Post mastectomy/ breast reconstruction, a lot of extra upper arm and armpit skin above braline- can this be addressed?

Question

Hello, I had a bilateral mastectomy with some unfortunate failed reconstructions. I am at a stable point in my journey with implants and flaps. I was thin at the time and fat was removed from my upper arms/sides for grafting to my breasts. Now though I have a lot of wrinkled/folded skin from my armpits to upper arms- my skin is very fragile and I constantly break out and it burns/hurts/bleeds.Would a crescent arm lift be possible with a future reconstruction? Any experience w/insurance coverage?

Randal Haworth, MD, FACS · Answer

Whether a crescent arm lift is possible in your case would depend on your individual circumstances and a thorough evaluation. Given the complexity of your medical history, it's crucial to consult with a board-certified plastic surgeon who has experience in post-mastectomy reconstructions and arm lift procedures.

As for insurance coverage, it varies widely based on your insurance policy, the specific procedure, and the medical necessity. Insurance coverage for cosmetic procedures can be challenging, but in some cases, procedures performed for medical reasons or to alleviate physical discomfort may be covered. It's essential to have a detailed discussion with both your plastic surgeon and your insurance provider to understand the potential coverage and the necessary documentation required to support your case.

I wish you the best of luck with your future reconstruction, and I hope you find a solution that brings you comfort and relief.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your query about managing extra upper arm and armpit skin above the bra line following mastectomy and breast reconstruction. Your concern is indeed valid and deserves careful consideration.
Initially, a thorough physical examination is crucial. Equally important is understanding the underlying cause of the skin's fragility and breakdown in that area. Factors such as previous radiation therapy, friction due to skin rubbing against the inner arm, or recurrent infections need to be evaluated to tailor an effective solution.
Generally, two surgical approaches can be considered:
Vertical Torsoplasty: This involves an incision from the armpit down the side to the top of the bra line. Given your description, this might be the most suitable option for you.
Horizontal Torsoplasty/Bra Strap Lift: This approach entails making an incision from the outer corner or lateral part of your breast, extending across your back. Some surgeons refer to this as a bra strap lift.
Insurance coverage varies based on your policy and whether the procedure is considered part of breast reconstruction. It's advisable to consult with your insurance provider to understand the specifics of your coverage.
I hope this information helps you in making an informed decision about addressing the extra skin in the upper arm and armpit area post-mastectomy and breast reconstruction.
Good luck.
Sincerely,
Dr. Katzen

Ashley Thorburn, MD · Answer

Yes, excess skin in the upper arm and armpit area, sometimes referred to as "bra bulge" or "bra roll," can be addressed through various surgical procedures. After mastectomy and breast reconstruction, it's not uncommon for individuals to experience changes in their body contour, including excess skin in the upper arm and armpit region. Here are some options for addressing this concern:1. Brachioplasty (Arm Lift):• A brachioplasty, or arm lift, is a surgical procedure designed to remove excess skin and fat from the upper arms.• During the procedure, an incision is made along the inner arm, and excess tissue is excised to improve contour and tighten the skin.• Brachioplasty can effectively address excess skin in the upper arm area, including the skin above the braline.2. Liposuction:• Liposuction can be used to remove excess fat deposits in the upper arm and armpit area.• This minimally invasive procedure involves suctioning out fat through small incisions, resulting in improved contour and reduced fullness.• Liposuction may be combined with brachioplasty or performed as a standalone procedure, depending on the individual's needs.3. Extended Breast Surgery Techniques:• Depending on the type of breast reconstruction performed, your plastic surgeon may incorporate techniques to address excess skin in the upper arm and armpit area during the reconstruction process.• Extended breast surgery techniques, such as Wise pattern mastectomy or latissimus dorsi flap reconstruction, may involve removing excess skin and tissue in the upper chest and armpit region.4. Combination Procedures:• In some cases, a combination of surgical procedures may be recommended to achieve the desired results.• Your plastic surgeon will assess your specific concerns and goals and develop a customized treatment plan that may include a combination of brachioplasty, liposuction, and other techniques.5. Consultation with a Plastic Surgeon:• If you're concerned about excess skin in the upper arm and armpit area following mastectomy and breast reconstruction, it's essential to schedule a consultation with a board-certified plastic surgeon.• During the consultation, your plastic surgeon will evaluate your individual anatomy, discuss your concerns and goals, and recommend the most appropriate treatment options to address excess skin and improve body contour.By working with a skilled and experienced plastic surgeon, you can explore options for addressing excess skin in the upper arm and armpit area to achieve a more balanced and proportionate appearance following mastectomy and breast reconstruction.

Connie Hiers, MD, FACS · Answer

An arm tuck might do well for you. Insurance does consider this cosmetic and will not cover arm tucks.  If you do not have too much skin, Renuvion, minimally invasive radiofrequency treatment might also be helpful.

Post mastectomy/ breast reconstruction, a lot of extra upper arm and armpit skin above braline- can this be addressed?

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