No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Brachioplasty with Limited Scar
Abstract
There is a growing interest in upper arm aesthetic surgery but many patients do not accept the visible inner arm scar. Minimal incision brachioplasty using a shorter scar, concealed in the axilla, produces results equal to that of the traditional approach in comparable cases. Patients with massive weight loss may not meet the criteria for surgery. Patient selection and careful preoperative markings are critical to the success of the procedure. The author describes the technique he has been using for more than 30 years along with refinements. Minimal incision brachioplasty is an alternative to the traditional long scar approach in selected patients. It is a less involved procedure, with a low complication rate and high patient satisfaction.
... 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 rise in awareness of obesity problems and the increasing obsession with the self-body image due to the widespread use of self-photography and social media in addition to, the great advances of surgical and non-surgical weight loss techniques, all lead to a progressive increase in the numbers of massive weight loss patients that in parallel [11]. Because incision shape and placement are some of the most critical elements of surgical planning, as they play an ultimate role in determining scar concealment and wound tension [4]; the trials of modifying the incision shape, chasing the optimal placement of the incision, and comparing between the different site is continuous by the authors. As patient satisfaction is the main goal of all cosmetic surgery; the authors had developed plenty of surveys and questionnaires to evaluate the satisfaction of the patient after any development or modification of cosmetic surgical technique to guide themselves and other surgeons in the hard process of proper technique selection. ...
... 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. 5,17 Liposuction alone was described by Gilliland and Lyos for correction of arm lipodystrophy; however, their work was limited to patients with adequate soft-tissue elasticity. 2 Many procedures have been reported that use liposuction to target the resection areas, but none of them addresses the circumferential lipodystrophy. ...
... 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. 5,8,27 Liposuction alone often does address the skin redundancy. ...
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.
... However, when it comes to classification and treatment of patients in-between these two extreme groups, there are certain differences in approach. Surgical treatment ranges from limited incision, limited incision with liposuction to the traditional brachioplasty [7,11] . Furthermore, there are several methods described in literature that address the moderate skin laxity in upper arms with reduced scars such as laser-assisted liposuction in order to provoke skin retraction [12] . ...
... In addition to the importance of patient selection in the success of this procedure, careful pre-operative assessment and appropriate skin markings are decisive [11] . With appropriate attention to these factors, the final aesthetic result should satisfy patient demands [ Figure 5]. ...
Aim: Brachioplasty in patients who are normal weight, with moderate skin excess and who are not accepting long scars, remains a challenge for plastic surgeons.
Methods: We present our experience in 47 patients with short scar brachioplasty in combination with posterolateral liposuction, fascia anchoring and fat grafting in the inferomedial arm in order to improve skin quality and correct minor irregularities. Patients’ satisfaction rates were evaluated after 3 and 6 months following the procedure.
Results: Patients (groups IIa, IIb and IIIa according to Rohrich classification) showed high satisfaction rates with the result both after 3 and 6 months after the procedure. The results were maintained. There were 2 cases (4.2%) of isolated wound dehiscence occurred, which were all resolved conservatively with dressings and antibiotics.
Conclusion: The technique presented in this paper has shown to be an easy and effective solution for a diverse selection of patients suffering brachial lipodystrophy. Limited scar brachioplasty only has specific applications, and should not be considered a replacement for traditional brachioplasty.
... In 2015, nearly 400,000 patients underwent body contouring procedures in the US alone, with an almost 5000% increase in the number of upper arm lifts performed in the last 15 years. 1 Multiple techniques for brachioplasty have been described singly, or combined with liposuction since 1954. 2,3 Patient satisfaction can be used to assess the quality of care. Recent publications on patient satisfaction after cosmetic surgery have shown that the majority of patients are satisfied with the outcome of the operation. ...
... The posterior point was marked in the posterior axillary fold. 2,5 The arm was then elevated 90°, and the two points connected. The redundancy of the lower part of the arm was grasped towards the axilla. ...
Brachioplasty is a common procedure performed by plastic surgeons, with type II brachioplasty being the most regularly performed procedure in the clinic. This study evaluates patient satisfaction after mini-incision brachioplasty using a five-question survey. We administered the survey to 26 patients six months after they had undergone mini-incision brachioplasty to correct type II deformity. Most of the patients considered the improvement by surgery acceptable (53.8%), while 84.6% reported a decrease of at least two clothing sizes post-surgery. More than half (57.7%) were satisfied with body symmetry following surgery, while 69.2% accepted the resultant scar. However, only 30.8% would recommend this type of operation without reservations. The results of this study indicate that adequate patient education prior to mini-incision brachioplasty is key to optimal patient satisfaction.
