A brachioplasty is the medical term for an operation to remove excess skin and fat from the upper arms. An upper arm reduction or upper arm-lift are the same procedure; these terms are more descriptive and more understandable. This operation can be used to tighten the upper arms where the skin is lax but is more usually used where there is an excess of skin and fat. The extra tissue that hangs from the upper arms is sometimes referred to as ‘bat wings’ or ‘bingo wings’. Liposuction may used as part of the procedure and in some people liposuction may be sufficient on its own to achieve the desired result.
An upper arm lift should be considered by someone who feels self conscious about excess skin and fat on the upper arm. It is particularly helpful where this hangs down when the upper arm is held out horizontally. If the skin does not hang significantly liposuction alone may be helpful. Arm-lift is a popular procedure amongst people who have lost significant amounts of weight and particularly those that have had bariatric surgery.
An upper arm-lift is usually carried out under a general anaesthetic with you asleep. It may be helpful to use liposuction to remove fat from the inside and back of the upper arm before taking the skin away. An incision is made down the inside of your upper arm. Sometimes it may need to go below the elbow and through your armpit onto the side of your chest, this may be called an extended brachioplasty. The extra from behind this incision is then removed and it is closed with stitches. The stitches are usually dissolvable and under the skin. Usually it is necessary to leave a drain in for a day or so. A drain is a narrow tube (about 4-6mm wide) which passes through the skin and into a drain bottle or bag. It collects excess blood and tissue fluid which would otherwise build up under the skin. Usually the drain is removed the next day but it may be advisable to leave it in longer. A dressing is left on the wound and a bandage placed over the top. Most people will go home the next day.
Liposuction is often helpful combined with an upper-arm reduction. In some people with less excess skin then liposuction alone may be sufficient to achieve the desired result. This has the great advantage of a considerably shorter scar.
where there is less skin laxity a shorter scar may be possible. The scar may be restricted to the upper one third or half of the arm. Occasionally the scar can be restricted to the armpit. Inevitably these shorter scar techniques produce less dramatic results and are usually only suitable for modest degrees of laxity.
Firstly you should ensure that you understand what is involved with surgery, what it may be able to achieve for you, how long you are likely to need for recovery and the risks. If you are overweight or are planning to lose weight you should do so before your surgery. This will make your surgery safer and is likely to give you a better result in the longer term. Smoking increases the risks of surgery so you are strongly advised to stop smoking 4 to 6 weeks prior to your operation. If you take medication you should discuss this with your surgeon before the operation. Certain drugs can increase the risk of bleeding and this needs special consideration with surgery. You should avoid aspirin and aspirin like drugs for 10 days before your operation as these increase the likelihood of bleeding with surgery. (If you take aspirin for medical reasons stopping the aspirin should be discussed carefully with your surgeon before stopping). Please do not take alternative or complimentary medicines or herbal remedies for 2 weeks before your surgery. Do not take omega fish oils. (Homeopathic arnica if bought from a reputable source is safe).
People vary considerably in how long they need to recover from surgery. If you had complications then your recovery can take considerably longer.
When will I be allowed home from hospital?
The majority of people go home the next day.
When will I be able to drive?
You must not drive by law for 48 hours after a general anaesthetic. You should also check your car insurance. In general most people will return to driving about 2 weeks following surgery. It is essential that you feel comfortable driving and able to control the car in an emergency.
When will I be able to return to work?
Most people will take 2 weeks off work if they do office type work. More active work will require longer.
When will I be able to exercise?
You should rest for 2 weeks following the surgery. However walking is good and protects you against clots in the legs. So taking regular short walks is healthy. 2-4 weeks following surgery you could start lower body exercise such as cycling or power walking. After 4 weeks you can start upper body exercise with a view to getting back to normal activity between 6 to 8 weeks following your operation. Some people may recover faster and others will require longer. You need to see how your body responds to activity. If you experience pain or swelling then you need to reduce your activity.
When and what can I lift?
You should avoid lifting for 2 weeks and straining to lift for 4 weeks. After 4 weeks you may start lifting heavier items but be guided by feedback from your body.
When can I return to swimming?
The wounds need to be fully healed before you swim. It is unlikely that you would return to swimming with in 4 weeks and 6 weeks is more realistic. If there are problems with the wound healing it may be necessary to avoid swimming for longer.
When will I be back to normal?
Recovery varies from one person to another. The majority of people feel they are mostly recovered by a month following surgery. However some areas of tenderness, lumpiness or swelling may take longer to settle.
An upper arm-lift is a very effective procedure for improving the shape of the upper arm and reducing the extra loose hanging skin. Immediately following the surgery the arm will be swollen and bruised. This normally settles over a few weeks. It is common to have altered sensation down the inside of the arm. This may feel tingly or numb. The area of changed sensation usually becomes smaller over time. Areas of numbness may always be present. Where this happens, most people come not to notice them with time.
What will the scars look like?
The surgery leaves a long scar running down the inside of the arm, usually from the armpit to the elbow. Sometimes shorter scars are possible. With greater amounts of excess skin it may advisable to extend the scar through the armpit onto the side of the chest and below the elbow. The appearance of scars varies from one individual to another. Although one attempts to make the scars as symmetrical as possible between the 2 arms there are usually differences.
In general the results do last although the aging process of the body does not stop. If you put on significant amounts of weight and lose it again then you may develop further loose skin.
