to perform liposuction along with brachioplasty skin resection in 2013, they had a high overall rate of complications, 20% in both groups indicating technical challenges and/or challenging patients. ...
Background
The topographic anatomical changes of the upper arms and axilla after massive weight loss (MWL) seem ill-described in the literature. The importance of the axilla in MWL brachioplasty and how the procedure differs from the postmenopausal “batwing” deformity of the upper arms is also unclear. Consideration of the underlying pathology seems imperative for a successful reconstruction. We aim to test a procedure specifically designed to mend the underlying pathology of obesity and MWL, liposuction-assisted axillobrachioplasty (LAAB).
Methods
A prospective pilot study was designed to test the effect of LAAB on the axilla and evaluate the results comparative to patient’s preoperative complaints and well-being and allow for adjustments for future trials. We measured the diameter of the arm and axilla at three specific points, A, B and C, and applied the arm module of BODY-Q regarding body perception and psychosocial well-being.
Results
Fifteen women, for a total of 30 arms, were included. Age average was 48 years (29–59) and showed a significant improvement in all measurements A–C, most significantly at point A in the axilla, where the reduction was associated with relief of preoperative ailments and great improvement on BODY-Q ratings. The procedure was uncomplicated, with high patient satisfaction.
Conclusions
LAAB significantly improves the axilla and upper arm contour after MWL and correlates strongly with improvement of preoperative ailments. The study furthermore supports the clinical relevance of a posterior arm fat pad. The presented procedure seems to be uncomplicated and reproducible with a high patient satisfaction warranting a long-term clinical trial
... Over the years, the procedure has undergone numerous improvements and enhancements, however, most of the expert surgeons believe that postoperative scarring remains the main worry for patients [4]. The complication rate in most of the studies ranged from 36% to 53% with a range of revision between 4% and 22.9% [5,6]. The most frequent complications are pathologic scarring, seroma, dehiscence, infection, and hematoma [7]. ...
... In this study, we have tried to assess the effectiveness of UAL alone in arm contouring for lipodystrophy stages II-III, and the outcome was evaluated through complications incidence, patient satisfaction survey, and an independent plastic surgeon appraisal of patients' photographs. In this study, we have done 180°inferior liposuction, unlike Mahfouz and Hill et al. [11,20] who have used circumferential liposuction and Bossert [22], who has used regional liposuction adjunctive to brachioplasty. In this study, the authors did not approach the upper region in the arm because of two main reasons; the first one is patient characteristics as most of them did not have significant lipodystrophy in that area and they did not complain of the upper part of their arm. ...
Background
A witnessed rise in patients’ requests for arm contouring reflects the parallel public’s pursuit of slimmed bodies and rapid advancement in weight reduction methods. Brachioplasty with its known complications is still the traditional method of management, but nearly all patients feel worried about the length and appearance of the scar and seek other non-excisional alternatives. The authors wanted to share their experience in arm contouring in non-post-bariatric patients using ultrasound-assisted liposuction (UAL).
Patients and Methods
Over 16 month period, 28 female patients complaining of arm lipodystrophy (classes IIA, IIB, III) underwent UAL contouring under general anesthesia. Preoperative and postoperative mid-arm circumferences were measured and recorded. Outcome evaluation was done by the complication incidence, patient satisfaction survey, and independent surgeon evaluation of patients' photographs.
Results
There were no complications in the study group. The outcome evaluation survey has shown high patient satisfaction. The outcome survey demonstrated that 85.71% of the patients were very satisfied, while 14.29 % were satisfied with the procedure and all of them recommend the procedure to others. On the other hand, the independent surgeon evaluation showed that 92.86% of the results were excellent and 7.14 % were very good.
Conclusion
Our work has shown how versatile is the UAL in contouring a wide spectrum of arm lipodystrophy stages in non-post-bariatric patients and presents a non-excisional alternative for arm aesthetic refinements without a rush for brachioplasty with its unpleasant complications.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... Brachioplasty is rarely performed as an isolated procedure in the MWL population [19] . The upper extremities represent an excellent and safe target for combination with an LBL as a first stage procedure. ...
Deformities in the body contouring population are rarely isolated to one area, and procedures can be combined to achieve more substantial results. While there is no formula for optimal surgical sequencing and timing, there are certain principles which - when applied appropriately - can yield results that are reliable, aesthetically pleasing, and aligned with the patient’s desires and preferences. In this article, we outline our latest thinking in circumferential body contouring and how to integrate the lower body lift with procedures of the abdomen, upper body, breasts, back, and arms to achieve the complete 360° look.
... No correlation was obtained between the outcomes and associated lipoaspiration, similarly to Gusenoff et al. [3] and Bossert et al. [37]. ...
Background
Upper arm lift is a widespread body contouring procedure, but no globally accepted guidelines exist in selecting patients and, due to comorbidity and heterogeneity of them, it is difficult to identify predictive factors of good surgical outcome. The authors review the team’s experience of 56 brachioplasty performed in massive weighs loss patients.
Methods
Data of 56 consecutive arm lifts were reviewed for preoperative, perioperative and postoperative variables and outcomes (complications, scarring, wound healing, revision surgery, need for blood transfusion, satisfaction, etc.). Surgical technique and postoperative care are described. A statistical analysis was performed to identify relationship between possible predictive factors and outcomes. Furthermore, an evaluation of different employed wound management devices was conducted.
Results
Follow-up ranged from 6 to 36 months (mean 20.1 months). Outcomes summary is reported (overall complication rate 50%, poor scarring rate 25%, delayed wound healing rate 26.8%, revision surgery rate 37.5%, need for blood transfusion rate 8.9%, satisfaction rate 71.4%) and statistical investigation evidenced the role of prior plastic surgery BMI and the associated change in BMI before and after weight loss, just prior brachioplasty, and the modality of weight loss.
Conclusion
The authors’ technique resulted in positive outcomes overall, considering the difficulty in dealing with the problems of MWL patients. Based on our results, we aim to suggest to perform brachioplasty in patient with the lower achievable BMI (preferably <30kg/m2) to reduce the negative effect of unmodifiable factors as diabetes, modality of weight loss, a wide ΔBMI, and other well-known negative predictive factors.
... Brachioplasty as one of the body contouring operations in MWL patients can be associated with post-operative complications such as hematoma, seroma, infection, delayed healing, unfavorable scars and contour deformities. In the literature, the rate of complications varied widely from 1.3% up to 56% [19][20][21]. Other rare serious complications include fluid overload, thromboembolism, fat embolism and cardiopulmonary dysfunction most frequently occurring if brachioplasty is performed in conjunction with other body contouring procedures [7,8,[22][23][24]. ...
... Brachioplasty as one of the body contouring operations in MWL patients can be associated with post-operative complications such as hematoma, seroma, infection, delayed healing, unfavorable scars and contour deformities. In the literature, the rate of complications varied widely from 1.3% up to 56% [19][20][21]. Other rare serious complications include fluid overload, thromboembolism, fat embolism and cardiopulmonary dysfunction most frequently occurring if brachioplasty is performed in conjunction with other body contouring procedures [7,8,[22][23][24]. ...
