Arm Reduction

Post bariatric or weight loss surgery (Arm Reduction)
 

Following massive weight loss many patients are left with residual folds of skin, significant amounts of stretch marks, residual fat which does not go back so it is common for this group of patients to request excision of these excessive folds.  

Arm reduction

The procedures that are usually involved with respect to the arms include arm reduction, with or without lift. 

Indications:  Usually after massive weight loss 
These people would have either had a gastric banding operation or gone through a programme of diet & exercise resulting in massive weight loss & this has left them with excessive folds of skin & fat which they do not find sightly & would like to have dealt with. 
It is important that the person achieves his or her ideal new weight or at least close enough & they are medically fit. 

 

An arm reduction operation removes the excessive folds of skin & fat on the inner aspects of the arms. It can easily be demonstrated to a patient by raising both arms outstretched like wings, these folds of skin & fat can usually be seen hanging down. This surgery is usually performed under general anaesthetic. 

Duration of stay in hospital: Usually an overnight stay. 

Time off work: Usually a couple of weeks. 

Duration of operation: 1 ½ - 2 hours if both arms are done. 

The amount of skin & fat to be excised is usually planned pre-operatively with the person concerned & the marks are designed in such a way that the scar lies on the inner aspect of the arm so, with the person standing in front with the arms by his or her side, the scar will be hidden. 
It can either be a straight line scar or a T-shaped scar with the transverse or horizontal part of the ‘T’ more in the armpits. Also by excising skin & fat in this armpit area one is able to lift the tissues of the arm as well. Sometimes drains are used & absorbable sutures are normally used to close the wounds. 

Post-Op Care: The patient is usually placed on painkillers as well as antibiotics, a supportive or pressure garment which is usually ordered before the operation, is fitted in theatre and usually worn for a period of 4-6 weeks to help make the arm more comfortable and reduce the amount of overall swelling. 

Risks/Complications: The usual complications are in accord with having the anaesthesia which includes chest infection & blood clots in the leg which can dislodge & travel to the lung, potentially fatal & the risk of this is reduced by fitting the patient with tight stockings as well as giving an injection of a blood thinning drug. 
Bleeding can occur & blood accumulation may require a trip back to theatre for evacuation. 
Infection is usually prevented by administration of antibiotics.
Wound breakdown usually superficial & minor & just requires dressing for a few weeks. It is more common in the upper parts of the scars where it is in the axilla. 
The scars are usually red initially & become pale as they mature. In some patients they can become lumpy & may require treatment with steroids & scar revision. 
Sensory problems. There can be changes in sensation in the inner aspect of the forearm. This is because some of the nerves that supply this area may be in the piece of tissue that is excised. With time most patients don’t find this bothers them. 
Dog ears. These are prominent folds which occur at the ends of scars,especially the lower end of the scar & may require a correction under local anaesthetic a few months down the line.