Forearm swelling 6 weeks post-op Brachiolasty. Any suggestions?

Question

I had a bilateral armlift 6 weeks ago out of state. At 3 week postop visit I showed Doc some swelling & tenderness just below inner side of right elbow. He said it was normal, massage from wrist up, keep arms elevated & wear comp garment another week. The CG I got from Doc came 1.5-2" below elbows. I quit wearing CG 4 weeks postop & swelling improved. A couple days ago I noticed swelling in right wrist & forearm. I also noticed a lump below rt elbow & it's a little hard & tender. Suggestions?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding forearm swelling after an arm lift / arm reduction / brachioplasty. After an arm lift, forearm and arm swelling is common; in fact, after a brachioplasty, upper arm swelling is expected. Upper and lower arm swelling can continue for 10 to 12 weeks after an arm lift / arm reduction / brachioplasty.  When I perform a brachioplasty, initially, I have my patients use an ACE bandages from the axilla to the fingers. When the upper arm incision has healed, then I have my patients wear a compression garment from the axilla to the mid forearm. If the foreman and hands are still swollen,  I have my patients wear  an ACE bandage over their hands and forearms, in addition to the upper arm compression garment. If upper arm, forearm, or hand swelling occurs,  I suggest arm elevation. If the swelling continues, I would suggest compression of the areas that are swollen. If your hands are swollen, you will need hand compression, like a glove.  If there is wrist swelling, you will need wrist compression.  Do not only compress the upper arms if the hands and wrists are swollen. Isolated upper arm compression will only aggravate matters and lead to further swelling in the hands. If the swelling is persistent for more than two weeks, you should follow up with your plastic surgeon.The lump below your right elbow is concerning. Without pictures, physical examination, and a thorough history, this sounds to me like a seroma. A seroma is not uncommon after an arm lift / arm reduction / brachioplasty.  A seroma is pocket of serous fluid. This pocket of serous fluid can usually be aspirated in the office with a small needle. Usually, the seromas disappear after two or three aspirations.  If this seroma does not disappear after several aspirations, the seroma may require surgical removal. This is a relatively simple outpatient procedure and can be done under local anesthetic. I hope this answers your question regarding arm lifts, arm reductions, brachioplasties, post-operative arm swelling, seroma, and seroma treatment.    Good luck! If you have any more questions regarding your arm lift, please contact my office. Sincerely, Dr. Katzen.

Charles Galanis, MD · Answer

Thanks for your questions.  Obviously first and foremost, make sure to relay your concerns with your plastic surgeon.  I recognize he/she may be far away but photos or video conferencing (Skype, FaceTime, etc) are options to help provide your surgeon with the best information to help you move forward.  This surgeon may also be able to direct you to a local follow-up option if necessary.As far as swelling below the elbow, it is not uncommon especially if the compression garments you had been wearing only went as far as the elbow.  This surgery can disrupt your arm's normal lymphatic channels.  The purpose of the lymphatic system is to collect fluid in the tissue and return it to the circulation.  When that system is disrupted, fluid can accumulate in affected areas.  Compression, elevation, and percutaneous drainage are all different methods of addressing this problem.  It can often be effectively managed with this and other techniques.  It is important to monitor for any infection as well which would be a concern if the areas was red, hot, and tender. Hope this helps and good luck!

Richard H. Tholen, MD, FACS · Answer

Compression that does not extend to the wrist can act as a sort of tourniquet, limiting drainage of blood or serum collections near the elbows. This could require better compression, aspiration via needle, or surgical treatment if allowed to go untreated. Please schedule an appointment with your surgeon. I know out of state surgery presents a problem (travel and additional time off), especially if s/he ends up saying everything is OK, but I'd start with a phone call and Facetime or Skype, or possibly digital photos and email if personal examination is out of the question. Best wishes! Dr. Tholen

Christian A. Prada, MD, FACS · Answer

i would suggest you see your PS again with your questions. Often with compression sleeves the forearm and hands swell because they don't drain as well with the compression at the elbow. Sometimes patients do develop seromas or fluid collections that cause swelling and tenderness. These can be drained with a needle in the office. Keep an eye out for redness, fever, etc.

Harry T. Haramis, MD, FACS · Answer

Swelling around the elbow is very common- keeping them elevated puts the elbow at a low point so it can stay swollen longer.  Especially with compression not going all the way to the wrist.  Firm spots are also common and part of the temporary healing process which can take upto 6-12 months.Warm gentle massage and time willhelp.  Close follow up with your plastic surgeon is recommended.

Forearm swelling 6 weeks post-op Brachiolasty. Any suggestions?

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Forearm swelling 6 weeks post-op Brachiolasty. Any suggestions?

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