... 29 These rates are lower than those previously published by Bossert et al, with an SSI rate of 6.4% among 80 patients who underwent excisional brachioplasty. 30 The authors attributed this difference to the fact that only major SSIs were included in the study (ie, requiring emergency room visit, hospital readmission, or reoperation within 30 days). A similar trend was found in another CosmetAssure study by the same group looking at 1493 patients who underwent thighplasty where the most common postoperative complication was SSIs in 2.7% of patients. ...
Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors, and varies depending on the specific operation performed. Understanding of the risk factors for the development of these infections is critical since careful patient selection and appropriate perioperative counselling will set the right expectations, and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course and avoid long-term sequelae.
... No statistically significant differences in complication rates were seen for the liposuction plus excision and the excision alone cohorts. 32 A multipractice cohort study of 96 patients showed that liposuction is a commonly used to address arm contouring patient. They reported that 53.1% of patients had simultaneous circumferential arm liposuction at the time of brachioplasty. ...
Arm contour improvement is a desired goal of the massive weight loss and the aging population who want to maintain the arm aesthetics. Brachioplasty is a growing and safe procedure to improve the arm contour and different approaches and innovative treatment options have been described since the 1930s. This paper reviews the relevant literature in arm contouring including surgical and nonsurgical procedures used to aesthetically improve the arm. A comprehensive literature review was performed using the words “brachioplasty,” “arm lift,” “arm contouring,” “arm liposuction,” “noninvasive arm lift,” “minimally invasive arm lift.” Commonly used techniques, classification systems, and procedure outcomes are described. The review demonstrated that there are several methods to accomplish good arm contouring. There is no consensus about the best incision type and location, but the classification systems help guide treatment. Assessment of fat excess, skin excess, and location of the deformity (proximal, entire arm, arm and chest) help determine the best approach including liposuction only, skin resection only, a combination of liposuction and excision, or even the use of nonsurgical devices. Infection, hematoma, and unsatisfactory scars are the most commonly reported complications. Brachioplasty is a growing procedure and can be performed with low complication rates and good patient satisfaction. Classification systems stratify deformities to the ideal treatment but no studies have shown the superiority of any technique. Nonsurgical fat removal and skin tightening of the arms are promising procedures for selected patients and higher levels of evidence are needed to show clear indication for different technologies and devices.
... 33 Other smaller cohorts studying hematoma following brachioplasties reported rates ranging from approximately 0% to 3%. [34][35][36] In a retrospective review of 25,478 abdominoplasties, Winocour et al found a major hematoma rate of 1.26%. 37 Interestingly, male sex was a significant risk factor for complications in that study with a relative risk of 1.8. ...
Hematomas represent one of the most common postoperative complications in patients undergoing aesthetic surgery. Depending on the type of procedure performed, hematoma incidence and presentation can vary greatly. Understanding the risk factors for hematoma formation and the preoperative considerations to mitigate the risk is critical to provide optimal care to the aesthetic patient. Various perioperative prevention measures may also be employed to minimize hematoma incidence. The surgeon’s ability to adequately diagnose and treat hematomas after aesthetic surgery is not only crucial to patient care but also minimizes the risk of further complications or long-term sequelae. Understanding hematoma development and management enhances patient safety and will lead to overall increased patient satisfaction after aesthetic surgery.
... [2][3][4][5] The overall complication rate ranges from 36 to 53.1 percent, with a revision rate ranging between 4 and 22.9 percent. 2,[6][7][8] The most frequent complications are pathologic scarring, seroma, dehiscence, infection, and hematoma. Wound dehiscence and hypertrophic scarring are major causes of reintervention, with an incidence of 7.3 to 9 percent and 24 percent, respectively. ...
Background:
Brachioplasty is an increasingly performed procedure following massive weight loss. A visible scar is the main hindrance to this surgery. The aims of the study were to develop a physical model to investigate the ideal location of the surgical incision and to present the authors' technical refinements with the posteromedial scar approach.
Methods:
Twenty-four postbariatric patients underwent brachioplasty with posteromedial scar placement, concomitant liposuction, fascial plication, and axillary Z-plasty. Skin specimens were tested and a physical model of the arm was set up to investigate the difference in mechanical stress on the posteromedial and medial scars. The validated Patient and Observer Scar Assessment Scale, the Vancouver Scar Scale, and a questionnaire assessing subjective improvements were administered to patients. Preoperative and postoperative photographs were assessed by three independent plastic surgeons.
Results:
The physical model showed that stress intensity and distribution along the scar were reduced in the posteromedial location, with smaller scar displacement in the loading simulations. Twenty-three patients healed uneventfully. One (4.1 percent) had a 2-cm dehiscence. Mean Patient and Observer Scar Assessment Scale scores were, respectively, 2 ± 0.76 and 2.13 ± 0.64 in the patients' and observers' questionnaires. The mean Vancouver Scar Scale value was 3.5 ± 1.7. Questionnaires assessing the subjective outcomes showed a mean value of 3.45 ± 0.63 of 4. The surgeons' assessment resulted in a score of 4.5 ± 0.4 of 5.
Conclusions:
The physical model demonstrated that the posteromedial scar was subjected to lower mechanical stress and displacement. The reported technical refinements allowed pleasant arm recontouring to be achieved with acceptable scarring and a low incidence of complications.
Clinical question/level of evidence:
Therapeutic, IV.
... Liposuction was performed to reduce the volume without damaging lymphatics, other vessels, and nerves, and to give better tissue mobilization. It did not increase the risk of post-operative complications and does not significantly modify the outcome, in accordance with the literature data (35,42). ...
Background:
Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing. Weight loss is the main cause, although not the only one, that drives patients to arm lift surgery. Several surgical techniques have been proposed over the years. Our aim was to consider the complications and outcomes according to the performed technique, through a wide review of the literature.
Methods:
A search on PubMed/Medline was performed using "brachioplasty", "upper arm lifting", and "techniques" as key words. Embase, Medline (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar were searched as well. As inclusion criteria, we selected the clinical studies describing techniques of brachioplasty. We excluded the papers in which complications related to brachioplasty were not specified. We also excluded literature-review articles.
Results:
We found 27 studies from 1995 to 2015. Overall, 1065 patients were treated. Different techniques were applied. Complications were observed in 308/1065 patients (28.9%). The most frequent complications were hypertrophic scarring, seroma and hematoma. Surgical revision rate ranged from 0 to 21 percent. Nerve damage occurred in a modest percentage of patients (16/1065, 1.5%). No major complications, such as thromboembolism and sepsis, were observed.
Conclusions:
Brachioplasty is a safe surgical procedure. All the brachioplasty techniques showed positive outcomes, in term of patients' satisfaction and clinical results. Nevertheless, minor complications occurred in a high percentage of patients, regardless the performed surgical procedure. Patients should be informed about the possible formation of hypertrophic scars and nerve injuries.
... It is unclear whether this finding is attributed to the increased operative time with each additional procedure, as shown by prior series, which might have led to this outcome. 53 Unfortunately, the length of operation is currently not available in the CosmetAssure database, thus we were unable to further explore this hypothesis. Interestingly, several prior studies have investigated the effect on postoperative complications of combining cosmetic procedures, within the same or different body regions, with mixed results. ...
