Brachioplasty in the Patient with Massive Weight L

Authors: Aly Al Pace Daniele Cram Albert

Publish Date: 2006/01/01

Volume: 26, Issue: 1, Pages: 76-84

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Abstract

In performing brachioplasty the authors have created a doubleellipse marking technique to avoid overresecting and leave adequate skin for closure After resecting they prevent the interference of softtissue swelling during wound closure by immediately closing each segment with temporary staples Their technique is ideal for patients with massive weight lossThe elimination of upper arm excess is often required in the treatment of the patient with massive weight loss The inflation and deflation of skin caused by weight gain and subsequent weight loss can lead to varied arm deformities Although the literature describes many brachioplasty techniques the severe deformity frequently presented by the massive weight loss patient inspired us to develop a technique that specifically addresses the arm deformities in this population We introduced this technique in 20021Careful examination of the intersection of the upper arm and lateral chest wall reveals that the anterior and posterior axillary folds create the boundaries of the hairbearing axilla When a person gains significant weight and then loses it the posterior axillary fold is the area of significant arm inflation and deflation Because the posterior axillary fold originates from the lateral chest wall by necessity the upper arm excess crosses the axilla onto the lateral chest wall Figure 1Preoperative view of a 51yearold woman who requested treatment after a 190lb weight loss and a 33point BMI drop She has the type of upper arm deformity typically seen in the massive weight loss population Note that the excess skin crosses the axilla onto the lateral chest wall as the posterior axillary foldPreoperative view of a 51yearold woman who requested treatment after a 190lb weight loss and a 33point BMI drop She has the type of upper arm deformity typically seen in the massive weight loss population Note that the excess skin crosses the axilla onto the lateral chest wall as the posterior axillary foldSome patients who gain significant weight in the upper arms retain most of their lipodystrophy after weight loss For these patients once weight loss has stabilized we recommend a preliminary lipoplasty procedure to deflate the arms 6 months before undergoing our excisional procedure If the skinfat envelope surrounding the noncompressible musculoskeletal system in the upper arm is thick the result of resection is significantly inferior to that achieved when the patient presents with a thin skinfat envelope The technique described in this article is ideal for the more commonly occurring arm presentation in the patient with massive weight loss—upper arms that are inflated by weight gain but significantly deflated by weight loss

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