Upper Arm Reduction (Brachioplasty)
Who would benefit from this procedure?
Brachioplasty (upper arm reduction) is most useful in those people who have loose skin or sagging tissue. This often occurs after significant weight loss or as the skin of the upper arm loses its elasticity. It is often difficult to improve this appearance with exercise or with non-surgical treatments as often the excess/sagging skin will not shrink back easily.
How is it done?
Brachioplasty is often performed under general anaesthetic and often involves an overnight stay. All such surgery involves scarring but the different techniques involved result in different patterns of scar. In many cases the scar runs along the inside of the arm but Mr Dheansa will discuss with you the best position for the scar to give you the best result.
In some case it may be useful to have further incisions in the armpit often resulting in T shaped scars.
Sometimes the skin excision is combined with liposuction. The skin is removed in a way to give you the best possible shape and to give a better profile that fits better with the rest of the arm.
The wounds are often closed with stitches underneath the skin that are dissolving. The dressings are usually tapes which can allow showers afterwards. If liposuction is performed Mr Dheansa may also recommend a elastic/compression garment.
What happens before surgery?
Anyone who has concerns about the appearance of their arms needs to have a thorough discussion about their concerns, their medical history and their desires with Mr Dheansa to make a clear plan about the best way to approach their concerns. Mr Dheansa will examine you thoroughly and make an assessment of the quality of the tissues, any potential technical difficulties and your aims to try and agree a specific plan to give the best possible result.
It is important to have a clear idea of what concerns you but also to have a realistic idea of what may be possible. In this regard, Mr Dheansa will try to give you the best advice possible. At the end of your first consultation you should have a clear idea of what kind of procedure would be most suitable for you, the potential outcomes as well as the risks associated with surgery. In some cases there may be some options available which you may need to think through.
At this point it is very useful to think through all that has been discussed so that you can make a decision as to whether surgery would be the best approach for you. If this is the case, it is useful to have a further discussion with Mr Dheansa to clarify any areas and to go over things again in more detail.
After the Surgery
What happens after the surgery?
You will often stay overnight after your surgery when you will be reviewed and made comfortable. Mr Dheansa will review you the following day and give you further advice in regard to looking after your new wounds. This often involves resting and avoiding excessive movement of your arms, elevating them as much as you can and avoiding any vigorous activities such as gym or work involving the upper arms.
Your dressings should allow you to shower/wash though often the tapes need to be dried with a cool hairdryer.
You should take regular pain killers which should keep you comfortable. An appointment will be made for you to be reviewed in the following week and Mr Dheansa will review you regularly until you are fully healed. If at any time you have any concerns you can contact Mr Dheansa’s team via the hospital where you have had your surgery.
Mr Dheansa generally recommends that you should avoid driving for at least 1-2 weeks and avoid the gym for approximately 4 weeks. You may be able to return to work after 1-2 weeks depending on your job. This needs to be discussed with Mr Dheansa to ensure you get the best possible result after your surgery. Once your wounds have healed Mr Dheansa recommends that you apply Micropore tape along the scars for at least 6 weeks after the surgery to help them mature and avoid them becoming thick or red.
What should I expect post-op?
After any surgery you may expect to feel sore and this should be easily controlled with pain killers. These should be taken regularly. Initially you will notice some swelling of the arms and often this make the arms look firmer than they will end up being because of the excessive swelling. The swelling often takes 2 weeks to mostly settle though this does very from person to person.
Wounds once they have healed should be supported with tape for 6 weeks. Scars do go through changes.
It usually takes 4-6 weeks for most of the swelling to have gone and it is usually around this time that one can see how your final result will be. The final result not only depends on how much skin was removed but also the quality of the skin and the amount of swelling that you may have had following surgery.
What can I do and not do at home?
In the first 2 weeks following surgery you need to take things easy and avoid any excessive activity. You should take your pain killers regularly and elevate your arms whenever you can. You can shower/wash but need to ensure your dressings are dried with a cool hairdryer afterwards.
You should not drive for 1-2 weeks and you should not go to the gym/play sports for up to 4 weeks. Working may be possible depending on your job but this needs to be discussed with Mr Dheansa to confirm the best time.
Will my scars change?
