Brachioplasty After Bariatric Surgery and Extreme Weight Loss

Weight loss surgery is often just the start for those on a weight loss journey. People that lose weight rapidly, whether due to extreme dieting or gastric bypass surgery, commonly deal with excess skin on the upper arm.

Unlike most patients considering arm contouring surgery (brachioplasty), these individuals may have loose skin not only from elbow to armpit but also within the armpit fold and the chest sides. Performing arm lifts on massive weight loss patients requires special surgical techniques, which you’ll learn about in this article.

Extended Arm Lift with Liposuction

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Massive weight loss after a gastric bypass frequently causes loose skin on the arms. Our surgeons regularly see patients that want to remove extra skin left behind after major weight loss.

While there are many different surgical procedures to remove excess skin and fat after weight loss, one of the most common operations they perform is arm contouring surgery.

Extended brachioplasty has a longer incision than traditional brachioplasty. The scar usually runs from the elbow to the armpit, then continues down onto the sides of the chest.

Why is a longer arm incision necessary after extreme weight loss?

Extended arm lifts are a more intensive procedure than standard arm lifts. Extended arm lifts remove excess skin and fat from the upper arms, armpits, and sides of the chest. But why do massive weight loss patients need such a long scar to achieve a good result? The answer lies in the anatomy.

As a scientific journal article explains, “When a person gains significant weight and then loses it, the posterior axillary fold [rear armpit] 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”. (Ref 2)

Some patients only have minor loose skin on the upper arm due to ageing or slight weight fluctuations. However, the anatomy of a massive weight loss patient differs because the extreme weight fluctuations cause a buildup of excess skin on the areas surrounding the upper arms such as the armpit and chest sides — areas that the average person usually doesn’t gain or lose weight.

Benefits of Adding Liposuction to Arm Lifts for Massive Weight Loss Patients

Liposuction

For post weight loss patients with sagging on the arms, chest sides, and armpit, our surgeons may recommend an extended arm lift paired with VASER liposuction. They find this dual approach provides an optimal result for patients with severely loose skin after dramatic weight loss.

Our surgeons frequently perform liposuction-based arm lifts for post bariatric surgery patients that have achieved massive weight loss. Yet they are not only interested in providing patients with sleeker arms. Their surgical techniques also keep safety top of mind.

For example, a 2018 medical study (Ref 1) found that:

“Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications,”

and

“the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction”.

Who is a good candidate for Extended Brachioplasty?

Patient 316 - Brachioplasty

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

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Losing weight with bariatric surgery can make a person slimmer and healthier. However, an unfortunate side effect is it often causes sagging skin. For people with loose skin on the upper arms, axilla (armpit), and lateral chest wall, an extended arm lift may be appropriate.

An extended arm lift can reshape the arms and surrounding areas. However, having loose skin on the upper arm, underarm, and lateral chest is not the only criteria you’ll need to meet to be considered for the operation.

Ideal candidates have reached a stable weight after they have undergone weight loss surgery. They will also need to have a healthy body mass index. This procedure is not for patients with minor excess skin. It’s usually only recommended for people that have achieved dramatic weight loss through bariatric surgery or extreme diet and exercise.

Maintaining a stable body mass index is just the start. You will also need to be a reasonably healthy non-smoker. Otherwise, wound healing problems and other risks are possible.

What other body contouring surgery options are available to massive weight loss patients?

Significant weight loss can cause excess skin on many areas of the body — not just the arms. In addition to arm contouring, many post weight loss patients interested in excess skin removal turn to our surgeons for body contouring surgery procedures such as:

Tummy Tuck (Abdominoplasty)

A tummy tuck is usually the first body contouring surgery for post weight loss patients. A tummy tuck removes sagging abdominal skin that is left behind after losing weight with an incision on the lower abdomen. In massive weight loss patients, an additional vertical incision is sometimes necessary. This is called a fleur-de-lis abdominoplasty.

