Hand swelling freaking me out! Had extended brachioplasty with BABL on December 2, 2014.....so it's been 8 days..early days yet.

Question

I was in tight arm garments until today. Now in a bra with sleeves garment but it is not tight on the upper arms...comfortable. The swelling in my forearms and hands has been severe. Not in alot of pain and generally feeling good and opitmistic. Could this be due to any nerve damage? I'm trying not to scare myself too much and am thinking I had a big procedure done and just need time to heal...this is a side effect of my healing process...2 to 3 month mark I should not be swollen like this.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your inquiry about managing swelling after an extended arm lift (brachioplasty). Swelling is indeed a typical and expected outcome following such a procedure. It's common to experience swelling in the hand, wrist, forearm, and upper arm after an arm lift, arm reduction, or brachioplasty.
In the initial phase post-surgery, it's crucial to keep your hands elevated and apply some form of compression. Most plastic surgeons recommend compressing the hand, wrist, forearm, and upper arm after the surgery. Mild ace bandages are often used for this purpose, as they provide adequate compression without being overly restrictive. Arm garments, while useful, can be too tight and challenging to manage immediately following an arm procedure.
Generally, after the initial 10 to 14 days, once the swelling has begun to subside, you might be advised to switch to an arm garment for continued support and compression.
Concerning severe swelling in the forearms, it's important to note that this is unlikely to be a result of nerve damage. Nerve damage typically manifests as numbness, loss of sensation, or functional impairment, rather than swelling. Swelling should be addressed with elevation, compression, and possibly lymphatic massage.
Additionally, nerve damage is quite rare when an experienced, board-certified plastic surgeon performs the surgery. It's always best to follow up with your surgeon for personalized advice and to address any concerns you might have during your recovery process.
I hope this response has provided clarity on how to manage swelling after an extended arm lift and reassured you about the likelihood of nerve damage. Wishing you a smooth recovery.
Good luck.
Dr. Katzen

Stephen M. Davis, MD, FACS · Answer

Sorry that you are having swelling. I doubt this has anything to do with nerve damage. You would be served best by: 1) discussing this with your plastic surgeon, I am certain he / she will be happy to help you understand what is going on, 2) elevate you hand forearms and arms as much as possible, gravity works,. Use pillow while sleeping or watching TV etc. you need to be anti-gravitational, let the fluid drain from your upper extremities.Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Chad Robbins, MD · Answer

Since you are just a little over a week post op and you just took off your compression garments , this can be what's causing this.  What type of activity are you doing at this point? If your arms aren't elevated it will make it worse.  I would put a couple pillows under each arm above your heart, as much as possible. I would also follow up with your Plastic Surgeon for re-assurance.

Jason M. Petrungaro, MD, FACS · Answer

You are describing symptoms that can be common after an arm lift.  I cannot diagnose or treat you over the internet, so the best thing for you is to go see your Plastic Surgeon to let them evaluate you.That being said, nerve damage would not really cause your swelling.  The most common nerve to be injured in an arm lift would cause numbness on the inside of your forearm.Postoperative swelling is most often due to tight compression garments on the upper arms and then looser garments (and often times no garments at all) on the forearms and hands.  Body fluid needs to get back to your heart by traveling up your arms, so if there is a tight compression on the upper arms the fluid will tend to stay where it is in the lower arms because it "backs up".Arm elevation above the level of your heart is a good start.  And using a compression garment that has equal pressure from the shoulder to the hands will help as well.  I typically wrap my postoperative arm lifts with ACE bandages making sure to place equal pressure from the shoulder to the hand up to your knuckles.  Yes, your swelling should resolve, especially since you are only 8 days out from your surgery.  But again, you need to make sure your Plastic Surgeon is aware that this is happening so he or she can officially tell you what to do.  Best of luck!

Tom J. Pousti, MD · Answer

I am sorry to hear about the concerns you have after arm lifting surgery. Unfortunately, nothing will replace in-person evaluation (by your plastic surgeon) to provide you with real meaningful advice. Generally speaking, the most common cause of this degree of swelling, after arm lifting surgery, would be the use of “tight arm garments” that you just had removed. I am glad that your current garment is more comfortable for you. I would suggest arm/hand elevation,  with 2 pillows on each side, above the level of the heart. You should see gradual resolution of the hand swelling. Again, follow up with your plastic surgeon for the most accurate assessment, advice, and (probably) reassurance. Best wishes for an outcome that you will be very pleased with long-term.

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