Background:
The number of men undergoing cosmetic surgery is increasing in North America.
Objectives:
To determine the incidence and risk factors of major complications in males undergoing cosmetic surgery, compare the complication profiles between men and women, and identify specific procedures that are associated with higher risk of complications in males.
Methods:
A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Gender specific procedures were excluded. Primary outcome was occurrence of a major complication in males requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for major complications including age, body mass index (BMI), smoking, diabetes, type of surgical facility, type of procedure, and combined procedures.
Results:
Of the 129,007 patients, 54,927 underwent gender nonspecific procedures, of which 5801 (10.6%) were males. Women showed a higher mean age (46.4 ± 14.1 vs 45.2 ± 16.7 years, P < 0.01). Men had a higher BMI (27.2 ± 4.7 vs 25.7 ± 4.9 kg/m2, P < 0.01), and were more likely to be smokers (7.1% vs 5.7%, P < 0.01) when compared to women. Men demonstrated similar overall major complication rates compared to women (2.1% vs 2.1%, P = 0.97). When specific complications were analyzed further, men had higher hematoma rates, but lower incidence of surgical site infection. Additionally, major complications after abdominoplasty, facelift surgery, and buttock augmentation were noted to preferentially affect males. On multivariate analysis, independent predictors of major complications in males included BMI (RR 1.05), hospital or ambulatory surgery center procedures (RR 3.47), and combined procedures (RR 2.56).
Conclusions:
Aesthetic surgery in men is safe with low major complication rates. Modifiable predictors of complications included BMI and combined procedures.
Level of evidence:
2.
... A possible explanation for this finding is the increased operative time with each additional procedure, as shown by prior series. 47 As a result, surgeon fatigue may lead to less meticulous hemostasis, and intraoperative hypothermia is more likely to occur, which in turn could potentially disrupt the coagulation cascade. The length of operation is not available in the CosmetAssure TM database, thus we were unable to explore this hypothesis further. ...
Background:
Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences.
Objectives:
To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database.
Methods:
A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures.
Results:
Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P < 0.01) and BMI (24.5 ± 5.0 kg/m2 vs 24.3 ± 4.6 kg/m2, P < 0.01) were higher in patients with hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P < 0.01). Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P < 0.01), and breast procedures compared to body/extremity or face procedures (1.0% vs 0.8% vs 0.7%, P < 0.01). On multivariate analysis, independent predictors of hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81).
Conclusions:
Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas.
Level of evidence 2:
... These authors suggested that preoperative debulking or staged procedures were unnecessary. 39 Aly 40 advised against performing liposuction with excisional brachioplasty, noting that edema and swelling can accompany liposuction and interfere with skin removal in brachioplasty, leading to over-or underresection. Among proponents of the combined procedure, some investigators disagree on whether to suction the arm at the excision site, 17 adjacent to the excision site, 2,3 or circumferentially. ...
Background
Varied deformities of the upper arm are common after massive weight loss. Brachioplasty techniques have been successively modified to improve aesthetic outcomes and avoid complications, especially lymphedema and sensory damage.
Objectives
The authors evaluated lymphatic drainage and sensory function of the upper limbs after brachioplasty performed with a double-ellipse marking technique, a medial incision, superficial undermining, and posterior arm liposuction.
Methods
This prospective study included 12 women who underwent brachioplasty after bariatric surgery and massive weight loss. Lymphatic drainage was evaluated by forearm volumetry and indocyanine green lymphography of the entire limb. Cutaneous sensitivity thresholds were determined with Semmes-Weinstein monofilaments.
Results
Patients received postoperative follow up for 12 months. Complications included a small dehiscence for 1 patient and hypertrophic scarring for 2 patients. Cutaneous sensitivity and forearm volumetry were unchanged after brachioplasty for all patients. Results of indocyanine green lymphography indicated that all patients had normal linear lymphatic patterns pre- and postoperatively.
Conclusions
Results of the study support the belief that this type of brachioplasty does not disrupt sensory or lymphatic function of the limb.
Level of Evidence: 4
... 3,8,9,14,15 Surgical procedures that involve substantial liposuction (ie, ≤600 mL per arm) and minimize skin excision have been shown to improve the aesthetic results of brachioplasty. [1][2][3][9][10][11][12][16][17][18][19][20][21][22] We have observed that patients with brachial ptosis present with a minimal to severe contour depression of the medial arm. This contour depression usually is associated with skin and fat excesses of the posterior arm, but occasionally occurs in patients with a normal posterior arm. ...
Background:
Current brachioplasty techniques include excisional surgery alone or in combination with liposuction. These techniques are associated with poor outcomes, such as residual contour deformities and unfavorable scarring.
Objectives:
The authors proposed a new classification system and treatment algorithm for brachial ptosis and described their experience with power-assisted liposuction and lipofilling to treat brachial ptosis without excisional surgery.
Methods:
Ninety-five patients with grades 1, 2, or 3 brachial ptosis who underwent brachioplasty were evaluated in a prospective study. Power-assisted liposuction was applied to the posterior arm and para-axillary region, and power-assisted lipofilling was applied to the so-called "bicipital triangle" of the medial arm.
Results:
The patients' mean age was 39 years, mean body mass index was 28 kg/m(2), mean lipoaspirate volume was 240 mL per arm, and mean fat-injection volume was 110 mL per side. The mean operating time was 50 minutes, and the average follow-up period was 24 months. Hematoma developed in 2 patients who underwent brachioplasty in combination with another body contouring procedure (1 abdominal hematoma and 1 thigh hematoma; 2.1% complication rate). No other complications were recorded.
Conclusions:
Brachioplasty by means of power-assisted liposuction and lipofilling is a safe and reliable option that obviates excisional surgery in patients with mild to moderate brachial ptosis.
Level of evidence:
4 Therapeutic.
Background
Upper arm aesthetics often suffer from aging effects like skin laxity and sagging due to collagen and elastin depletion. Fat loss, obesity, and weight fluctuations further exacerbate these issues. Existing classification systems for upper arm excess are complex and have practical limitations.
Objectives
To develop a more concise and clear classification of upper arm excess that can guide surgical interventions effectively and assess clinical outcomes.
Methods
Patients undergoing upper arm rejuvenation surgery from January 2020 to January 2023 were categorized as mild, moderate, and severe. Mild cases underwent suction-assisted liposuction (SAL), moderate cases underwent radiofrequency-assisted liposuction (RFAL) combined with SAL, and severe cases underwent brachioplasty combined with SAL. Arm circumferences and BODY-Q questionnaire were collected pre- and post-operatively.
Results
The study included 50 female patients, aged 21-49. The average follow-up time was 7.5±2.2 months. Arm circumference reduction rates were 6.8% in mild cases, 15.1% in moderate, and 17.3% in severe. Regarding the BODY-Q questionnaire for upper arms, the average score increased by 0.9 for mild, 2.1 for moderate, and 2.9 for severe cases. Complications were minimal, including one seroma and two cases of scar widening.
