110 lb. weight loss - What type of surgery can make my arms thinner and remove the fat between my armpits and breasts? (Photo)

Question

Lost about 110 pounds during the last 5 years and been weight lifting for the last 10 months. My arms are stretched and no matter how much I heavy lift, I don’t see any improvement. I’m 43 y/o women who have struggled with overweight for as long as I remember, had gastric sleeve in 2020 hit plateau and been in Mounjaro for about a year. My main concern are my arms that are big , also the fat accumulation between my breasts and armpit, as well as the extra skin I can pull from the back of my armpit. Is there surgery that can correct those areas? also I noticed a fat pad right above my elbow when standing straight. Can this procedure be done under sedation instead or GA? Age 43, Height 5.5, Weight 145. Sex Female.

J. Timothy Katzen, MD, FACS · Answer

HI Prc82, Thank you for your question regarding what type of surgery can make my arms thinner and remove the fat between my armpits and breasts.  Thank you for your history and your pictures.  Congratulations on your weight loss; great job.  First, we should analyze your pictures to determine the best arm procedure and how to remove the excess skin and fat between your armpits and breasts.
You have moderate lipodystrophy (excess fat) from the axillae (armpit) to the elbow.  You have moderate cutis pleonasmus (excess skin) and dermatocholosis (loose skin) from the axillae (armpit) to the elbow.  You have mild lipodystrophy (excess fat) from the armpits to the lateral breasts.  You have mild cutis pleonasmus (excess skin) and dermatocholosis (loose skin) from the armpits to the lateral breasts.  
To treat your arms, you best results would be achieved with an arm lift or arm reduction.  The medical term for an arm lift or arm reduction is a brachioplasty.  The reason you need a brachioplasty is because of your weight loss history of 110 pounds, physical appearance in photos, and your age of 43.  No matter how much you lift, exercise, or diet, your triceps skin will not recoil.  Arm liposuction only addresses the excess arm fat and does not remove excess arm skin; therefore your need a brachioplasty which removes arm skin and fat.  There are several types of arm lifts.  You would do best with a longitudinal brachioplasty.  During a longitudinal brachioplasty, arm liposuction is performed from the arm pit to the elbow.  Then, an incision is made in between the biceps and the triceps.  The reason the scar is placed in this groove, is that the brachioplasty scar is somewhat hidden when your arms are held at your sides.  Tissue dissection is carried to the back of your arms.  Excess arm skin and fat are removed. The arm skin is redrapped over your arms.  Usually, drains are not required. Arm lift are best performed under general anesthesia and take about 3 to 4 hours to complete.  Allow yourself a 2 week recovery.  You will need to wear your compression garment for about 6 weeks.  
In regards on how to remove the excess skin and fat between your armpits and breasts, most plastic surgeons would recommend a vertical torsoplasty.  During a vertical torsoplasty, an incision is made from the arm pit and down the side of your chest in the mid-axillary line.  Tissue dissection is carried posteriorly towards the back.  The lateral breast skin and fat is pulled forward.  A large paddle of excess lateral breast skin and fat in the shape of a football is removed.  The vertical torsoplasty scar is in the midaxillary line and can be concealed when your arms are held at your sides.  The vertical torsoplasty is performed under general anesthesia and takes about 2 hours to complete.  Usually a drain is kept inlace for about 7 to 10 days. you will need to give yourself a 2 week recovery period.  to minimize scarring, swelling, and pain, a medical grade compression garment is recommended for at least 6 weeks.  The vertical torsoplasty is commonly performed with the longitudinal brachioplasty.  Usually, the vertical toroplasty and brachioplasty incisions connect in the axillae.  
I hope that I have answered your questions regarding the arm reduction and vertical torsoplasty. Specifically, I hope that I have answered your question regarding what type of surgery can make your arms thinner and remove the fat between my armpits and breasts. If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm crease fat grafting, contact an experienced plastic surgeon.  To get an accurate assessment of what exactly you need, schedule a free virtual consultation.  Most plastic surgeons offer free virtual consultations.
Since an arm lift and vertical torsoplasty can be a challenging surgery, please seek an experienced, board certified plastic surgeon with significant experience performing these types of lifts. Do your research.  Make sure they have performed at least 150 arm lift procedures.  Make sure they have the before-and-after  pictures to prove it.  Carefully examine their before-and-after  pictures and check their reviews on RealSelf.   Sincerely, Dr. Katzen, MD, MBA, FACS, FICS ( Plastic Surgeon , President of  the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

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

John Reilly, MD, FACS · Answer

Hello, congratulations on your weight loss and exercise program! You've achieved some great results. Unfortunately, excess skin requires a surgical procedure to remove the excess and tighten what remains. From the single photo it does not appear that you have a fat issue, it is a skin issue and is very common. You can consider researching a brachioplasty to tighten the skin of the upper arm. Two other procedures you can also look at is a upper back lift. This treats loose skin that hangs below the bra line. Either one of those two procedures can be extended onto the side of the chest to also treat some excess below the armpit. A physical exam would be required to see if one or both procedures would be necessary to give you the results you are looking for. So again, congratulations and best of luck.

Harry T. Haramis, MD, FACS · Answer

Unfortunately, arms are extremely stubborn after massive weight loss.

Brachiaplasty (arm lift with skin excision) extending into axillae and along S curve of breast if needed will address excess arm and armpit skin for better contour and balance.

Around the elbow can be addressed with liposuction at the same surgery and/or possibly extending incision- however, usually try to stay above the elbow.

An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Jacob Carlson, MD · Answer

I think the two best options for your scenario are either Longitudinal brachioplasty + Bra strap excision vs. Extended longitudinal brachioplasty
In a Longitudinal brachioplasty, excess and fatty tissue are removed from the upper arm from the elbow to about the level of the armpit. The next thing to consider is how much excess tissue there is underneath the armpit and where that excess tissue is located. If it extends around the flank to the back area, a decent might would be a Bra strap excision. In that procedure, the excess is tissue is cut out from the back, which improves the contour from the back to the area underneath the breasts. One of the downsides of that option is that is results in a horizontal scar across the back to the underside of the breasts.
An alternative option would be the Extended longitudinal brachioplasty. In the "Extended" longitudinal brachioplasty, the excess tissue is removed from the elbow to the armpit (like in the Longitudinal brachioplasty), but then incision is continued down past the armpit to remove tissue from underneath the armpit. This results in a long scar from the elbow all the way down onto the torso (vertically). The end point for the scar will depend on how much tissue needs to be removed to achieve the desired contour.

Cihan Sahin, MD · Answer

Extended arm lift surgery is better for you. But this surgery should be done under general anesthesia.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  An arm lift sounds like the right procedure for you.  It can be combined with liposuction to remove excess fat and skin and sculpt the arms to improve contours and show off all your hard work!  General anesthesia is typically recommended for your comfort and safety.  Visit with a board certified plastic surgeon near you to learn more.

110 lb. weight loss - What type of surgery can make my arms thinner and remove the fat between my armpits and breasts? (Photo)

Answers (7)

More Arm Lift Questions

WE SEND PRETTY
EMAILS

Answers (7)

More Arm Lift Questions

Armpit rolls after adding galaflex. How can this be fixed? (Photos)

Brachioplasty Following an Extended Tummy Tuck - how long should I wait?

I'm concerned with scarring - Is an arm lift the only solution for my arms? (Photos)

Mini arm lift WITH or WITHOUT lipo? (Photos)

Size 4, 133 pounds. I HATE my arms! What treatment options would be best? (Photo)

Lipo and weight loss, left with saggy, lumpy arms. How can I improve the rippling? (Photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS