A man in his late 50’s who had a gastric sleeve performed endoscopically by the bariatric service 3 years before and reduced his weight from 385 to his present weight of 257. He is 5’9″. He was bothered by a feminine appearing chest and hanging skin of his arms. He is shown before and again, 11 months after bilateral brachioplasty and bilateral gynecomastia excision with free nipple grafting. Discussion: Studies show that the risk of infection and wound healing complications increases above a BMI of and with His BMI of 37.67 we can expect a nearly 3 fold increase in these issues. As expected, he had small areas of skin separation and infection that delayed his healing, and we can see some inconsistent healing of his free nipple grafts. Scars will typically continue to fade and improve in the arm area after brachioplasty for 3 years.
A woman in her mid 50’s who has lost more than 60 lbs with diet and exercise. She is troubled by the ‘bat wing’ appearance of her upper arms and also by the droopiness of her D cup breasts. She would like to be slightly smaller but lifted and still proportional. She is shown before and again nearly 7 months after a mastopexy (breast lift) / minor reduction and a bilateral brachioplasty (upper arm lift). Although scars will typically continue to fade for up to 2 years, she is already quite pleased with her results. The appearance of the upper arms is improved with the arms at the side and raised. The tradeoff of a brachioplasty (upper arm lift) is a scar that is visible and sometimes unfavorable on the inner arm that is hidden with the arms at the side. Some surgeons prefer to place this scar at the back of the arms, but this would be visible with the arms down, and not my preference. As is typical with a brachioplasty in a patient with poor skin elasticity the results are not “perfect” but are much better. Swelling after surgery tends to re stretch the skin slightly, and there is no longer enough “spring” left in the skin to bring it completely back to the contour achieved at surgery. And tighter would risk skin breakdown, wider scars, and possible problems with pressure on the nerves and blood vessels of the arms. But much better is much better. The excision has been continued into the upper axilla (arm pit area) and down the lateral upper border of the breast to improve the contour.
A 56 year old woman who has never been pregnant, shown before and 11 months after mini-abdominoplasty and external ultrasound assisted liposuction of the hips, flanks and the medial, lateral and posterior thighs. 3.8 liters of fat were removed.