Conclusions
The revised classification system for upper arm excess proved effective in guiding surgical decisions. Different surgical approaches based on severity—SAL for mild cases, SAL combined with RFAL for moderate, and SAL with brachioplasty for severe—resulted in satisfactory outcomes, as indicated by BODY-Q scores. This system offers a concise, objective, and practical tool for plastic surgeons.
Body contouring procedures are rewarding endeavors for the patient and surgeon alike. For massive weight loss patients in particular, these procedures have the potential to transform body appearance, improving quality of life and self-esteem. However, they are also associated with perioperative risks that are among the highest in all of plastic surgery. Safe and effective body contouring relies on preoperative optimization of patient comorbidities, thoughtful surgical planning, and diligent implementation of measures to prevent complications. Our goal is to review safety in body contouring as pertaining to the patient, procedure, surgeon, and facility, the four facets of the ISAPS Safety Diamond.
Current brachioplasty techniques include excisional surgery alone or in combination with liposuction. However, these techniques generally have poor outcomes, such as unfavorable scarring and residual contour deformities. We propose a new classification system and treatment algorithm for brachial ptosis and describe our experience with power-assisted liposuction and lipofilling to treat brachial ptosis that avoids excisional surgery. Power-assisted liposuction can be applied to the posterior arm and para-axillary region, and power-assisted lipofilling can be performed in the so-called bicipital triangle of the medial arm. Nevertheless, a short skin excision remains indicated in cases of moderate to severe skin excess.
Brachioplasty has risen in popularity as a safe and effective method to address upper arm contour, particularly as increasingly common bariatric procedures have generated a large population of massive weight loss (MWL) patients. Surgical decision-making is guided by physical examination which will reveal excess of skin, adiposity, or both. Patients must be carefully selected and counseled to manage their expectations, as brachioplasty results in a conspicuous scar. Minimally invasive options may provide satisfactory results in some patients, but do not adequately contour the arm and chest in patients who have had loss of skin elasticity as a result of massive weight loss. Brachioplasty can be safely and effectively provided alone or in combination with most other upper body contouring procedures, including mastopexy and upper body lift.KeywordsArm contouringArm liposuctionArm liftBody contouringMassive weight loss
Introduction
Since 1972, when first pioneered, liposuction has developed and is now one of the commonest aesthetic procedures performed worldwide. Evidence of its application in aesthetic lipomodelling is widely known, but there are scant reports in the literature on the use of liposuction in more unusual cases. We report its use as a safe and successful method of contour correction in two cases of lipomyelomeningocoele, a form of spina bifida. To our knowledge this has never been reported before.
Method
A prospective review was performed and both cases were followed up during the treatment period. Both patients were treated at the Royal Belfast Hospital for Sick children. Patient charts were reviewed and Magnetic Resonance Imaging was used.
Results
Two patients, aged 11 and 17 years, had a large lipomyelomeningocoele over the lumbo-sacral area. Pre-operative imaging was obtained in each case to ensure the procedure could safely avoid the underlying spinal cord structures. Use of the Microaire© suction device allowed precise fat extraction. Post-operative images demonstrate reduction of lipomatous bulk and improved contour.
Conclusion
We have shown that when used with caution, liposuction is a safe and effective technique for volume reduction of a lipomyelomeningocoele in carefully selected cases.
Brachioplasty has become one of the fastest-growing aesthetic surgery procedures, paralleling rising rates of weight loss surgery nationally. However, controversy persists regarding incision placement and utility of concurrent liposuction. In this article, the authors describe indications, patient selection, expected outcomes, and photographic standards for patients seeking brachioplasty after weight loss. Preoperative markings, scar placement, and operative steps of a posterior incision technique with or without concurrent liposuction if indicated are described. A personal experience with posterior incision brachioplasty along with current controversies, complications, and patient-reported outcomes after upper arm contouring are reviewed.
Background:
Brachioplasty procedures have experienced a surge in popularity over the past decade, mirroring the rise in bariatric procedures and growing population of massive weight loss patients. The authors estimated the incidence of associated complications and identify possible patient- or procedure-related predictive factors.
Methods:
A systematic review was performed using the PubMed, Cochrane, and Embase databases; extracted data were synthesized through a random-effects meta-analysis of proportions and a multivariate meta-regression.
Results:
Twenty-nine studies were included in the meta-analysis, representing 1578 patients; all studies followed an observational design. The incidence of adverse outcomes assessed included aberrant scarring, 9.9 percent (95 percent CI, 6.1 to 15.6 percent); ptosis or recurrence, 7.79 percent (95 percent CI, 4.8 to 12.35 percent); wound dehiscence, 6.81 percent (95 percent CI, 4.63 to 9.90 percent); seroma, 5.91 percent (95 percent CI, 3.75 to 9.25 percent); infection, 3.64 percent (95 percent CI, 2.38 to 5.53 percent); nerve-related complications, 2.47 percent (95 percent CI, 1.45 to 4.18 percent); lymphedema or lymphocele formation, 2.46 percent (95 percent CI, 1.55 to 3.88 percent); skin necrosis or delayed healing, 2.27 percent (95 percent CI, 1.37 to 3.74 percent); and hematoma, 2.06 percent (95 percent CI, 1.38 to 3.06 percent). The operative reintervention rate for aesthetic purposes was 7.46 percent (95 percent CI, 5.05 to 10.88 percent), and the operative reintervention rate for nonaesthetic purposes was 1.62 percent (95 percent CI, 1.00 to 2.61 percent). Multivariate meta-regression demonstrated that medial incision placement was associated with a higher risk of complications, whereas the incidence of certain complications was lowered with adjunctive liposuction (p < 0.05).
Conclusion:
In the absence of large clinical trials, the present meta-analysis can serve to provide plastic surgeons with an evidence-based reference to improve informed consent and guide procedure selection with respect to the complication profile of brachioplasty.
Body contouring procedures are highly impactful because of their potential to improve a patient's quality of life. These procedures, particularly when performed on patients following massive weight loss, may require secondary intervention to treat residual contour abnormalities. Presently, there is a paucity of information in the literature detailing the avoidance and correction of body contouring deformities. Herein, we will discuss the management of patients seeking revisional body contouring procedures.
Learning objectives:
After studying this article, the participant should be able to: 1. Understand the types of tumescence available for liposuction. 2. Explain the various modalities available for liposuction. 3. Describe the patient selection, staging, and complications associated with debulking liposuction. 4. Describe ways to optimize outpatient liposuction.
Summary:
Liposuction is one of the most common procedures performed by board-certified plastic surgeons and is likely greatly underestimated, given underreporting of office procedures and the number of non-plastic surgeons performing these operations. With the ever-increasing popularity of liposuction, various methodologies and technology have been designed to make this task simpler and faster for the surgeon and hasten the recovery for the patient. In the past 10 years, over 50 devices or techniques have been released to assist, refine, or altogether replace liposuction. With the advent of these newer tools, a thorough Continuing Medical Education study was performed to review the available literature.
