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Abstract
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
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Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not “severe enough” to justify an excisional procedure, but not “mild enough” to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional methods. The purpose of this supplement is to describe the utility of radiofrequency (RF) microneedling (Fractora modified to Morpheus8 InMode Aesthetic Solutions, Lake Forest, CA) in combination with bipolar RF (FaceTite/BodyTite, InMode Aesthetic Solutions). By combining these procedures, the aforementioned treatment gap can be addressed. The RF microneedling allows for subdermal adipose remodeling and skin tightening. Addition of bipolar RF also tightens the skin by contraction of the underlaying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50°C. In our experience, these technologies have been effective and safe in these patient populations.
Level of Evidence: 4
Contour deformities after post–bariatric surgery weight loss are varied and often complex. Existing classification systems do not adequately address the various post–weight loss deformities that can occur in every part of the body. At the University of Pittsburgh, we have devised the Pittsburgh Rating Scale, a classification system that allows grading of 10 areas of the body on a four-point scale. The scale has been validated in a previous study. Currently, the scale is being applied during our initial assessment of the post–bariatric surgery weight loss patient. We have found that accurate classification can assist the surgeon in operative planning. The scale is useful in both classifying the individual deformities in a specific region and performing a comprehensive assessment.
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.
Background:
The literature has witnessed an evolution in brachioplasty technique since the procedure was introduced by Thorek in 1930. Aesthetic refinements in brachioplasty have been increasingly described in the literature, and this has paralleled the rise in the massive weight loss population. The aim of this review is to share the plastic surgery experience with this challenging body region and present different approaches to achieve the best results for a broad spectrum of patients.
Methods:
A literature review studying brachioplasty was performed through PubMed. Throughout the literature there has been debate about scar placement, scar length, application of liposuction, drain placement, and optimization of outcomes, and differences of opinion have been compared.
Results:
There is no definitive best method of brachioplasty, as evidenced by multiple classification systems which present algorithms for management depending on presentation. Not only does approach differ depending on degree of presentation, but there are also different approaches depending on author for similar manifestations. Approaches vary through incision length, incision placement, and use of liposuction. Outcomes studies similarly reveal lack of consensus.
Conclusion:
This literature review has elucidated multiple approaches to brachioplasty, and the pearls and pitfalls described may all be incorporated to produce excellent outcomes and patient satisfaction in an individualized approach.
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.
This article contrasts the ideal appearance of the female upper arm, axilla, and upper midlateral chest with the sagging and/or oversized deformity. The constellation of postbrachioplasty aesthetic deformity is introduced. These aesthetic shortcomings are best avoided, because they are difficult to correct. The L brachioplasty with liposuction is described in a recent case and applied to a variety of deformities to show the range of applicability and quality of results. The role of liposuction in arm reshaping is examined. The aesthetic advantages and low complication rate of the L brachioplasty are contrasted with other currently popular brachioplasties.
Patients presenting for plastic surgery consultation after massive weight loss require a thorough preoperative evaluation that takes into account the complex medical and psychosocial issues associated with obesity. A number of factors must be considered, including type of weight loss procedure, nutritional deficiencies, body mass index at the time of consultation, and unresolved cardiovascular and pulmonary problems. This assessment will help identify issues requiring more detailed evaluation, provide an accurate risk profile, allow for optimization of active disease states before surgery, and increase patient safety.
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.
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.
Complications associated with brachioplasty: a literature review
- A Sisti
- R Cuoma
- L Milonia
- J Tassinari
- A Castagna
- C Brandi
- L Grimaldi
- D Aniello
- C Nisi