... Many variations of the short scar developed as short-scar approach with only a vertical incision in the axilla [8], L brachioplasty with an unremarkable scar across the axilla and chest wall [9] inaddition to many W, T or Z axillary incisions patterns [10,11]. However these modification was applicable in type I and IIa patients with proximal deformities only and could not address distal deformities [12]. ...
... L brachioplasty is with an inconspicuous scar across the axilla and chest wall [16]. For proximal deformities, Reed LS suggested a short-scar approach with only a vertical incision in the axilla [17]. Nguyen and Rohrich proposed liposuction to short-scar techniques, adopting all the merits of the short-scar brachioplasty and using liposuction for refinement of the distal part. ...
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 .
... A key point for the success of this procedure was that the most dependent portion of the upper mid arm from the humerous to the bottom of the hanging skin of the arm, should not measure more than 12 cm with the arm abducted at 90 degrees, otherwise a traditional approach should be considered. 16 This procedure was commonly employed in conjunction with liposuction outside the resection area. In 2016, Hill described a liposuction assisted short-scar brachioplasty employed in 165 patients using liposuction combined with axillary and a small proximal arm incision to address minimal to moderate skin laxity. ...
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.
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
Background:
Surgical excision remains the gold-standard therapy for arm skin laxity. However, many patients refuse surgical treatment for fear of the prominent long scars associated with brachioplasty.
Objectives:
The objective of the study was to compare the aesthetic outcome of 2 energy-assisted liposuction arm-contouring techniques, radiofrequency-assisted liposuction (RFAL; Group A) and Renuvion helium subdermal coagulation (Group B), with a control group treated with VASER-assisted liposuction (VAL) alone (Group C).
Methods:
This is a randomized controlled study of 176 patients seeking arm contouring, who were treated between February 2017 and December 2020. All of the patients underwent VAL, followed by either RFAL (53 patients, Group A) with the BodyTite RF platform or subdermal coagulation (66 patients, Group B) with the Renuvion platform; 57 patients in the control group (Group C) received VAL alone. Patient data, marking techniques, operative details, complications (and tips and tricks to avoid them), and aesthetic outcomes were recorded and tabulated. Surgical team, third-party, and patient satisfaction surveys were conducted 6 months postoperatively.
Results:
The study included 176 patients (153 female and 23 male) with a mean age of 32 years (range, 20-59 years). All patients were followed up for a minimum of 6 months. In total, 96 (80.6%) patients reported their satisfaction with the overall technique. An independent plastic surgeon considered the result good to excellent in 97 of 119 cases of the studied group.
Conclusions:
The umbrella of nonexcisional arm contouring can be extended to include treatment of difficult cases of arm laxity with energy-producing machines. The procedure can achieve a reduction in fat deposits and significant improvements in skin laxity.
Level of evidence: 4:
Background
Due to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty.
Patients and Methods
26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated.
Results
None of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery.
Conclusion
The piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes.
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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
Upper extremity body reshaping is a very frequent surgical procedure in massive weight loss patients. Many surgeons have presented different patterns of brachioplasty skin excision and a variety of adjunctive techniques, each of them claiming improvements in scar aesthetic, arm shape or overall safety of the procedure. In this pape,r we want to illustrate our personal brachioplasty technique for massive weight loss patients. Our incision design named ‘J’ Brachioplasty is described. Between March 2013 and March 2016, a retrospective study of patients with massive weight loss and clinical diagnosis of brachial ptosis undergoing surgical reconstruction with ‘J’ brachioplasty was performed. All patients were treated according to a standard surgical procedure described in detail in the paper. The presence of axillary and thoracic skin excess was also recorded for every subject, as well as clinical and surgical postoperative complications. A total number of 73 Caucasian underwent J-shaped brachioplasty. Our technique allowed us to treat both arm and thoracic skin excess with a single skin incision. Among our casuistic we had only two cases of postoperative bleeding and four cases of partial wound dehiscence due to tension. Seroma was reported only in one (female) patient. Despite the recent introduction our technique has proven to reach good results in massive weight loss patients.
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.
The growing popularity of bariatric surgery has increased the number of brachioplasties performed. One of the major drawbacks of brachioplasty is the unsatisfactory appearance of the surgical scar. The author describes a short-scar brachioplasty, or minibrachioplasty, that can achieve much of the improvement of a traditional brachioplasty while concealing the scars within the confines of a short-sleeve shirt or blouse. Eight patients treated with this technique saw a significant improvement in the appearance of their upper arms.
