Brachioplasty surgery aims to address excess tissue present in the upper portion of the arm (and the armpit and lateral portion of the chest where present).
Risks and complications of brachioplasty surgery
Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms of achievable outcomes and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of brachioplasty surgery. It is important that you take the time to read over them again prior to your next consultation.
Scarring
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than surrounding skin. Scar appearance may also vary within the same scar, exhibit contour variations or “bunching” due to the amount of excess skin. Scars may be asymmetrical (appear different between right and left side of the body). Scars can appear thick, red and raised all or part of the way along the incision line (a hypertrophic scar) or more rarely can involve tissues beyond the incision itself (and can resemble a badly healed burn), this is known as a keloid scar. Additionally scars can tether to underlying structures or become abnormally pigmented or can stretch. It is possible that additional treatments may be required for adverse scarring.
Bleeding
It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require an emergency treatment to drain the accumulated blood or blood transfusion. Intra-operative blood transfusions may be required. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time following injury. If blood transfusions are needed to treat blood loss, there is a risk of blood related infections such as hepatitis and the HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Seroma
A seroma can be best thought of a collection of fluid beneath the skin at a surgical site. The composition of a seroma is much the same as that of blood but without the actual blood cells (it contains similar proteins and salts to blood) and is usually the result of lymphatic fluid accumulation (this is the 10% of the fluid that escapes from capillaries within tissues but does not return back to the veins via the small blood vessels but rather by the lymphatic drainage vessels) or by direct production from inflamed tissue (think of the tissues ‘sweating out’ the fluid). If this occurs there is the possibility it will need to be drained (often by simple aspiration with a needle or syringe, though in rarely can require a further operation to remove completely). If a seroma were to become infected it could form an abscess which could require further surgery to washout and drain.
Infection
Infection is unusual after surgery. Should an infection occur, treatment including antibiotics, hospitalization, or additional surgery may be necessary. There is a greater risk of infection when body contouring procedures are performed in conjunction with abdominal surgical procedures. Very rarely significant infections can occur which may be life threatening.
Skin Contour Irregularities
Contour and shape irregularities and depressions may occur after abdominoplasty. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility as is skin pleating when there is excessive redundant skin. This may improve with time, or it can be surgically corrected. If liposuction is used in conjunction with your abdominoplasty procedure the risks of skin contour irregularities associated with this treatment are applicable.
Major Wound Separation
Wounds may separate after surgery. Should this occur, additional treatment including surgery may be necessary.
Skin Discoloration / Swelling
Bruising and swelling normally occurs following thigh lift or skin excision surgery. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Change in sensation
It is common to experience diminished (or loss) of skin sensation in areas that have had surgery, like wise it is possible to develop nerve related pain within the area of surgery (neuropathic pain) and this may be temporary or permanent. It is not unusual for your arms to feel tight following a brachioplasty though some patients may find this sensation uncomfortable and persistent. Diminished (or complete loss of) skin sensation on the inner aspect of the arm and forearm may not totally resolve after brachioplasty and can affect the hand. The medial cutaneous nerves of the arm and forearm are particular nerves that are encountered within the field of the surgery (they supply sensation to the medial aspect of the arm and forearm) and it can be subject to the problems described above.
Skin Sensitivity
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolve during healing, but in rare situations it may be chronic.
Sutures
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.
Skin necrosis
If the blood supply to the skin is insufficient following surgery (which can be for a variety of reasons) the skin, particularly at the incision site, can necrose (die). If this happens the skin will form an eschar (scab) which may need to be removed surgically. Dressings are likely to be required for a period of time and further surgery including skin grafting may be needed.
Delayed Healing
Wounds can break down following surgery (wound dehiscence) or after suture removal or may be slow to heal. If this occurs dressings may be required for a prolonged period of time (weeks to months) prior to wound healing and in occasional cases a further operation may be needed. Scar revision may be necessary in cases of delayed wound healing. Smokers have a greater risk of skin loss and wound healing complications.
Fat Necrosis
Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
Asymmetry
Everyone has a degree of asymmetry between right and left halves of the body. Sometimes certain asymmetries that were present, but less noticeable pre-operatively are revealed after thigh lift surgery. It is important to be aware of this possibility prior to undergoing surgery. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features. Regarding the scar, although every effort is taken to make the scar as symmetrical as possible, the scar is often slightly different each side. This too must be appreciated prior to undergoing surgery.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, blood vessels and muscles. Injury to deeper structures may be temporary or permanent, may require further surgery and may result in loss of function of the limb.
Shock
In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Persistent Swelling (Lymphedema)
Swelling in the arm, forearm and hands can occur following a brachioplasty procedure. This is usually temporary and resolves with time and massage but it can be persistent and in some cases permanent.
Pain
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after a brachioplasty procedure. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after abdominoplasty.
Surgical Anesthesia
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation
Unsatisfactory Result
Although good results are expected within the limitations discussed at the time of your consultation, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of brachioplasty surgery. This would include risks such as asymmetry, unsatisfactory or highly visible surgical scar location, unacceptable visible deformities, bunching and rippling in the skin near the suture lines or at the ends of the incisions (dog ears), poor healing, wound disruption, and loss of sensation. It may not be possible to correct or improve the effects of surgical scars. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Additional surgery may be required to improve results.
Deep Venous Thrombosis, Cardiac and Pulmonary Complications
Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life- threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots, swollen legs or the use of estrogen or birth control pills that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. Should any of these complications occur, you may require hospitalization and additional treatment. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately.
Long term outcomes
The appearance of your arms may change with future alterations in body weight, aging, sun exposure and hormonal changes (such as medication and the menopause) together with other circumstances not related to your surgery.
Alternatives to brachioplasty surgery include weight loss and exercise, liposuction (where appropriate) or not having any treatment.