All scars go through a maturing process and go through a series of changes before settling down. This process varies from person to person as well as from site to site on the same person. Generally once a wound has healed the scar will be a thin pale line. Over the ensuing 6-12 weeks the scar may become raised, pink and wider. It often becomes itchy too. It then stabilises before slowly becoming flatter, paler and less itchy. This can take up to a further 12 months. Even after this time scars continue to improve but at a much slower rate.
Avoid sunlight on the scar for the first year to avoid it getting burnt and then subsequently dark. It is very hard to make it pale again. Mr Dheansa will advise you of any further precautions or actions if required.
Things to Consider
It is important to be prepared before and after your surgery. Here are a few things to consider about this operation.
Abnormal Scars
Sometimes even if all heals well a patient may develop abnormal scars (pink, wide, raised and itchy). Patients may already have noticed such a tendency from previous scars. Such scars take a very long time to settle (up to 18 months) if at all and may be difficult to treat.
Asymmetry
People are rarely exactly symmetrical and the intention of any surgery is to get both sides as equal as possible. However, the healing process is not always predictable and may result in differences from one side to the other.
Swelling/Lymphedema
Although Mr Dheansa’s technique tries to avoid affecting the lymph vessels in the arm in rare incidences the lymph flow may be affected by Brachioplasty. This means that there may be long-term swelling that develops in the hand, forearm and arm that may not easily resolve. In such incidences one may need to consider wearing compression garments in the long-term.
Bruising and Swelling
Some patients may experience some bruising. This often results in increased swelling and some tenderness. The skin may become discoloured and take a few weeks to settle down. Swelling in the initial stages can make the arms appear tighter than they will eventually be. It does take some time for the swelling to settle down in certain cases.
Pain
This is usually easily controlled with painkillers and again often resolves within a week or so.
Scars
These may become thick and red. This is uncommon but often they settle down.
Stretch Marks
Brachioplasty may remove some stretch marks though often only in the area where the skin will be excised. Other stretch marks may remain and may become wider because the skin is pulled tighter.
Numbness
The treated area will lose sensation (feeling) after the operation and it will take several weeks for it to return. Some areas may remain numb. In Brachioplasty you may also get numbness in the forearm, wrist and hand. Although this is unusual it may not be possible to improve the sensation should it occur.
Clots
Clots in the leg (DVT) or chest clots are uncommon with this operation but you will be assessed and given appropriate stockings/injections to help reduce this risk.
Are there any potential risks?
There are potential risks and complications with any operation and it is important to be aware of them before committing to any surgery. You may also have particular circumstances that affect the final outcome and these will be discussed with you at your consultation.
Anaesthetic
You will be assessed for fitness for anaesthetic and providing this is appropriate the risks from general anaesthetic are low. Anaesthetic can sometimes cause a reaction though this is very rare.
Bleeding
Rarely there may be significant bleeding under the skin that does not settle. Should this occur you may have to return to theatre to control the bleeding.
This may affect the long term appearance.
Wound Infection
Wounds can very occasionally get infected. If you notice increasing redness, pain or an offensive odour from the wound, contact Mr Dheansa as soon as possible. If this should occur you will need to have antibiotics and frequent dressings. The wound may take longer to heal and the resulting scar may be less than perfect.
Dog Ears/Change in Contour
Some wounds can result in a slight dip in the middle if the tissues are not elastic enough. Dips tend to improve over time. Conversely the ends of a wound may have slight bumps (dog ears) which again usually settle but may require a procedure to correct.
Seroma (Fluid Collection)
Occasionally the body produces fluid underneath the skin despite everything healing well. This is called a seroma. This may need to be tapped on several occasions before it resolves. Rarely, it may result in extra scarring underneath the skin.
Sutures (Stitches)
Sutures (stitches) used in Brachioplasty are often underneath the skin but occasionally as they dissolve they may cause some inflammation and “spit out” with a small amount of pus. This is not often an infection and the wound may open up in that area for a short period of time. Often these settle down though the scar may remain red for some time.
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Frequently Asked Questions
How long is the operation?
About 90 minutes.
When can I shower?
SEE 'What can I do and not do at home?' section above.
How long should I keep taking pain killers?
Usually pain settles within 1-2 weeks.
When can I go to the gym?
You need to avoid the gym for approximately 4 weeks.
How long until the final result?
Usually one has a good idea what the result is like after 6 weeks.
When can I fly?
Usually it should be possible to fly within 2-3 weeks after your operation but check with Mr Dheansa first.
