What is the BEST placement for my brachioplasty incision?

Question

My surgeon believes there are less complications with a posterior incision. I am really worried about scarring. Would love to hear your comments on scarring and this type of approach.

J. Timothy Katzen, MD, FACS · Answer

Dear ThinIn13,

When it comes to brachioplasty, the placement of the incision is indeed crucial, both for achieving optimal aesthetic results and for ensuring a smooth recovery with minimal complications.

From an aesthetic standpoint, I personally prefer the incision on the inseam of the arm. This placement helps in avoiding a highly visible scar, especially when the arms are by the side or during most common daily activities. The inseam location typically offers a more concealed scar, which can be a priority for many patients.

Your surgeon's preference for a posterior incision might be based on their experience or specific technical considerations. It's true that every incision placement has its own set of advantages and potential challenges. The posterior placement might offer certain benefits in terms of skin tightening or reduced complications in some cases.

It's essential to have an open dialogue with your surgeon. Discuss your concerns about scarring and understand the rationale behind their preferred approach. Express your preference for an incision on the inseam, and together you can weigh the pros and cons of each approach to determine the best course of action for your specific needs and desires.

Remember, the goal is to achieve a result that not only improves arm contour but also ensures that you're comfortable and confident with the appearance of the scars.

Best wishes for a successful procedure and a satisfying outcome.

Sincerely,
Dr. Katzen

Kenneth Hughes, MD · Answer

Most of the time I will use the inner arm placement.  I would have to examine you to make this determination.Kenneth Hughes, MDLos Angeles, CA............

Thomas Fiala, MD, FACS, FRCSC · Answer

Having used both approaches, I now prefer the posterior approach (straight down the back of the arm).  I think the scarring is actually better than the traditional anterior approach.  If the patient has lateral chest skin excess as well, that can be easily tailored, just by extending the incision.  The chance of nerve injury is less.  You typically don't need to do a Z-plasty at the axilla.  The pre-operative marking is accurate, and straightforward.  The scar doesn't show when the patient waves at people.I would strongly disagree with the previous comment about "all experienced surgeons put the scar in the crease... ."  Dr. Al Aly wrote the textbook on body lifting after massive weight loss.  Where does he put the scar?  Posteriorly.The mini-lift, which is hidden in the armpit, is only suitable for patients with very small amounts of skin excess in the upper arm.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Typically for our lives the incision is placed on the inner aspect of the arm. It runs from your armpit just short of your elbow in most cases. Post your score candy place but it is obviously very noticeable. Her goal is to improve contour with the least visibility of the incision as possible

Jon S. Wilensky, MD · Answer

The placement of brachioplasty incisions depends on factors such as skin laxity and individual anatomy. Common placements include the inner arm or along the back of the arm. Consult with a skilled plastic surgeon to determine the best option for your specific case.

Patricia Yugueros, MD · Answer

The incision depends on the amount of skin that needs to be removed, but the medial aspect of the upper arms and the armpit area can hide the scars really well. If the amount of skin is not to large you may get away with laser liposuction which helps with collagen production and skin tightening.

Richard Bloom, MBBS (Hons), FRACS · Answer

Hi there,I tend to place the scar between the inner aspect of the arm and the very back of the arm. If you can imagine your right arm as clock face with 3 o'clock being the inner arm and 6 o'clock being the back of the arm, then I aim to place the scar between 4 and 6 o'clock.Some surgeons argue that placing the scar closer to 6 o'clock reduces the risk of injuring a sensory nerve, however I have never had that as a problem.Placing the scar slightly on the inner aspect tends to hide the scar as much as possible. If its too far forward or too far back than it can be seen more often I think.Truth is it is impossible to completely control scar position and you need to be prepared to deal with a scar regardless of exactly where it ends up.Generally the scar is tolerated pretty well and depending on the degree of sag, most patients ultimately will happily trade their loose skin for a scar, even if it is visible.Best wishesRichard

Charles A. Wallace, MD · Answer

Exact positioning of the scar can very from patient to patient, but I prefer to hide the incision inthe axillary (armpit) area, leaving no unsightly scar running from armpit to elbow.  My brachioplastypatients are thrilled with this method.

Samir Shureih, MD · Answer

Never seen a posterior incision for brachioplasty. The right placement of incision for a brachioplasty is on the inner aspect of the arm and in the arm pit. Make sure your surgeon is a Board Certified Plastic Surgeon (American Board of Plastic Surgery) and not a wannabe plastic surgeon.

C. Bob Basu, MD, MPH, FACS · Answer

A brachioplasty is essentially an upper arm lift. In this procedure, the excess hanging skin and fat in the upper arm is removed. Its the procedure used to correct the common "bat wing" of skin that manifests in patients who have lost a significant amount of weight.  I preference to place the scar along the posterior shadow line of the arm.  But remember, this proedure needs a scar to achieve better form.  I recommend Embrace 2-3 weeks after your procedure for scar management.

What is the BEST placement for my brachioplasty incision?

Answers (12)

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