Background Information on arms
Early brachioplasty or arm lift procedures were done with simple, short elliptical excisions that achieved only fair corrections. As the procedure was refined, brachioplasty results improved when emphasis was placed on the correction of the middle to upper third of the arm, where the soft tissue laxity is usually most pronounced . Further improvement occurred after surgeons recognized the importance of secure tightening of the superficial fascial system, as emphasized by Lockwood. Suturing of the superficial fascial system results in a smoother contour, tighter closure, and a finer scar. With adjunctive liposuction, brachioplasty results improved further because liposuction helps contour and debulk the arm and loosens the subcutaneous tissue plane, making the flap dissection easier
Operation in Belgium
Some patients undergoing brachioplasty present because of normal aging while others present secondary to weight loss. Determining the appropriate approach depends on the purpose of the reconstruction and the degree of skin laxity. Traditional brachioplasty procedures involve incisions that run from the medial epicondyle to the axilla. This incision is generally placed slightly posterior to the medial bicipital groove to minimize appearance of the scar. Caution is advised when elevating cutaneous tissues as they have close proximity to the ulnar nerve and terminal branches of the MACN (medial axillar cutaneous nerve ) and the MBCN (medial brachial cutaneous nerve) . These cutaneous nerves provide pressure and pain sensation to the medial arm and elbow. Injury to this cutaneous system has resulted in the development of pressure ulcers over the elbow in some cases. Injury to this cutaneous system has resulted in the development of pressure ulcers over the elbow in some cases.
Minibrachioplasty techniques coupled with liposuction offer similar contouring. The entirety of the scar is placed in or close to the axilla to minimize the outward appearance of a scar on visible skin. While the scarring and direction of resection are more transversely oriented, the liposuction cannula can potentially injure these nerves or denervate their corresponding dermatomes, leading to a transient or permanent anesthesia over the medial arm . It is also worth noting that although the aesthetic outcome can be more favorable with the minibrachioplasty in the appropriate patient population, the surgeon is more limited in the contouring of the excess skin than with a traditional brachioplasty.
The plastic surgeon will be challenged to effectively manage excess skin from weight loss. Placing the incisions more posteriorly on the arm will help avoid morbidity associated with injury to these nerves, while still providing an acceptable aesthetic outcome. Knowledge of the anatomy of the course of the medial brachial cutaneous nerve can help the surgeon better plan his or her operative approach to maximize aesthetic benefit and limit nerve injury.