Background
Body contouring procedures provide patients with a meaningful improvement in health-related quality of life (QoL). We aim to compare the difference between the QoL in patients undergoing a single post-bariatric abdominal body contouring procedure (BCP) and those undergoing two or more concurrent procedures.Methods and MaterialsPatients evaluated for post-bariatric BCP were identified and administered the BODY-Q©. Patient demographics, clinical and operative characteristics, surgical outcomes, cost data, and absolute change in QoL scores were analyzed using descriptive statistics, chi-square, and Mann–Whitney U-test, between patients who underwent single (SP), double (DP), or triple (TP) concurrent procedures.ResultsA total of 45 patients were included. The median age was 52 years old ([IQR] ± 13). The majority were female (71.1%) and African-American (55.5%). The most common single procedure was panniculectomy (75%). Surgical site occurrences, readmissions, and the complication composite outcome did not differ between groups (p>0.05). No difference was seen between SP and DP QoL score (p>0.05). The DP had a statistically lower net QoL score compared with TP cohort in four domains. The SP had a statistically lower net QoL score compared with the TP in three domains. Average total cost for patients receiving an SP was 19,063.94 for DP (p<0.01), and $19,765.02 for TP (p>0.05).Conclusions
Body contouring procedures are associated with improvements in QoL irrespective of the number of concurrent procedures. Further improvement in psychological well-being occurs for patients who proceed with double concurrent procedures, albeit with an increase in cost.Level of Evidence IVThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Background
Ambulatory or outpatient surgery is defined as surgery that does not require an overnight hospital stay. It offers patients both convenience and reduced costs. With the increased use of bariatric surgery, Extended L-shaped Lipo-brachioplasty is now frequently requested as a follow-up procedure. Although numerous studies have focused on its technique and outcomes, none have evaluated its acceptability as an outpatient procedure. This was the aim of this prospective study.
Patients and methods
This study was performed between January 2016 and September 2019. All patients undergoing extended L-shaped Lipo-brachioplasty during that period were included and divided into two groups, according to the type of hospitalization. For both groups, we recorded the demographics, medical and surgical data, as well as any postoperative complications. In the outpatient group, we also recorded discharge failures at day 0.
Results
75 patients were included in the study (40 outpatients, 35 hospitalizations). There were no significant differences between the two groups in terms of demographics, surgical data, or the incidence of complications. In the outpatient group, three patients could not be discharged the evening of the procedure and had to stay overnight. No readmissions or major complications were reported in this group.
Conclusion
Our prospective study shows that outpatient Extended L-shaped Lipo-brachioplasty safely provides the same outcomes as those performed during traditional hospitalization. We believe that for eligible patients, it should routinely be performed as an outpatient procedure.
Due to an increasing number of major weight loss after bariatic surgery, the demand for body-coutouring surgery increase in paralell. Among all the technics which can be realized, brachioplastyis one of them. The goal is to reach a functionnal but an aesthetic improvement too. The literature show that the rate of major complication is very low (or not reported in the majority of the series). Minor complication is more common : hypertrophic scar, large scar, paresthesia, and wound dehiscence. Re-operation can be asked by the patient in order to improve the result. With the help of clinical cases and literature review the authors try to analyse the balance between benefice and risk to realize a second operation.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
Arm contouring after massive weight loss is a popular procedure but has several important challenges that should be addressed. The pre-operative arm assessment is important for determining the amount of fat present on the posterior aspect of the arm, global adiposity of the arm and axilla, and presence of any pre-existing arm bands. Understanding these anatomic variations will improve post-operative results and avoid either suboptimal outcomes or patient dissatisfaction. Key points include determining scar position, minimizing removal of axillary contents with superficial dissection, taking care to avoid injury to the medial antebrachial cutaneous nerve, and understanding how to combine brachioplasty with additional procedures such as a mastopexy or upper body lift. “Precision excision” is the technique preferred to avoid over-resection and inability to close the arm. Common post-operative complications and undesirable results are reviewed.
Brachioplasty is an increasingly popular procedure performed for improved arm contour in the massive-weight-loss population. There are challenging deformities presented in this population, such as redundant skin, posterior arm lipodystrophy, and loosening of fascial layers of the upper arm and chest wall that must be addressed to achieve successful contour of the arms. Common complications can be minimized with meticulous technique and knowledge of surgical anatomy. Additionally, brachioplasty can be combined with liposuction of the posterior arm as a safe and effective method for arm contouring without a higher risk of complications.
Background:
Demand for post-passive weight loss (MWL) brachioplasty in the United States has seen a dramatic increase, from 338 procedures in 2000 to 17,099 in 2015. New challenges are emerging, some without clear solutions. Here we describe our series of arm band deformities not yet been described in the literature.
Methods:
This is a retrospective review of MWL patients undergoing brachioplasty at our institution (2000-2016). Pre- and post-operative photographs were reviewed to identify the defect. Descriptive statistics and t-test were used.
Results:
In our cohort of 1,090 MWL patients, 172 patients underwent brachioplasty, 25 patients (15%) were identified with the deformity. Twenty-four (96%) were female (ave 60y [36y,85y], BMI 34 at time of surgery, ave 2y since GBP, mean delta BMI 22). The bands were generally single bands (100%) found bilaterally (68%) in the distal third (74%) of the upper arm and exacerbated (50%) by brachioplasty. The average specimen weighed 1005g. We found arm banding was associated with higher current BMI, but not with maximum BMI or delta BMI.
Conclusions:
For MWL patients, arm band deformity is a challenging problem which can be exacerbated by brachioplasty and is not currently surgically correctable. It can be identified pre-operatively to aid in counseling. We found patients with higher current BMI to be at a higher risk for the arm band deformity after brachioplasty.
Brachioplasty is becoming more popular as patients lose large amounts of weight from dieting or bariatric surgery. Some patients seek treatment of excessive skin laxity in the absence of a history of weight loss. Most are women.
Upper arm contouring is based on the location and amount of excess skin and fat. The short-scar brachioplasty addresses minimal to moderate skin laxity and lipodystrophy in the proximal arm in patients with appropriate skin tone and quality. This article highlights technical refinements of the senior author's (R.J.R.) approach to short-scar medial liposuction-assisted brachioplasty to maximize results and minimize incision length. To highlight this simple and safe approach with high patient/surgeon satisfaction, the authors discuss the following in this Video Plus article: patient examination, preoperative assessment, surgical pearls, and postoperative outcomes.
Brachioplasty is a good solution for women with pendulous lax skin, but the resulting scar is difficult for most patients to accept. Liposuction leaves almost no scar and can remove the fat tissue from a large fatty arm. The author discusses the problems of radiofrequency in liposuction patients and the use of radiofrequency in obtaining skin contraction. Multiple cases are presented.