After removing the redundant skin, the surgeon pulls the skin downward and closes the tummy tuck incision. This surgical procedure can remove the skin excess and fatty tissue on both the lower and upper abdomen. It may also remove some stretch marks, although that is not the ultimate goal of the operation. Long term outcomes are usually very good so long as the patient follows all their aftercare instructions.

Arm Contouring Surgery (Brachioplasty)

Removing saggy skin and fat can significantly improve the upper arm contour after dramatic weight loss. It is one of the most common aesthetic procedures post bariatric surgery. There are many different types of arm lifts. For the major weight loss patient, a long vertical incision on the inner upper is usually needed.

Lower Body Lift (Belt Lipectomy)

Lower body lift surgery is for people with extreme skin sagging around the entire circumference of the waist after weight loss with bariatric surgery. Our surgeons make an incision all the way around the abdomen, then they remove the excess skin. As they close the lower body lift incision, sagging skin on the lower tummy, hips, and buttocks is virtually eliminated.

Lower body lift surgery also lifts and tightens the inner thighs to an extent. While a body lift is an extensive body contouring surgery, the results can be worthwhile since a lower body lift addresses multiple areas at once.

If you’re considering a body lift, you’ll need to speak to an experienced surgeon. Body lift operations are complex and the surgery duration is longer than many other body contouring procedures. It takes great skill and expertise to get a great body lift result after major weight loss.

Thigh Lift (Thighplasty)

Thigh lift operations remove excess skin and fat from the upper thighs. This body contouring surgery may be performed with or without liposuction for added refinement after major weight loss.

Tightening the skin and underlying tissues may reduce skin infections and discomfort caused by friction from the thighs rubbing together. It can also give the outer thighs (medically known as the lateral thighs) a firmer, sleeker appearance. While it is not the most common body contouring surgery, it can significantly improve the legs after massive weight loss for patients dealing with excess skin and fat in these areas.

Note that patients considering a thigh lift and lower body lift should have a lower body lift performed first. The reason? A lower body lift has a tightening and lifting effect on the thighs. Since a lower body lift can improve thigh laxity to a degree, it is better to have the lower body lift procedure first. A few months after healing from a lower body lift, your surgeon may recommend a thigh lift to further tighten saggy thighs.

Breast Lift (Mastopexy)

While an extended arm lift may get rid of loose skin on the sides of the chest, it won’t improve sagging breasts. Breast surgery may be needed to lift a woman’s breasts and put the finishing touches on her appearance after her weight loss journey. Since breast sagging is common after weight loss, many female bariatric patients decide to have breast surgery to reshape their breasts. A breast lift operation removes excess tissue, restoring perky breasts without a significant change in size.

Breast Reduction (Reduction Mammoplasty)

Some women have large, heavy breasts that they feel are too big for their figure. If the breasts remain too large even after weight loss, a breast reduction can remove the excess breast tissue to make the breasts appear smaller, perkier, and better proportioned.

Breast Augmentation (Breast Implants)

Minor breast deflation can sometimes be addressed with breast implants. If the patient has sagging breasts and desires a fuller cup size with better projection, then breast augmentation with implants may be the way to go. In post weight loss patients, a breast lift and breast augmentation may be combined into one operation.

Gynaecomastia Surgery

Some men have breasts that are too large or cone-shaped, even after losing weight with bariatric surgery. Gynaecomastia surgery (also called a male breast reduction) can remove excess skin, fat, and glandular tissue to create a flatter, more traditionally masculine chest.

Liposuction

Liposuction can be added to many body contouring procedures. Since many weight loss patients have stubborn fat pockets, liposuction is one of the most popular add-ons.

We interviewed Dr Beldholm, a specialist general surgeon that offers body contouring procedures to address redundant skin after dramatic weight loss and pregnancy. According to him, he has found that adding VASER liposuction to a tummy tuck or arm surgery helps to reduce subcutaneous fat for a more streamlined result.

Liposuction-assisted arm lifts removed both skin excess and excess fat in post bariatric patients in one surgery. The results of liposuction last a long time, so long as the patient avoids future weight gain. Diet and exercise are integral to a lasting outcome.