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Brachioplasties rely on optimal scar placement, incision closure

Article-Brachioplasties rely on optimal scar placement, incision closure

Key iconKey Points

  • Inappropriate wound closure tension a pitfall of brachioplasty surgery
  • Scar placement can range from bicipital groove region to posterier locations
  • Patients with greater change in body mass index had higher chance of wound infection

The growth in brachioplasty surgery has paralleled the evolution of weight loss surgery; as the number of massive weight loss patients has soared, so has the frequency with which brachioplasty is performed.

Brachioplasty patient preoperatively
J. Peter Rubin, M.D., associate professor of Plastic Surgery at the University of Pittsburgh, has performed scores of brachioplasty procedures in recent years. Massive weight loss patients represent almost 100 percent of his brachioplasty patient population. "There is more to doing this operation correctly than surgeons often anticipate," Dr. Rubin says. "We have learned a lot about how to avoid the pitfalls."

Five months after the procedure
MARK AS YOU GO Inappropriate wound closure tension is a major pitfall of brachioplasty surgery, according to Dr. Rubin. "Rather than rely entirely on a preoperatively marked pinch test, I do a measured segmental resection, checking the tension and re-marking each spot during the procedure, to avoid any possibility of over-resecting. This maneuver also helps to achieve the best contour," he says.

18 months after the procedure. (PHOTOS CREDIT: J. PETER RUBIN, M.D.)
Dr. Rubin also points out that brachioplasty is an operation for which there have been reports of over-resection of the skin which required skin grafting. "Avoiding inappropriate tension on the closure — either too much or not enough — is where the challenge lies," he stresses.

SCAR PLACEMENT There are two constants in brachioplasty surgery, Dr. Rubin points out: One is the inevitable scar that will result from the procedure and the other is the ongoing debate among surgeons regarding exactly where that scar should be. Scar placement can range from the region of the bicipital groove to very posterior locations. Additionally, some surgeons rely on a Z-plasty at the level of the axilla to prevent scar contracture.

Dr. Rubin says he prefers to place the scar in the bicipital groove.

"There is always some discussion among plastic surgeons about where that scar should be. My technique is designed in a manner that compensates for any posterior tension by the resected tissues on the scar," Dr. Rubin explains. "It involves scar placement along the bicipital groove under the biceps muscle. I favor that location because it is nicely hidden when the patient has his or her arm at their side, and that location is well-accepted by patients."

Optimal incision/scar placement has profound implications beyond aesthetic concerns.

"An incision that forms a scar band across the flexion crease of the shoulder could limit motion in the shoulder," Dr. Rubin explains. "Until the massive weight loss patients showed up, no one had a truly large experience with brachioplasty. Talking to colleagues about what complications they've encountered has helped me refine my technique. The chance to review some cases that were considered problematic by other surgeons has also helped me to understand important issues."

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