“Incidence and Risk Factors of Major Complications in Brachioplasty: Analysis of 2294 Patients” is an outcomes analysis that describes the greatest number of patients undergoing brachioplasty studied in the literature.1 Patients who underwent brachioplasty and were covered by CosmetAssure health insurance comprised the database. The study investigates risk factors for major complications as well as the major complications that occur in patients undergoing brachioplasty as a stand-alone or as part of a combined cosmetic surgical procedure. The investigators found that patients undergoing brachioplasty were more likely to be older than 50 years and typically have a body mass index (BMI) >30 kg/m2. With regard to complicated outcomes, 77 patients (3.4%) developed at least one major complication, the most common being infection (1.7%), followed by hematoma (1.1%), venous thromboembolism (VTE) evaluation (0.4%), hypotension (0.1%), and cardiac complications (0.04%). Male gender led to an increased risk in overall complications, and specifically hematoma rates. BMI ≥ 30 was similarly found to be a risk factor for overall complications and infection. Brachioplasty was most frequently combined with liposuction or abdominoplasty, and there was an increase in hematoma rates and overall complications in combined procedures. The study assists plastic surgeons in forming a risk stratification scheme for patients pursuing brachioplasty, with a greater understanding of the factors that incite a higher risk for a major complication.
The literature investigating body contouring outcomes (and brachioplasty outcomes more specifically) is generally young and relatively thin. The majority of papers are retrospective and emanate from a single surgeon experience. The benefit of this source of data is that the investigator knows the study population and has followed the patients, so the reader knows …
Obesity is a complex mixture of psychological, environmental, social, cultural, economic, geographic, and genetic influences with little discrimination regarding age, ethnicity, or gender. Bariatric surgery may help in massive weight loss but often determine significantly alteration to the body profile with functional impairment. Reconstructive plastic surgery interventions correct post-bariatric surgery deformities and must be included in morbid obesity management as body contouring helps long-term weight control. As a general rule, contouring operations should be done after weight loss is complete, as wound complications tend to be higher when surgery is performed in patients who are still obese. The authors present a description of personal surgical approaches to abdominoplasty, mastopexy, brachioplasty, and inner-thigh lift.
Brachioplasty has become one of the most rapidly growing operations in plastic surgery. There are a variety of arm presentations, due to either weight loss or other reasons, and the extent of the defect can carry into the lateral chest wall and the back. In this featured operative technique article, the author describes indications, patient selection, and criteria for classifying brachioplasty, and illustrates the surgical techniques of this procedure. Markings, scar positioning, and the various operative steps are described along with the intricacies of postoperative care, including scar control. A personal experience, along with the limitations of brachioplasty, are discussed. © 2015 The American Society for Aesthetic Plastic Surgery, Inc.
With the increased popularity of minimally invasive cosmetic treatments, this study evaluates the efficacy and safety of microfocused ultrasound with visualization (MFU-V) for tightening lax skin above the elbow.
Subjects were treated bilaterally above the elbows with MFU-V using transducers with different focal depths. Photographs were taken before treatment and at 90- and 180-day follow-ups. Masked observer ratings and physician and subject global aesthetic improvement scales (PGAIS and SGAIS) were completed at follow-ups. Safety, based on adverse event (AE) incidence, was assessed.
Masked blinded assessment was completed at 90 days; 56% showed aesthetic improvement. Overall improvement in SGAIS was 83% and 81% at 90 and 180 days, respectively. The overall improvement in PGAIS was 94% at both 90 and 180 days. Patient satisfaction questionnaires showed that 83% noticed improvements in elbow characteristics at 90 days, with 81% still indicating improvement at 180 days. No serious AEs or treatment-related AEs were reported.
This pilot study suggests that MFU-V is a safe and promising nonsurgical option for the treatment of skin laxity above the elbow. Based on the positive results of this study, a larger trial is warranted together with testing different treatment densities to optimize this noninvasive approach.
The L-brachioplasty is an L-shaped pattern of excision with the long limb from the elbow to the axilla and the short limb extending at right angles through the axilla and along the lateral chest. The width of the excisions through the arm, axilla and chest is based on preoperative assessment through anatomical point locations followed by pinch and gathering maneuvers. The following modifications have improved aesthetics and reduced complications: 1) improved geometric design, 2) anchor fixation of the posterior V-shaped advancement flap to the deltopectoral fascia, 3) excision site liposuction (ESL), and 4) and barbed suture closure.
The free hand markings are followed by measuring equal anterior and posterior incision distances. The subcutaneous fat within the excision site is completely suctioned. After the perimeter is incised, the skin resection begins full thickness from the chest and through the axilla and then the skin only through proximal to distal arm skin. An anchor suture advances the posterior triangular flap to the deltopectoral fascia. A long-lasting absorbable barbed suture is passed through as a running horizontal mattress, starting from the center of the wound. A second continuous rapidly absorbing barbed intradermal suture completes the closure.
Over the past 30 arms, only one seroma was aspirated on one occasion. There have been no lymphoceles. Appreciable swelling is over within a month. Incision dehiscence was limited to less than one centimeter in five patients. Tip necrosis of the V advancement flap occurred in three arms, leaving small wounds in the axilla to heal secondarily. Minor secondary skin reduction is rare. There were no contractures across the axilla. The women appreciated the reduced hair and axillary hollow. In most cases the skin laxity was corrected and the contour from the arm across the axilla to the lateral chest was excellent. No patient expressed regret over their scar.
Patients presenting trophic alteration in the skin of their arms are usually those who submitted themselves to a weight loss diet that gave a fast result or who show the after effects of a specific disease. Exuberant skin and fat appear as a “fat pad” under the axilla or as a redundant fold along the posteromedial aspect of the arm when the limb is abducted.
A growing number of massive weight loss patients are undergoing brachioplasty. The authors analyzed data from a prospective registry of massive weight loss patients who underwent brachioplasty alone or with concomitant operations to identify statistically significant complications.
One hundred one massive weight loss patients underwent brachioplasty. Outcome measures included operative time; time since gastric bypass; need for revision; arm liposuction; and complications such as seroma, dehiscence, hematoma, infection, and nerve injury. Univariate analyses were performed to assess outcome measures.
One hundred one patients (97 women and four men; mean age, 45.9 +/- 10.1 years; mean body mass index, 29 +/- 3.9) with a mean time since gastric bypass of 28.5 months (range, 7 to 252 months) underwent brachioplasty. Ninety-seven patients (96 percent) had concomitant body contouring procedures; 23.8 percent had concomitant arm liposuction; and 36 patients had complications related to their arms, mostly in the form of a seroma, whereas dehiscence, infection, and hematoma were more prevalent with the concomitant procedures. Patients with a greater change in body mass index had a higher chance of wound infection (odds ratio, 1.1; p = 0.028). Longer operative time was associated with increased rates of surgical complications (p = 0.003; odds ratio, 3.8) at the operative site. There was a trend toward increased complications when arm liposuction was combined with brachioplasty (odds ratio, 2.5; p = 0.05).
Brachioplasty is a safe and effective method of treating upper arm deformity in the massive weight loss patient. Although patients with greater weight loss are likely to present for longer contouring procedures and are at highest risk for wound-healing complications, these complications occur most frequently in areas other than the arms.
Brachioplasty has increased 4059 percent from 2000 to 2008 in the United States, with 14,059 upper arm lift procedures performed in 2008. Numerous variations in the evolution of brachioplasty have been described to improve on complications and outcomes. Liposuction-assisted posterior brachioplasty is the next step in the series of refinements in upper arm contouring.
