80 & sagging underarm after mastectomy on right breast & lymphedema therapy, recommendations? (Photo)

Question

I’m 80 yrs old. Diabetic, Now, I have sagging underarm.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding excess underarm skin and fat after a mastectomy and lymphedema therapy. I appreciate your history and the photo you provided.

From analyzing your photo, it appears you have excess skin and fat in the underarm area. The most effective and safest way to address this issue is through skin and fat removal surgery, typically performed with an incision in the armpit. This procedure allows for the precise removal of the sagging tissue and provides a smoother contour.

It is important to note that isolated liposuction of the underarm area is not recommended in your case. Liposuction is a blind technique, and the underarm contains many critical structures, including major arteries, veins, nerves, and even the lungs. Attempting to perform liposuction in this area could carry significant risks. An open surgical approach with an incision in the armpit is much safer and more effective for achieving your goals.

When considering this type of surgery, it is essential to consult with an experienced, board-certified plastic surgeon who has performed at least 200 arm lifts in their career. Be sure to request before-and-after photos to confirm their expertise and results.

Good luck, and I hope this information helps address your concerns about sagging underarm skin and fat.

Sincerely,
Dr. Katzen

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

James Knoetgen, III, MD · Answer

Thanks for sharing your situation. It sounds like you're dealing with several overlapping concerns: age-related skin laxity, post-mastectomy changes, and lymphedema-related swelling or tissue changes. Here are some tailored recommendations for your situation:
Options for Sagging Underarm ("Bat Wings")
Since you're 80 and have a history of mastectomy, lymphedema, and diabetes, it's important to focus on gentle, safe approaches — both surgical and non-surgical. Here’s a breakdown:
1. Non-Surgical Options
These might be the safest starting point, especially with diabetes and lymphedema in the picture.
Skin Tightening Treatments
•	Radiofrequency (RF) or Ultrasound Skin Tightening can help slightly tighten loose skin
•	Not as dramatic as surgery, but lower risk
•	Important to check with your doctor if you’ve had radiation or lymph node removal
Compression Sleeves (for Lymphedema Management)
•	This help support sagging skin and reduce swelling
•	You may already be familiar with these from therapy, but consider a custom-fitted sleeve to match your current arm size and needs
Physical Therapy & Gentle Exercises
•	Specific lymphatic drainage exercises can improve circulation and skin tone
•	Light arm-strengthening exercises may improve muscle tone under the sagging skin, but need to be approved by your care team
Medical-Grade Skincare
•	Products with collagen-boosting ingredients (like peptides or retinol) might help improve skin quality
•	Hydration is key, especially with diabetes, to prevent skin tears or infections
2. Surgical Options
At 80 and with diabetes, surgery is possible but higher risk, especially if you have poor circulation or healing issues. However, if your health is well-controlled, a limited arm lift could be considered.
Possible Procedures:
•	Brachioplasty (Arm Lift): Removes excess skin and fat, but you’d need a surgeon with experience handling post-mastectomy patients and lymphedema risk
•	Mini Arm Lift: Less invasive, just tightens the upper arm near the armpit
Risks to Discuss:
•	Delayed healing due to diabetes
•	Increased lymphedema risk from disrupting lymphatic flow
•	Infections
3. Combination Approach
•	Many people (especially post-mastectomy) do best with a combination of treatments — gentle skin tightening, compression, light exercises, and possibly skincare

Connie Hiers, MD, FACS · Answer

You might get benefit with liposuction to remove some excess fat and some swollen tissue. I do not recommend the arm lift because of your swelling. Please visit with a plastic surgeon to discuss your options.

Camille Cash, MD · Answer

I would begin by speaking with your surgeon about your concerns. You may see improvement with lymphatic massages if cleared by your surgeon.  Other more involved options can be discussed if that doesn't help you achieve desired results.

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