Could the lymphatic system as a whole be disrupted during a brachioplasty?

Question

I’m aware that lymph nodes should not disrupted during a brachioplasty, but what about the lymphatic system in a whole? I keep reading stories of women contracting cellulitis years after their surgery and it being contributed to the lymphatic system being distrusted?

Richard Nadal, MD, FACS · Answer

Hi and welcome to our forum!
The lymphatic system exists throughout the human body, draining interstitial fluid from the tissues back into the bloodstream. While radical mastectomy with axillary node dissection has been associated with the development of chronic lymphedema of the arm, the brachioplasty procedure does not significantly interfere with the lymphatic system and should not be affected. 
You note "lymphatic system as a whole"...Disruption of a major lymphatic trunk will only affect the area served by the involved lymphatic vessels, not the system as a whole.
Best wishes...

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether the entire lymphatic system can be disrupted during a brachioplasty. No, the entire lymphatic system is not disrupted during a brachioplasty. During a brachioplasty, typically arm liposuction is performed from the armpit to the elbow. Additionally, during a brachioplasty, an incision is made from the armpit to the elbow and excess skin and fat is removed. Very occasionally, lymph nodes are removed; they are usually at a deeper level. So, the lymphatic system is not significantly disrupted, and the entire lymphatic system is certainly not disturbed. The odds of you contracting cellulitis years after surgery are probably not connected to the brachioplasty. When considering an arm lift surgery, please seek an experienced board-certified plastic surgeon who has performed hundreds of arm lift surgeries. Look for a plastic surgeon who has at least 100 before and after pictures on their website. I hope this helps answer your question regarding whether the entire lymphatic system can be disrupted during a brachioplasty.

Sincerely,
Dr. Katzen

Sincerely,
Dr. Katzen

Kenneth Hughes, MD · Answer

It can take weeks or months for your immune system to bounce back completely after major surgery. The reason for this is not fully understood but you become more prone to infections that can affect any area of the body, such as the sinuses, throat, mouth, lungs, skin, and urinary tract. Several factors are known to contribute to immunodepression. Surgical stress and drugs that are used for anesthesia and analgesia can impact immune response.  I know of no evidence based medicine studies documenting cellulitis as a result of a brachioplasty.Swelling after an armlift can last up to six months or even a year.  Induration and hardness are components of the normal healing process.  If there is anything suggestive of a fluid collection, hematoma, infection, or blood clot, follow up with your PS.

Richard J. Restifo, MD · Answer

The brachioplasty will often come close to the lymphatics so care must be exercised to avoid damaging them. Lymphedema after brachioplasty is a very rare complication, and in my experience cellutlis is very rare also.These are good questions to bring up with your plastic surgeon; ask him or her what the plan is to avoid disruption of the lymph system. Best wishes.

Francis Johns, MD · Answer

Thank you for your question.With any surgery there can be disruption to the lymphatic system. Over time and as your body heals, the lymphatic system will repair itself. I would suggest an in person consultation for evaluation to make sure you feel comfortable with your surgeon and discuss all of your concerns up front. Good luck.

Donovan Rosas, MD · Answer

Temporary disruption of the localized lymphatics in an area treated by liposuction is not uncommon. However, over time, as one heals, proper lymphatic drainage is typically restored.It is highly uncommon to develop permanent lymphedema in the post brachioplasty setting. That being said, patients with pre-operative issue or prior axillary node disssection/sampling should avoid brachioplasty as they are elevated risk.As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
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David Nguyen, MD · Answer

Hi BandRevisionWanted96,
The superficial lymphatic system will be partly disrupted during an arm lift, but that it only in the area that is being removed. It should be fully intact deeper in the arm and in the other untouched superficial areas. Each case that you read probably needs to be examined in detail, so I can't comment on them much more unfortunately. Blessings on your journey!

Matthew A. DelMauro, MD, FACS · Answer

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) As with any surgery, temporary disruption of the lymphatics should be expected. However, as you heal, the lymphatics should regrow. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!Matthew A. DelMauro, M.D.

Stephen M. Davis, MD, FACS · Answer

Thanks for writing,There can be some degree of disruption but in my experience this, if at all, is temporary. Relative to the cellulitis, I have yet to see this after operating for over 20 years, Good luckStephen M. Davis, MD, FACS
Certified: American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery
Member: American Society of Plastic Surgeons
Member: RealSelf Hall of Fame
VERIFIED: Plastic Surgeon

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Could the lymphatic system as a whole be disrupted during a brachioplasty?

Answers (9)

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