The great majority of healthy people undergoing an upper arm-lift procedure have an uneventful recovery and are pleased with the outcome of their surgery. However, as with all surgery, there remains the potential for complications. Complications include those of having a general anaesthetic, complications that can occur with any operation and those that need particular consideration for an arm-lift procedure. Serious complications are rare but as with all surgery could be life threatening.
There are the risks of having a general anaesthetic such as allergic reactions, chest problems, for example a chest infection and the possibility of clots in the legs (deep vein thrombosis or DVT). A clot in the legs can move to lungs causing a pulmonary embolus which is a particularly serious complication. Underlying medical conditions e.g. asthma can be aggravated. In general if you are healthy, modern anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery for an assessment and a discussion.
Bleeding and haematoma:
During surgery great care is taken to stop bleeding. However after the end of the operation, particularly if the blood pressure is raised, a bleeding point may start bleeding again. This causes a build up of blood under the wound called a haematoma. Small haematomas usually are absorbed by the body over time. Larger haematomas may need to be removed with a further operation. Most people will then recover normally. It would be most exceptional to need a blood transfusion following an upper arm-lift.
Infection and slow wound healing:
As with all surgery there is the potential for wound infection. Most wound infections settle down with a short course of antibiotics. If a wound becomes badly infected the wound may open up and take time to heal up. If this happened regular wound dressings would be required until it was fully healed. Serious infections are rare.
Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained but usually resolves on its own. Seromas are quite common following an upper arm lift. Draining a seroma is usually a simple procedure in outpatients. It may need to be repeated.
Scarring varies from one person to another. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide or become lumpy, hypertrophic or keloid. Keloid scars are lumpy and grow out from the incision that caused the original scar. Hypertrophic scars are more frequently seen than keloids. Hypertrophic scars become widened, thickened and red for a few months after surgery. They then settle down to a pale widened scar although this may take many months and even several years. Scars may be itchy and occasionally tender or painful.
Arm swelling is normal in the initial weeks following the surgery. This normally settles down over several weeks, although can take longer. It would be unusual for swelling below the elbow to become permanent or cause long-term problems such as lymphodeama.
Over or under correction:
The amount of fat to be removed with liposuction is a matter for clinical judgment. There is the possibility that too much fat is removed or that you feel not enough fat has been removed. It is generally better to remove too little rather than too much as it is easier to remove more later than to put fat back.
Liposuction: skin irregularities, skin laxity and skin excess:
When liposuction is used the end result for the overlying skin needs to be considered. The elasticity of the skin is very important in the end result from liposuction. If the skin has little elasticity it is more likely that the skin will show irregularities following liposuction. With larger amounts of fat removal there is the possibility that the skin will be loose and wrinkled following the procedure.
Following liposuction the tissues under the skin tend to swell, may feel hard and be tender. This usually settles over a few weeks. In some people this may take longer but usually settles over a few months. Permanent lumpy tenderness is rare but possible.
Tenderness and pain:
Following surgery the inside and back of the arm area will be painful and remain tender for several weeks. In some people these symptoms may last several months. It is very unusual for symptoms to last longer than this or be permanent.
Following surgery the tissues swell and so the skin may be stretched a little. As the swelling goes down usually skin retracts. However there may be some residual laxity although usually there is a considerable improvement on the appearance before surgery.
Deep vein thrombosis (DVT) and pulmonary embolus (PE):
Deep vein thrombosis is a blood clot forming in the veins, usually in a leg vein and a pulmonary embolus is where one of these clots breaks off and travels to the lungs. These are serious complications and a pulmonary embolus can be life threatening. This is a recognised complication of surgery. There are many factors that can increase the your risk such as a family history of clots, having previously had a clot yourself and various drugs and illnesses. Being over weight or obese, having an operation and being inactive are some of the most common factors that increase the risk of deep vein thrombosis (clots). For patients undergoing an upper arm-lift precautions are routinely employed to reduce the risk, although the risk can never be completely eliminated. You can help to protect your self by getting up and walking around as soon as you can following your operation and continuing to take regular short walks during the early stages of your recovery.
There are no other special considerations.
There is always the option to live with your current appearance and not have surgery. Suitable clothing will cover the upper arms.
If you are overweight or obese then losing weight may be helpful in reducing excess fat in the upper arms. An important consideration will be how well your skin retracts.
Speak to your General Practitioner
Your General Practitioner has a broad knowledge of medicine. Your GP may recommend a surgeon or a hospital where they feel you will get good advice and treatment about surgery.
Outpatient consultation with a Consultant Plastic Surgeon
An outpatient consultation with a Consultant Plastic Surgeon will enable you to discuss what result you would like to achieve. They will also be able to make recommendations as to how best to treat you and whether there are any special considerations for you.
Department of Health (England and Wales):
www.dh.gov.uk search under – Cosmetic surgery and non-surgical cosmetic treatments. Independent and objective advice on cosmetic surgery from the department of health.
British Association of Aesthetic Plastic Surgeons (BAAPS):
www.baaps.org.uk/ The association of British Plastic Surgeons with a particular interest in cosmetic surgery. Jeremy Hurren is a member of BAAPS.
British Association of Plastic Reconstructive and Aesthetic Plastic Surgeons (BAPRAS):
www.bapras.org.uk/ The association of British Plastic Surgeons. Jeremy Hurren is a member of BAPRAS. Formerly British Association of Plastic Surgeons (BAPS).
General Medical Council (GMC):
www.gmc-uk.org/ Tel: 0207 915 3630 The register of British registered doctors. Check whether a particular doctor is on the medical register as a specialist. Jeremy Hurren is on the GMC register (registration number 3243048) as a Specialist Plastic Surgeon.