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American Association of Plastic Surgeons
2. Long Term Outcomes and Complications Associated With Brachioplasty
James Knoetgen, III, MD, Steven L. Moran, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE:
While there are a large number of publications detailing brachioplasty techniques, long-term follow up data and complication rates have not been consistently reported. Here we report our series of brachioplasty patients from a single institution with careful evaluation of postoperative complications and the need for revision surgery.

METHODS:
This study was approved by our hospital’s institutional review board. A retrospective review was performed examining all brachioplasty procedures performed between 1988 and 2004. Patient charts were reviewed for demographics. Hospital and clinic notes were reviewed. Complications noted included hypertrophic scar formation, seroma, wound dehiscence, cellulitis, subcutaneous abscess, nerve injury, and the need for revision surgery.
Technique for all cases consisted of a relatively elliptical skin and subcutaneous fat resection from the medial aspect of the upper arm, with extension into the axilla when necessary.

RESULTS:
Over a sixteen-year period 40 patients underwent bilateral brachioplasty. Average patient age was 47 years. All patients were female. Brachioplasty was combined with another procedure in 85% of cases. 76% of patients underwent brachioplasty following significant weight loss, and of these 74% had undergone gastric bypass surgery. No patients were tobacco smokers. Average follow up was 50 months. Postoperative complications occurred in 25% of patients, and all complications were considered minor because no patient required operative treatment. Complications included seroma (10%), hypertrophic scarring (10%), cellulitis (7.5%), subcutaneous abscess (2.5%), wound dehiscence (7.5%), and nerve injury (5%). The surgical revision rate was 12.5% (skin revision in 80% and liposuction in 20% of patients).
There were 2 documented injuries to the medial antebrachial cutaneous nerve documented by EMG. These both led to prolonged dysesthesia and a complex regional pain syndrome in one patient.

CONCLUSION:
Overall, the complication rate associated with brachioplasty surgery in this study was 25%. Revision surgery was required in 12.5% of patients. Both the plastic surgeon and patient should be aware of the complications associated with brachioplasty prior to any surgical undertaking.


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