Dear ranamoharam, Firstly, congratulations on your significant weight loss and your journey towards improved health and body contour. When it comes to resuming exercise after a brachioplasty, it's crucial to proceed with caution to ensure optimal healing and prevent any complications. Given that you're four weeks post-op and your surgeon has given the go-ahead to resume exercise with caution, here are some general guidelines: Begin with Gentle Stretches: Start with gentle arm and shoulder stretches to regain flexibility. Perform basic wrist rotations, elbow flexion-extension, and gentle shoulder rolls. Isometric Exercises: Before moving to dynamic exercises, consider isometric exercises where you contract the muscle without moving the joint. For example, press your palms together in front of your chest and hold. Progress to Resistance: After you're comfortable with stretching and isometric exercises, consider using light resistance bands or weights. Begin with low weights and higher repetitions to build endurance. Aerobic Exercise: Activities like walking or cycling can be resumed early on as they don't directly stress the surgical site. Avoid Overhead Activities: Initially, avoid exercises that require lifting your arms overhead or placing undue strain on the incisions, such as pull-ups or overhead presses. Monitor Your Axilla Wound: Given that you mentioned a small opening in your right axilla (armpit area), be especially cautious with exercises that stretch or stress that area. It's essential to ensure that the wound heals completely. Listen to Your Body: It's crucial to pay close attention to how your arms feel during and after exercise. Any pain, increased swelling, or unusual sensations should be taken as a sign to rest and possibly consult with your surgeon. Regular Check-ins with Your Surgeon: Schedule regular follow-ups with your surgeon. They can monitor your progress, ensure you're healing well, and provide more personalized exercise recommendations. Remember, the goal post-surgery is not only to achieve the desired aesthetic result but also to maintain and improve overall arm strength and function. Taking a gradual approach and prioritizing safety over speed will yield the best long-term outcomes. Best wishes on your continued recovery and fitness journey. Sincerely, Dr. Katzen