What Is Brachioplasty?

Introduction

Brachioplasty is a body-contouring surgery which is also known as “bingo wing” surgery, it is an arm operation which involves the removal of extra tissue. The surgery removes excess skin from the upper arms that most commonly hang down, which is seen in patients who have experienced significant weight loss. Brachioplasty requires a long incision from the underarm area, along the chest wall into the armpit and then down, usually along the posterior border of the arm, and across the elbow just into the forearm.¹

Anatomy of the arm

The basic structure of the arm consists of three sections- the upper arm, the forearm and the hands. The arms are made up of many nerves, muscles and blood vessels(arteries and veins). The four major muscles are the biceps, brachialis, coracobrachialis and the triceps.²

When it comes to the arms, individuals may be self-conscious about the way they look, and this may affect their self-confidence. After significant weight loss, the skin tends to droop with age and this procedure can help remove this, giving individuals a more balanced appearance.¹

There are many factors that can cause the skin to droop:

• Changes in skin elasticity - which often occurs with age
• Losing weight
• Genetic factors 

Indications for brachioplasty

Individuals who have this procedure done have loose and damaged/compromised tissue. The quality of the tissue does not change during brachioplasty, just the excess is removed.³

The extra skin may cause individuals the following problems: 

• Inflammation/Rash - which can lead to an infection
• Poor self-esteem
• General discomfort
• Hygiene problems in the area of concern

Preoperative evaluation

A preoperative visit is carried out ten days to two weeks before the surgery. The doctor will take the medical history of the patient during this time.⁴

It is essential that patients understand the following:

• Where to show up on the day of the procedure
• What to do
• What the procedure involves
• What medication to take, and not take, on the day

On the day of the procedure, individuals will be introduced to their anaesthetics team and the nurses will get the patient ready by putting in an IV line.⁴

General anaesthesia is given during the surgery.

Surgical techniques

Brachioplasty is typically carried out using two techniques: 

Full Brachioplasty

During this procedure, the plastic surgeon carefully marks out where the incision is to be made. The incision is then made between the armpit and elbow, and where necessary, fatty tissue is removed from the underside of the arm. The procedure can be combined with liposuction, as appropriate. Once the excess skin and fatty tissue have been removed, the incision is neatly stitched up with a strong fine thread. After one week, the surgeon checks the upper arm and removes the stitches. Now the upper arm will return to its usual shape and any swelling will subside over time. After one week, the results will generally be plain to see.⁵

Liposuction

Liposuction is used to remove the fat from the upper arm, particularly in the shoulder and triceps area. During liposuction, a small metal tube known as a cannula is inserted into the armpit and the triceps area. Ensuring the suction is carefully monitored and controlled, the excess fat is removed. This will result in the upper arm looking more toned.⁵

Postoperative care and recovery

Immediate postoperative period

In the immediate period after the surgery, there is expected to be a burning sensation of the skin. This skin pain will improve within a couple of days. It is essential to stay immobile during recovery, hence it is key that the arms are kept in tight and not raised. The patient may also undergo some bruising and swelling, which may cause pain and discomfort.³

Scarring

Brachioplasty can leave one of the most unpredictable scars of any operation performed in plastic surgery, as the shoulder is the most mobile joint in the body, causing the incision to be subject to several different stresses and tension lines. This can lead to irregular scar formation.³

Potential complications and their management

Patients are recommended to wear a compression sleeve during recovery. For people assigned female at birth (AFAB) there is a bra that is incorporated with some sleeves. For people assigned male at birth (AMAB) there can be a vest incorporated with some longer sleeves. This helps to massage, mould and shape the arm and scar. It is recommended that these vests are worn for up to six weeks, or until the swelling reduces. Furthermore, it is key that strenuous exercise is avoided for at least a month, and any bleeding or severe pain should be reported to the patient’s medical practitioner.⁶

Risks and complications

In general, brachioplasty is considered a safe procedure, however, there are a few associated risks. Risks can vary depending on factors such as age, other health issues and the amount of weight that the person has lost. 

Risks of the procedure include:

• Infection
• Trouble with wound healing
• Excessive bleeding
• Damage to lymphatic tissue, which may cause swelling
• Damage to nearby nerves
• Anaesthesia complications
• Blood clots, which may include pulmonary embolism
• Thick or widened scars

In some cases, individuals may need further surgery to contour the upper area of the arm.

There has been a strong link identified between risk factors including smoking, hormone therapy and diabetes, and complications such as infection, deep venous thromboembolism (DVT) and problems with wound healing. Infections are one of the most common complications, and they can be followed by bleeding and/or seroma formation. This is why it is important that the utmost care and attention is given during the surgery, and afterwards, to ensure that complications and risks are minimised.⁶

FAQ’s

How successful is brachioplasty?

Brachioplasty tends to be highly successful when it is planned and executed properly. It has a low complication rate and very successful long-term outcomes for those candidates who are ready and require surgery.⁷

How long do the results from the procedure last?

The results of the procedure can last a very long time if maintained. If weight is gained excessively the arms can return to their preoperative state, therefore, the patient must adopt a normal diet and exercise routine.

Can other medical conditions make having a brachioplasty risky?

There are some factors that can make brachioplasty risky. For example, an individual who smokes any tobacco products, including vaping and nicotine patches, should cease to use these at least four to six weeks before the surgery. Individuals who have been taking long-term oral steroids would not make an ideal candidate for Brachioplasty.

Summary

Brachioplasty is often used to restore confidence in individuals. This can be done through full brachioplasty and liposuction, where the excess tissue is removed leaving a contoured arm. Just like every other procedure, brachioplasty comes with risks. Individuals can have varied symptoms from burning, pain and swelling to nerve damage and blood clots. It is a safe procedure when properly planned and executed, leading to positive results, which may be dependent on weight management.