Brachioplasty: Association of Concomitant Procedures with Complication Rate

PURPOSE:  Upper arm deformities following massive weight loss have lead to an increased demand for aesthetic contouring procedures such as brachioplasty. The authors performed a review of all patients who underwent a brachioplasty procedure in a multi-practice medical center, evaluating complication and revision rates, as well as the safety and efficacy of liposuction and co-procedures performed at the time of brachioplasty.

METHODS: A retrospective review was performed for all patients who underwent a brachioplasty procedure from a multi-practice medical center comprised of 10 surgeons.  Outcomes measured included patient demographics, operative interventions, post-operative course, and patient satisfaction.    

RESULTS: Ninety-eight patients, 50.4+11.9 years of age (mean+SD), were included in the review.  The etiology of upper arm deformities included massive weight loss from previous bariatric procedures (49.0 %) and diet and exercise (30.6%), in addition to senile elastosis (19.4%).   Fifty-five patients (43.9%) underwent a concomitant procedure, with 53.6% undergoing arm liposuction at the time of brachioplasty.  The total complication rate was 49% with major and minor complications rates of 18.4% and 40.8%, respectively. Common complications included hypertrophic scarring (22.4%), infection (13.3%), and dehiscence (7.1%).  Hypertrophic scarring was typically treated with laser therapy (63%, n = 14) with a mean of 2.14 treatments.  The total revision rate was 24.5%, with residual contour deformity (10.2%) and hypertrophic scarring (9.2%) representing the most common cause for revision. Patients who underwent a previous bariatric procedure or a co-procedure were at an increased risk of developing a major complication (p = 0.03 and p = 0.04, respectively).  However, there was no relationship between complication rate and concomitant upper arm liposuction (p = 0.39).  Logistic regression analysis indicated that bariatric surgery and use of a co-procedure were both predictive for major complications, with odds ratios of 3.41 (95% CI: 1.08 – 10.75) and 3.56 (95% CI: 1.05 – 12.05), respectively.

CONCLUSIONS:  Brachioplasty, despite being an effective treatment for contour irregularities of the upper arm, is associated with significant revision and complication rates.  Post-bariatric patients should be informed of the potential for increased complications.  Furthermore, additional procedures increase complications, strengthening the argument for staging patients who desire multiple procedures.  However, liposuction of the upper arm can be safely performed as a concomitant procedure to brachioplasty.