Arm Lift (Brachioplasty)

arm lift - brachioplasty surgery - Dr Magnusson

 

What is an arm lift?

An upper arm lift is also called a brachioplasty or arm reduction and is designed to shape, reduce and tighten the tissues between the shoulder in the elbow. This is an area that is frequently problematic and unfortunately receives a number of unflattering descriptions such as”battling” or”tuckshop arms”.

For some people this is a genetic area of concern that also affects other members of the family. The problem can be exacerbated during the weight gain and weight reduction cycle but also develops associated with the natural ageing process. This has become an increasingly popular procedure and in the US where there are good statistics thousands of people undergo successful arm lift surgery each year.

This is a procedure that Dr Magnuson performs regularly.

Liposuction is used in combination with skin tightening to achieve the best outcomes and perform the greatest amount of reduction.

What is it for?

Physical symptoms: Excess tissue initiate can be associated with chafing or intertrigo. It can inhibit the ability to exercise due to rubbing and discomfort.

Aesthetic concerns: A brachioplasty is considered when the shape of the arms is dominated by underarm skin laxity. For patients who have lost significant amounts of weight this problem is exacerbated and the amount of laxity generally increased.

The Surgery

What happens at operation?

A brachioplasty is performed under general anaesthetic and can be undertaken as a day case or an overnight stay.

The area of skin removal is that skin which hangs from the bottom of the when the arms are held out to the side. The area of looseness is marked. This indicates the area where skin will be removed.

At operation local anaesthetic with adrenaline is infiltrated into the area to be treated. This means that pain is less noticeable during the operation, a lighter anaesthetic can be administered and there is less pain immediately after the operation as well as a reduction in bleeding during surgery and bruising afterwards.

Complete liposuction is performed in the area where skin is to be removed so that all of the fat is taken away leaving behind nerves, blood vessels and lymphatics which improves the recovery.

Lower volume liposuction is then performed around the rest of the arm which helps reduce the volume in other areas and also increases the amount of skin that can be removed.

Following liposuction, the skin excess is removed. This will lead to a scar running from the armpit to the elbow and it will be placed in the most inconspicuous location possible. The skin is then brought together which smooths out the contours and removes the hanging skin.

In patients with massive weight loss the excision will sometimes continue onto the side of the chest wall to reduce loose tissue adjacent to the breast.

A drain is not usually required.

Dressings that are waterproof are placed over the incisions and a bandage is fitted in the operating room that will be worn night and day for two weeks apart from shower time. Normal daily showering is resumed the next day and the bandage reapplied after the shower for two weeks.

Alternative procedures.

Drawback of a brachioplasty procedure is the scar running from the armpit to the elbow. The scar will improve over a period of time during which it is pink and readily apparent. Although the scar is placed in the least conspicuous area possible its appearance can’t be entirely predicted. Uncommonly it can be widespread when it has matured.

Quite understandably, some patients are reluctant to accept this scar and then maybe options particularly if the quality of the skin is good and the amount of excess fat is only moderate.

Liposuction

Some patients will be candidates for liposuction alone if the sagging skin is not excessive and the patient does not require skin tightening or does not want to accept the scar from the brachioplasty.

Liposuction is a surgical procedure performed in an accredited operating theatre. If significant areas are treated such as in the instance are treating both arms, a general anaesthetic is still required with an anaesthetist present.

Frequently the outcome from liposuction and coolsculpting can be equivalent particularly when treating the arms. Occasionally the choice to consider liposuction is because other procedures are also being undertaken such as breast surgery and consequently there is already a planned trip to the operating room. Convenience may tip over in favour of liposuction.

The Ideal Candidate

Who is a good candidate for arm lift surgery?

Like many body contouring procedures substantial results can be achieved however these are significant operations.

The early recovery period is associated with reduced activities, a reduced ability to perform normal household chores and no driving.

The ideal candidate for an upper arm lift or brachioplasty surgery redundant underarm skin following weight loss or ageing:

  • Has good general health with a positive attitude, a healthy diet and lifestyle with realistic goals.
  • Is close to or in the normal body weight range and has achieved their goal weight. iIf weight loss was required, the weight has remained stable at this weight for some time.
  • The chemicals in cigarettes reduce the blood flow in the skin and have the ability to impact wound healing. The goals of this surgery are for an improved appearance of the arms and wound healing problems would be a substantial concern. This surgery is not performed by Dr Magnusson on current smokers. Every patient who smokes would be required to stop smoking for at least six weeks prior to surgery and remain off cigarettes for at least 4 weeks following surgery.
  • The best outcomes from any procedure involve three aspects: selection of the correct proceeded to reach the goal, are a technically well performed and safe procedure and finally the patient diligently following the post-operative management plan. Deviation from this path at any step may alter the outcome and importantly that also includes not following the post-operative instructions.