Upper arm contouring has evolved to offer effective and safe procedures to a diverse patient population [1]. Aesthetic brachioplasty was first described in 1954 by Correa-Iturraspe and Fernandez [2]. The drawback to a classic brachioplasty has always been the longitudinal scar burden placed on the inner arm. In order to decrease the visibility of the scar, different longitudinal incision positions have been described, though none of which conceal the scars with the arms abducted in short-sleeved garments. The inspiration for a limited incision brachioplasty was likely the description of the local excision of axillary hidradenitis suppurativa with primary closure in 1972 [3]. This demonstrated that a significant excision of tissue in the area could be resected and the scars were well tolerated and concealed in the axilla. This procedure in the treatment of hidradenitis obviated the need for skin grafting, though the goal in the aesthetic application is to obviate longitudinal scar extending from the elbow to the axilla.
In minimal incision brachioplasty, surgical rejuvenation of the arms is achieved with incisions limited to the axilla. When needed, lipoplasty is added to surgical resection of skin and axillary tissue. The authors contend that minimal incision brachioplasty is safe and effective with predictable, reproducible, and long-lasting results.
After 4 years of experience with this technique, the author recommends using minimal incision brachioplasty (MIB) to treat mild to moderately severe upper arm soft tissue excess and laxity. However, when treating arms with gravity-induced skin furrows, he finds MIB problematic.
Background
Many women complain that the combination of loose skin and excess fat deposits in the upper-arm area inhibits them from wearing sleeveless clothing. Most of these women are reluctant to undergo arm reduction surgery in part because of the highly visible scar that results from a standard brachioplasty.
Objective
A new arm reduction technique is described that significantly reduces both the arm circumference and the visual vertical height of the arm when held outstretched, while concealing the scars so as to not inhibit the wearing of sleeveless clothing.
Methods
Nine patients aged 25 to 75 years underwent the minimal-incision brachioplasty procedure. This included lipoplasty of the upper arm, wide-axillary and upper-arm skin excision, and dermal suspension of the upper-arm skin to the axillary fascia. The patients' arm circumferences were photographed and measured preoperatively and postoperatively.
Results
All patients achieved significant reductions (15% to 25%) in arm circumference measurements as measured at the levels of the distal deltoid insertion and at the mid arm. The scars in all patients were smooth and flat, without hypertrophy. Most of the hair-bearing axillary skin was removed with this procedure, a side effect that all patients viewed as positive. All but one patient expressed satisfaction with the results.
Conclusions
The minimal-incision brachioplasty technique can be used as the first-choice procedure in arm reduction. Slight modifications of the procedure may be necessary in patients with massively obese arms and in older patients with poor skin tone and minimal elasticity.
During the course of life, the upper arm demonstrates skin relaxation and fat deposits that become increasingly evident, particularly with age. However, the degree of skin ptosis and accumulation of subcutaneous fat varies from patient to patient. Therefore, it is critical to evaluate each patient individually, to inform the patient of the available options, and to tailor the procedure to his or her needs. We have described four categories of upper-arm problems. Patients with minimal to moderate subcutaneous fat and minimal skin laxity generally do well with circumferential lipectomy alone. With an increased amount of subcutaneous fat and more pronounced skin laxity, suction lipectomy in conjunction with a "ridge" provides good results, with a well hidden scar in the axilla. In the obese patient in whom skin laxity becomes much more noticeable after suction lipectomy, we recommend a purse-string closure of the modest brachioplasty incision to decrease the scar size. In those patients who have minimal fat but extensive skin laxity, a traditional brachioplasty cannot be avoided. Carefully selected and properly informed patients will result in an extremely high satisfaction rate. The techniques and guidelines described are designed to provide simple, easily performed procedures with minimal complications that safely and effectively rejuvenate the upper arm.
The growing popularity of bariatric surgery has increased the number of brachioplasties performed. One of the major drawbacks of brachioplasty is the unsatisfactory appearance of the surgical scar. The author describes a short-scar brachioplasty, or minibrachioplasty, that can achieve much of the improvement of a traditional brachioplasty while concealing the scars within the confines of a short-sleeve shirt or blouse. Eight patients treated with this technique saw a significant improvement in the appearance of their upper arms.
Dermolipecto-mia braquial
- M Correa-Iturraspe
- Fernandez
- Jc
Correa-Iturraspe M, Fernandez JC. Dermolipecto-mia braquial. Prensa Med Argent 1954;41:2432.