Colloquially known as bat wing or tuck shop lady arms, excess arm tissue and its treatment is becoming more openly confronted. Brachioplasty, or arm reduction, is less often discussed than some of the more glamorous and media-friendly plastic surgical procedures. However, in the appropriate patient who has bothersome excess skin in the arm region after massive weight loss, it can deliver tremendous joy and life-changing benefits. The arm is one of the regions of the body where the skin seem to lack sufficient elasticity to “bounce” back to its pre-expanded state. That is, the fat may have gone with the weight loss, but the skin remain stretched. It seems a great shame that after all the effort has been made to loose so much weight that one is still not liberated to wear desirable short sleeve or sleeveless tops due to the embarrassment or physical limitations caused by the excess skin.

It is important to understand who an appropriate candidate for a brachioplasty is. Of course, every patient needs to be properly assessed for their suitability, but in general, a brachioplasty will get the best result in patients who have a lot of loose skin and NOT a great deal of excess fat in their arms. Ideally, the arms should be “deflated”. If the arms still have significant fat content, then liposuction may need to be performed prior to brachioplasty so as to “deflate” them. Another seemingly obvious consideration in brachioplasty is the inevitable scar. The scar from this procedure will extend from around the elbow region, up onto the axilla, and frequently onto the lateral chest region. Appropriate scar management must be followed in order to produce the best scar possible, and most brachioplasty scars will fade over time. Scarring can vary from individual to individual however, and can be influenced by various factors such as genetics and wound healing. One must accept that scarring is a trade off for removal of loose skin.

With the rising popularity of bariatric (weight loss) surgery, attention needs to be placed beyond loosing the kilos. With massive weight loss comes extreme amounts of loose skin, and this “deformity” can at times cause as much if not more distress for the patient than been overweight. The process of massive weight loss is only half complete after the weight has been shed. Beyond this, consideration needs to be given to reshaping and restoring the contour of the body, one step at a time.