Preparation

The consultation.

hen you attend for your consultation with Dr Magnusson you will initially be seen by a nurse who will check your medical history, your current medications, any allergies you may have and clinical photographs for your record will be taken. These images are a private and confidential part of your medical record and are not shared in any way without your consent and prior approval. Clinical photographs greatly assist the consultation process as we can look at photographs of the body from angles that you would not normally see to help explain relevant points of the examination and treatment decisions that may be considered.

Information that is important includes past surgical procedures, medications, allergies and adverse reactions to medications.

You will be seen in a consultation with Dr Magnusson.

He will want to determine your goals, expectations and motivating factors.

Your body mass index will be assessed as there is a differential rate of risk and different outcomes associated with different levels of body weight and different body shapes. If necessary, Dr Magnusson will have a frank discussion about your weight and your goals in this regard.

There are several treatment options for the arms and Dr Magnusson will want to determine which option is best for you.

An examination will be performed that will include:

  1. The assessment of skin elasticity and the distribution of stretch marks if any are present
  2. Determine the distribution of fat and loose skin around the arm and confirm what areas concerning you.
  3. Dr Magnusson will then spend time educating you about the various options for treating the arms and what the are designed to do and how this could relate to you specifically.

Commonly there is more than one option to consider when deciding between nonsurgical, liposuction and surgical brachioplasty. The natural tendency is to choose the smaller and simpler option.

A most important element in choosing a procedure is to have a clear outcome goal. By understanding how the various elements of the procedure contribute to the outcome it will become clear which procedure or combination is going to get you closest to that goal.

Choosing an alternative procedure which won’t logically take you to your goal may be performed well, you may recover flawlessly and yet not be completely satisfied. If your goal and the surgical procedure do not align it is time to pause and realign your decision-making to avoid this.

Dr Magnusson will expertly guide you along this path.

Realistic expectations.

There are many factors that impact surgical outcomes and while good outcomes can be achieved in many different body shapes and sizes, it is important for the patient to appreciate which category they fit into and therefore what type of outcome they will individually achieve.

The arms can be full with a significant bone of subcutaneous fat all be predominantly loose with hanging skin. These 2 different body types will achieve different outcomes.

Additional elements such as massive weight loss, lead to other concerns and there are also frequently concerns in other areas such as the breast, abdomen, thighs and even the face. These additional areas may be addressed at the same time or at subsequent procedures especially the chest wall behind the breast.

Preparation for the hospital.

Brachioplasty surgery is performed by Dr Magnusson at fully accredited hospitals under a full general anaesthetic with fully qualified and experienced anaesthetists.

While some patients will have this surgery as a day procedure, some patients remain one night in hospital and if the surgery is more complex such as the inclusion of additional procedures some may stay two nights.

You will want to wear loose and roomy clothes on the day of your surgery so it is easy to get dressed again after the procedure.

You will be contacted by the hospital prior to admission who will go through your medical history to ensure there are no additional requirements in preparation for your anaesthetic.

You will be admitted to the hospital a couple of hours prior to your surgery and these details will be checked again to ensure that the right person has the right operation.

Dr Magnusson will see you before the anaesthetic and lines will be drawn onto your skin while you are awake to plan the operative procedure. You will have an opportunity to ask questions at this point however it is not a good time for complex questions because at this point most patients are more focused on the immediacy of the surgery rather than the answers to these questions.

You will be well cared for.

After you are asleep, the skin is prepared and the procedure is undertaken as outlined above.

You will wake up in the recovery room, and you will have bandages on your arms.

For those staying overnight you’ll be taken to the ward after about 45 minutes and attending family will be able to see you there.

At the end of the day’s operating Dr Magnusson will see you before he leaves the hospital and you will be seen on each day you remain at the hospital.

For those patients going home on the day of the surgery, you will remain in the hospital for up to 3 or 4 hours. You will only be able to go home as a day case if there is another adult who will be with you for the first 24 hours.

Brachioplasty patient’s did not require drains as a general rule unless there are additional procedure is performed.

Dr Magnusson will need to see you on a number of occasions over the next 12 months. Your post-operative visits will be two weeks, two months, six months and 12 months following surgery. If there are concerns or problems arising along the way you will be seen as required at other times.

