Background: Large amounts of weight loss, whether from bariatric surgery or from other non-surgical methods, creates a lot of secondary body issues. The loss of subcutaneous fat causes deflation of the overlying skin, resulting in skin sagging and often interference with numerous normal bodily functions. The arms are a classic example of this expected phenomenon with large amounts of loose skin hanging off of the back of the arm creating the classic ‘batwing’ appearance. Besides its unsightly appearance it often causes problems in fitting into shirts and other upper body wear.
Removal of excessive arm skin is done by the well known arm lift or brachioplasty procedure. This arm reshaping procedure has been around for a long time and not much has changed in how it has been performed. It involves removing the loose skin and fat that hangs below the arm when one has their arm extended out at 90 degrees from their body. There are no vital structures in this skin segment, not even any major artery or veins. An armlift does create a prominent scar but this is always a better aesthetic tradeoff in the extreme weight loss patient with true batwings.
The relevant issues about surgically planning an arm lift is the scar location and whether it should cross past the armpit into the side of the chest. The latter is simply decided by whether a web of skin extends between the arm and the chest wall. But the scar location has been a matter of surgical and patient discussion for years. The final arm lift scar can end up being placed on the inside (medial), the back side (posterior) and an intermediate location between the two. (posteromedial) This is purely a function of how the excision of excessive arm tissue is oriented.
Case Study: This 42 year-old female had bariatric surgery three years previously with a stable weight loss of 110lbs. Her primary body shape concerns were her arms and stomach. Her breasts and thighs were less important and were planned for a second stage procedure
Under general anesthesia , she underwent a fleur-de-lis extended tummy tuck and arm lifts. The armlifts were performed by a posterior excision of tissue that was marked upright before surgery. During surgery her arms were elevated, crossed and attached to a padded metal bar which allowed direct access to the arm excisions. The excess tissue was excised down to the deep arm fascia and just past the lower portion of the armpit. It was closed into two layers and no drain was used.
Her postoperative arms showed a typical bariatric arm lift patient result with a dramatic improvement in the size of her arms and elimination of hanging skin. The back of the arm scars were only seen when the arms were raised and at certain angles from the back. There were typical arm lift scars, not great by plastic surgery standards, but would go in to fade considerably with further healing. (two month healing result)
The arm lift procedure is the single most satisfying of all the bariatric plastic surgery procedures. It is easy for patients to undergo, produces very satisfying results and is associated with few complications. It is an excellent body contouring procedure to do as part of a first stage bariatric plastic surgery program.
Highlights:
1) Arm lifts are an important part of bariatric plastic surgery after extreme weight loss and is often part of the first surgical stage of the body contouring procedures.
2) Of all the body contouring procedures after weight loss, arm lifts have the easiest and least painful recovery.
3) The excision of loose hanging arm skin can be done from multiple locations on the arm but the posterior approach offers the best arm lift scar location.
Dr. Barry Eppley
Indianapolis, Indiana