The authors present a series of 21 patients who underwent upper arm contouring with liposuction-assisted posterior brachioplasty, and include an operative video detailing the enhancements. After anatomical analysis of the posterior arm, noting skin and fat redundancy, appropriate patients were selected for this procedure. Operative markings, liposuction technique, and the unique excisional technique are presented with intraoperative video footage.
Patients tolerate liposuction-assisted posterior brachioplasty very well, with minimal complications and good results. One post-bariatric surgery patient experienced a small wound dehiscence, and one non-bariatric surgery patient developed a slight hypertrophic scar in one arm. No other complications were noted. No revisions were performed.
Liposuction-assisted posterior brachioplasty is an efficient and reproducible procedure in selected patients with generalized inferior arm skin and fat redundancy. It simplifies the markings and resection. It provides a safe procedure by preserving lymphatics, blood loss, and nerves. It produces reliable and predictable results with optimal outcomes. This technique offers another refinement in the evolution of upper arm contouring.
Body contouring following massive weight loss (MWL) has gained in popularity. The demand for upper arm contouring procedures has increased, and we elected to evaluate our results, complications, and patient satisfaction with brachioplasty techniques in MWL patients. A retrospective review was performed on all patients who underwent a brachioplasty procedure. Patient demographics and risk factors were queried. We evaluated surgical techniques and outcomes. Thirty-one patients underwent a bilateral brachioplasty, with an average follow-up of 16 months. The surgical technique included double ellipse n = 16, and L-shaped n = 15. The average weight loss before the procedure was 146 pounds, and the average body mass index at the time of the surgery was 30. Risk factors were present in 68% of the patients. The complication rate was 22%, including cellulitis, hematoma, infection, delayed healing, and lymphocele. The revision rate was 16%, most being minor scar revisions for contour improvement. Patient satisfaction scores included overall satisfaction 4.3/5, contour improvement 4.3/5, symptomatic improvement 4.9/5, and scar appearance 3.9/5. Most patients (94%) reported improved self-esteem, 94% being more comfortable wearing short sleeve shirts, and 94% would undergo the procedure again. Brachioplasty is a relatively safe and effective procedure for upper body contouring in the MWL patient. Complications are minor, and small revisions in contour are not uncommon. Patients report improvement in contour and self-esteem, and a high level of satisfaction with this procedure, despite the potential for an unfavorable scar.
In performing brachioplasty, the authors have created a double-ellipse marking technique to avoid overresecting and leave adequate skin for closure. After resecting, they prevent the interference of soft-tissue swelling during wound closure by immediately closing each segment with temporary staples. Their technique is ideal for patients with massive weight loss.
The author discusses how wide experience with lipoplasty techniques, the development of modified brachioplasty procedures, and improved understanding of skin retraction have reduced surgeon discomfort about brachial lipoplasty and brachioplasty.
To analyze the impact of body mass indices on postbariatric reconstructive surgery complications.
An increasing number of patients are presenting after massive weight loss due to bariatric surgery or diet and exercise. Many of these patients have residual obesity, which may compromise outcomes.
449 patients were enrolled in a prospective registry over 6 years. Measures included medical complications and comorbidities. All cases were analyzed together as well as in two subgroups: single procedure cases (Group I) and multiple procedure cases (Group II).
449 patients (407 female, 42 male) with a mean age of 44.5 +/- 10.3 underwent 511 separate operations. Mean pre-weight loss BMI (Max BMI) was 51.6 +/- 9.5 kg/m2, post-weigh loss BMI (Current BMI) was 29.3 +/- 5.0 and the DeltaBMI was 22.3 +/- 7.5. For all cases (n = 511), the presence of a surgical complication was directly related to Max BMI (P = 0.002) and DeltaBMI (P = 0.002) but not Current BMI.Group I consisted of 194 single procedure cases. Complications in Group I were related to Max BMI (P = 0.006) and Current BMI (P = 0.02) but not DeltaBMI. Max BMI impacted infections (P = 0.003) while Current BMI impacted dehiscence (P = 0.009) and infections (P = 0.03). Group II consisted of 317 cases with only DeltaBMI directly related to overall complications (P = 0.01).
Body mass indices influence complications in postbariatric reconstructive surgery. Current BMI may impact complications in single-procedure cases, but appears to play less of a role in larger cases. Careful patient selection, assessment of surgical complexity, and recognition of the particular risks increased by residual obesity can help to optimize outcomes in this patient population.
There have been conflicting reports regarding the incidence of postoperative complications in body contouring procedures in obese and morbidly obese patients. Our subjective impression has been that the complication rate is significantly higher for these patients than it is for other weight groups.
The purpose of our study was to conduct a retrospective chart review to delineate our institution's complication rate in body contouring operations across all weight groups and to identify predictors of poor outcomes/complications that would help guide patient selection.
The records of 129 patients who underwent a single body contouring procedure at The Penn State Hershey Medical Center from 1993 to 2002 were reviewed. Patients were categorized based on their body mass index into the following weight groups: ideal, overweight, obese, morbidly obese, and severely morbidly obese. The complications were grouped into minor, major, or combined (minor or major). Patients who underwent combined procedures were excluded from the study.
There was a statistically significant association between minor (P = .0006), major (P = .0098), and combined (P < .0001) complications and weight group. More specifically, the percentage of complications increased as weight category increased. The percentage of minor complications increased from 3.3% in the ideal weight group to 46.9% in the severely morbidly obese group. Similarly, the percentage of major complications increased from 6.6% in the ideal weight group to 43.7% in the severely morbidly obese group. Both major and minor complications saw the largest increase in complication rates between the morbidly obese and severely morbidly obese groups. Furthermore, those in the obese (odds ratio [OR] = 6.43; P = .0115), morbidly obese (OR = 5.54; P = .0237), and severely morbidly obese (OR = 19.80; P < .0001) weight groups were more likely to experience minor or major complications than those in the ideal weight group.
This study demonstrates two points: (1) it confirms that there is a significant increase in the occurrence of complications among morbidly obese and severely morbidly obese patients undergoing a single body contouring procedure, and (2) it shows there is an increase in the occurrence of complications with worsening degree of obesity. The (post-weight loss) body mass index at the time of body contouring surgery is a predictor for postoperative complications.
In the surgical treatment of drooping skin on the underside of the upper arms, the running W-plastic technique gives a less conspicuous scar than the standard technique involving longitudinal fusiform excision.
Although significant innovations in brachioplasty occurred in the 1970s, it remains an unpopular procedure. Current brachioplasty techniques are somewhat unpredictable and are commonly associated with significant untoward results. Recent anatomic studies demonstrate that in youth the posteromedial arm soft tissues are firmly suspended to a tough yet dynamic fascial system sling that ultimately gains its strength from the clavicular periosteum by means of the clavipectoral and axillary fasciae. Loosening of the connections of the arm superficial fascial system to the axillary fascia, as well as relaxation of the axillary fascia itself, with age, weight fluctuations, and gravitational pull yields a "loose hammock" effect, resulting in significant ptosis of the posteromedial arm. On the basis of this anatomic concept, the brachioplasty procedure was modified to provide secure anchoring of the arm flap to the axillary fascia along with strong superficial fascial system repair of incisions, reducing the risk of widening or migration of scars and unnatural contours. Five patients having brachioplasty with or without liposuction were followed for 6 to 12 months. The primary indication for surgery is moderate to severe skin laxity of the arms with or without associated arm fat deposits. Results were consistent, and complications were limited.
