Purpose: With the increasing popularity of morbid obesity gastric bypass surgery, there has been an increase in the number of brachioplasty operations performed in attempt to remove excessive skin laxity and adiposity, while recreating a normal upper arm contour. The massive weight loss creates a contour deformity of the arm and axilla, resembling the appearance of a bat wing as well as a poorly defined axilla. Our refined surgical incision design, named a swallow tail incision, is a reliable, easily performed method to recreate the natural axillary contour, decrease the appearance of the patients bat wings and prevents a midline axillary scar.

Materials and Methods: A prospective series consisting of 3 subjects was performed utilizing a swallow tail incision design. The swallow tail incision utilizes a standard elliptical incision in the upper arm but differs in that there are anterior and posterior limbs in the axilla which closes to form a “Y” type incision.

Conclusions: In all patients the swallow tail incision design helped to recreate the axillary dome, giving a more natural appearance of the axilla while prevented midaxillary scars and therefore contracture. It also decreased anteroposterior distance of the axillary tissue helping eliminate the appearance of bat winging.