A Brachioplasty or upper arm lift, is an operation performed to improve the shape and contour of your arm from armpit to elbow. The operation can remove excess skin, unwanted scars, stretch marks and fat. There are a variety of different brachioplasty procedures and depending on your particular problem(s), the operation will be individualised and tailored to suit you. Brachioplasty is usually performed under general anaesthesia and usually requires an overnight hospitalization. A wedge or ellipse of skin and fat is excised from the posterior inner arm leaving a scar that can run from axilla to elbow. The scar can sometimes be shorter if you need a mild lift only. It can also be longer and incorporate the removal of lateral chest fullness – e.g. in massive weight loss patients. In addition liposuction can be performed to the arm, which helps to remove additional fat.

What can be expected at the initial consultation?
At the initial consultation you will be assessed as to whether you are a good candidate for brachioplasty. Your arms will be carefully examined to assess the amount of excess skin and fat. Your general fitness for the procedure will be evaluated and the potential for problems sought. It is important to know about past medical problems, medication that you are on, and whether or not you smoke. Your reasons for wanting the procedure will also be discussed. It is important that your expectations concerning the outcome of the procedure are realistic. If they are, you can expect to be happier with the result. Once you have been fully assessed, an operative plan tailored to your individual needs will be formulated. The incision to be used, the amount of skin and fat to be excised, and whether liposuction will be used as an adjunct will be discussed with you. Do not be hesitant to ask questions, now or at any other time. Medical aids or health insurance companies do not usually provide cover for this kind of surgery although occasionally a motivation can be done especially if you have lost large amounts of weight.

Preparing for surgery
Ideally surgery is performed when you are fit and healthy. No special diet or exercise program is required prior to brachioplasty, but you should be close to your ideal weight. It is a good idea to have a good fluid intake for a few days before your operation. You should not have been on a long-haul flight for 2 weeks prior to surgery. It is advisable to stop smoking at least six weeks prior to surgery and not to smoke until your wounds have healed - usually about two to three weeks after the operation. It is well known that there is a higher frequency of complications in patients who smoke. On the morning of surgery you should wash well. Do not shave your axillary hair specifically. Prior to surgery, the incision lines will be marked with a pen in your room. Mr. Soldin usually takes photographs for your records immediately before surgery.

The Surgery
Surgery will be performed in an operating theatre under general anaesthesia. A brachioplasty takes between one and two hours. Following surgery the wounds are closed with dissolving sutures, and drains may well be left in place for a day. Dressings will be applied.

What can be expected after the operation?
Following the operation you should be relatively pain free although you may feel some discomfort with movement. You will be given analgesic tablets to take regularly. Daily showers are encouraged. Someone will need to drive you home and help around the house for a few days. You will be given painkillers to take home with you. The drains if needed are removed before you go home.

How long does it take to get back to normal?
Healing is a variable process and it may take you two weeks to feel like your old self again. People vary enormously in their recovery period. The scars are healed by the end of the first week, but continue to mature for up to a year, by which stage they should be thin, fine, inconspicuous lines. Massage of the scars with an aqueous cream helps, but should only be started after 1 month. Bruising take about 2 weeks to settle. Swelling can take up to 12 weeks to settle. To help diminish swelling and bruising tubigrip support should be worn for 24 hours a day and arnica, a homeopathic preparation, can be started from about day 2 post-op. Mobilisation should be gentle, but begun early. Vigorous exercise should be avoided for six weeks, until you feel comfortable – your body will tell you if you are pushing it too hard. Do not drive until you really feel well – usually 2 weeks. Shower daily to stay clean. Depending on the procedure you have, you may be able to begin work after about one week (liposuction), and 2-3 weeks for a full brachioplasty.

What are the risks?
When performed by a qualified plastic surgeon, brachioplasty is normally safe and the results predictable. Nevertheless, as with any surgery, there is always a possibility of complications, including the following:

• Sensory alterations in the area - numbness occurs in nearly all patients but is usually transient. Can take up to two years to resolve.
• Bleeding (early or late) which can lead to fluid collections. These may require drainage with a syringe or, rarely, repeat open operation.
• Infection at the operative site or elsewhere (e.g., pneumonia)
• Loss of tissue - Usually small and treated with dressings.
• Unsatisfactory scarring - usually not keloid, but scars can stretch or become raised and red.
• Asymmetries or irregularities in contour, the commonest being dog-ears at the ends of the scars. These may require simple revision under local anaesthesia.
• Clots in the legs which can migrate to the lungs.
• Problems with anaesthesia, drugs, etc. These should be rare and the risks will be explained to you by your anaesthetist.

• Bring all your usual medication, toiletries and pyjamas.
• No smoking (six weeks), and no aspirin (2 weeks) before the operation.

If you are worried post-operatively

• Telephone the ward of the hospital from which you have been discharged.

• Telephone my secretary during office hours – 07780 785186.

• In an emergency (and you have failed to contact me by the above two methods) then please telephone St George’s Hospital (020 8672 1255) and ask them to either bleep me or the Resident Plastic Surgery House Officer on call (Bleep 7050).