Recovery

Going home.

When you return home from hospital you will have a reduced ability to perform your normal activities and especially your normal household duties.

For those with young children arrangements will be necessary to ensure that they are adequately cared for during this time.

Meals: prepare with simple meals that are easy to reheat and healthy snacks with lots of available water.

Accessibility: think of those things that you will need to wake toiletries, medications, tissues/wet wipes, phone/charges/computer/TV remotes. These items should be readily available at waist height so that they don’t require bending or reaching.

Written instructions: keep information about your medications, their timing and your post-operative recovery instructions handy for regular reference as required. Consider a medication organiser so that regular medications can be taken at the right time of the day.

Recovery.

There are various stages of the recovery from surgery and especially from a significant procedure such as an brachioplasty.

Immediately after the surgery is common to feel a little dizzy, discomfort and a bit disorientated in association with the medications from your anaesthetic and for managing pain.

The various stages include managing discomfort and the activities of daily living, managing more general household responsibilities, returning to activities including driving and exercise and finally the full maturation of the outcome and the scar. These aspects all occur at different speeds.

You will remain in hospital until you are able to manage your discomfort and perform all the necessary routine activities of daily living with the level of support that you will have available at home. This maybe as a day case or after one or two nights in hospital for most patients.

In the short term when you get home there will be no driving, no significant exertion and you will feel limited in activities requiring a a lot of reaching. In bed most patients require some extra pillows supporting your arms for comfort. After about one week most people mobilising without concern but performing tasks more slowly and deliberately than usual.

At about one week you are well in control. You can return to driving, you know what makes the pain it worse and therefore you avoid it. The medications are becoming far less necessary to remain comfortable. A relatively moderate discomfort during the day can be ignored when you are busy or thinking the other things but may become more noticeable when you are trying to clear your mind for sleep. Consequently many patients will still take a stronger pain tablet at night.

Patients with a sedentary job and need to be back at work will be able to go back to work if they are no longer requiring strong painkillers and especially if they are able to have shortened hours. Most patients will prefer to wait until two weeks if their circumstances permit. If the level of exertion at work can’t be controlled then six weeks off work will be required in uncommon circumstances.

By three weeks you are performing gentle exercise such as walking quietly without hand weights. You are in control of all aspects of your recovery and almost all patients are completely off painkillers.

At six weeks you are liberated! You can return to all activities even exertion at the gymnasium however it will take a while to build back up to normal speed. You will have both good days when you do a bit more and bad days when you feel the results of those activities.

At six weeks your scar will appear as a relatively fine pink line. From this point it will actually become pinker and reach its most obvious appearance between three and five months.

At about three months most patients feel that they are not reminded daily about the surgery. There will be further improvements particularly in areas of liposuction over the next 12 months but these won’t be occurring at a appreciable rate from day-to-day.

At 6 months the scar will be improving but the full improvement of the scar is slow and takes 18 to 24 months.

Is there any Medicare and health fund assistance with arm lift surgery?

At the end of 2015 the federal government limited the accessibility of item numbers for procedures relating to loose tissue to post-weight loss patients. As a consequence this procedure is considered cosmetic for many patients.

Some individuals will still receive assistance with the costs of the hospital admission and medical expenses relating to the surgery if they meet the government requirements. These item numbers are subject to change without notice and are meant as a guide.

The item number for brachioplasty is 30171 or 30172 if additional procedures are performed at the same time such as a thighplasty.  There are certain requirements that need to be met to qualify for this assistance:

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical brachioplasty, with or without repair of musculoaponeurotic layer and transposition of umbilicus if:

  • (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and
  • (b) the redundant skin and fat interferes with the activities of daily living; and
  • (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Similar restrictions apply for body lift but with a different item number 30179:

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical brachioplasty (Pitanguy type or similar) if:

  • (a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and
  • (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and
  • (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Following your consultation you should understand and have answers to the following questions:

  • Are you a good candidate for arm lift surgery?
  • What type of procedure am I going to need to achieve my goal?
  • Are your goals realistic and achievable?
  • The length, quality, duration and location of scarring.
  • The important aspects of your recovery.
  • The timing of your return to work and other activities.
  • The risks of surgery and the likelihood of complications and what is required to manage them.
  • What it is required of you to achieve the best outcome from surgery both in preparation for the procedure and the recovery from surgery.

Dr Magnusson

Dr Mark Magnusson

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