The aging female with excess arm fat and poor skin tone frequently refuses a brachioplasty scar due to permanent detectability. Traditional deep liposuction localized to the posterolateral aspect of the arm frequently leaves sagging, wrinkled skin. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was developed to maximize skin retraction and create regional harmony by preparatory compartment magnification with dilute lidocaine and epinephrine followed by circumferential treatment of the arm and adjacent areas utilizing superficial and/or subdermal liposuction. Early CAST liposuction results in patients with moderate fat and excess skin revealed excellent skin retraction. CAST liposuction was then offered as the first of two stages to patients with excess fat and poor skin tone to avoid or shorten the brachioplasty scar. Twenty-six patients underwent CAST liposuction with 9-22 months follow up. Only two patients (7.7%) eventually required brachioplasty. Although postoperative seromas were frequent (38.5%) and preexisting skin wrinkling usually returned, the final result is acceptable to the vast majority of patients (84.6%) who refuse a brachioplasty scar.
Liposuction of arms when properly performed with realistic expectations is almost always a "patient pleaser." Patients routinely marvel at the degree of skin contraction that typically occurs. Before and after photos, even as early as 1 week, routinely show dramatic skin contraction when significant volumes of fat are removed although textural changes may evolve for weeks to months (Figs. 14-19). Only the lower abdomen and neck consistently obtain such profound and predictable contraction. I am convinced that historically liposuction of the arms has been performed in a substandard fashion. Inadequate fat removal will often produce irregularity and will always result in less than maximal skin contraction. As I have performed progressively larger-volume cases, the indications for brachioplasty, in my opinion, are nearly nonexistent. My present approach, except in the most extreme cases, is to initially recommend liposuction and possibly even a second liposuction prior to performing or recommending brachioplasty. Even massive arms with good skin tone will usually obtain an aesthetically pleasing result when treated properly. Massive arms with poor skin tone, however, may not. One does not "burn bridges," however, by performing liposuction alone in these questionable candidates. If brachioplasty is subsequently desirable, in spite of the major drawback of the resultant scar, it can be performed at a later date. In summary, the key concepts for maximizing the potential of liposuction of the arms are to perform thorough but gentle fat removal and to avoid immediate subdermal fat removal or trauma to the underside of the dermis.
Various techniques for the management of upper extremity contour deformities have been suggested since aesthetic brachioplasty was first described. Such deformities are commonplace with aging, after normal weight loss, and especially after massive weight loss such as is seen following bariatric surgery. Despite the multiplicity of procedures described for the correction of these deformities, there are still problems associated with current brachioplasty techniques, including incorrectly placed incisions, widened hypertrophic scars, and postoperative contour deformities. In addition, postoperative skin laxity and ptosis in the axillary region are frequently encountered in the more extreme deformities. The authors present their technique for upper extremity brachioplasty. This technique is suitable for patients with severe brachial ptosis and skin laxity, with relatively little lipomatous tissue, which may extend from the olecranon to the chest wall. The described surgical approach provides excellent overall extremity contour with favorable scars while simultaneously addressing axillary contour deformities.
The epidemic of obesity in the United States has led to a rapid increase in the number of bariatric procedures performed over the past several years. The dramatic changes to the torso following massive weight loss are only partially addressed by routine procedures such as abdominoplasty and liposuction. Circumferential body lifts or simultaneous abdominoplasty, thigh, and buttock lifts are becoming the method of choice for treating the postbariatric condition. In this article, the authors review the senior author's experience of 200 body lifts with massive weight loss individuals.
The charts of 200 consecutive body lift patients were reviewed for complications and other variables. The preoperative markings, current surgical technique, and postoperative care are described. The patients were classified into three types according to their body mass index at the time of surgery. Type I individuals had a body mass index less than 28, type II individuals had a body mass index between 28 and 32, and type III individuals had a body mass index greater than 32.
Type I and II patients in many instances achieved a nearly ideal body contour. Type II and III individuals also had a significant functional and aesthetic improvement but were more likely to have complications. The overall complication rate was 50.0 percent. The most frequent complications were skin dehiscence and seroma formation at 32.5 percent and 16.5 percent, respectively.
The body lift very effectively addresses the functional and aesthetic concerns of the massive weight loss patient. Careful patient selection and education are essential to a good outcome.
Brachioplasty is aesthetic reshaping of the upper arm after removal of excess medial skin and fat. Massive weight loss patients evolve a severe arm deformity that extends through the axilla and onto the chest. Prevalent operations are incomplete and leave conspicuous scars along the bicipital groove that end as Ts or Zs in the axilla. The L brachioplasty starts with a long ellipse centered over the lower half of the inner arm that sweeps up to the deltopectoral groove. A shorter ellipse is connected at right angles through the axilla onto the chest. The V flap formed between the ellipses is advanced across the axilla to raise the posterior axillary fold. An improved arm, axilla, and chest have an L-shaped zigzag crossing the axilla.
L brachioplasty, along with upper body lifting, was applied to 24 female weight loss patients over the last 2 years. Ultrasound-assisted lipoplasty was also performed in five patients. All patients were interviewed. Follow-up ranged from 6 to 28 months.
All 22 patients were improved and pleased. One patient requested and received a limited scar revision. Three patients had delayed healing at the tip of the triangular flap. Four seromas near the elbow responded to multiple aspirations. One hypertrophic scar was improved with intense pulsed light.
The L-shaped brachioplasty is an innovative, effective, reliable, aesthetic, and safe technique. Integrating the brachioplasty into the upper body lift improves the contours of the axilla, breast, and upper lateral chest, contributing to improved harmonious body contour.
To determine the overall complication rates associated with brachioplasty, a retrospective review was performed of all brachioplasty procedures performed at the authors' institution over a 16-year period.
Hospital charts were reviewed for patient demographics. Ten fresh frozen cadaveric arm dissections were performed to better evaluate the anatomy of the medial antebrachial cutaneous nerve as it relates to brachioplasty.
Forty bilateral brachioplasties were performed over the 16-year period. Average patient age was 47 years, and all patients were women. Average length of follow-up was 50 months. The revision rate was 12.5 percent. The overall complication rate was 25 percent. Ninety-five percent of the complications were classified as minor. None of the complications required correction with surgery. Complications noted were seroma, hypertrophic scarring, cellulitis, wound dehiscence, subcutaneous abscess, and nerve injury. Two patients (5 percent) developed an injury to the medial antebrachial cutaneous nerve during the procedure. Nerve injuries were classified as major complications. In cadaveric studies, the medial antebrachial cutaneous nerve was found to penetrate the deep fascia of the forearm at 14 cm proximal to the media epicondyle.
Brachioplasty can be performed with a very low incidence of major complications, but both surgeon and patient should be aware of the possible risks associated with brachioplasty. Cadaveric dissections revealed that the medial antebrachial cutaneous nerve lies within the plane of dissection of the standard brachioplasty technique and is therefore at risk of injury.