Body-Contouring des Arm-Thorax-Bereichs und Oberarmstraffung

Massive weight loss patients suffer severe arm deformity, extending through the axilla and onto the chest. We found current operations inad- equate, often with conspicuous scars. The L bra- chioplasty was evolved to treat the entire de- formity through the excision of two right angle unequal ellipses, leaving natural contours and an unobtrusive L-shaped scar. The upper body de- formity consists of loose upper arm skin, over- sized axilla, descent of the posterior axillary fold, flattening and elongation of the anterior axillary fold, and lateral chest rolls of skin. By tissue gath- ering and pinching, a hemi-ellipse is drawn over the lower half of the inner arm, sweeping up to the deltopectoral groove. Then a shorter ellipse is extended through the axilla onto the chest. These ellipses are connected by an inverted V-re- section through the axilla. After skin resection the wound margins are closed with a triangular flap advancement of the posterior axillary fold. The result is a properly contoured reduced arm, axilla, and lateral chest with a sweeping inverted L-scar coursing upward along the lower medial arm to cross the dome of the axilla and then drop vertically along the mid lateral chest. Over the past four years more than fifty weight loss pa- tients have been treated with aesthetic reshaping of the upper arm leaving inconspicuous scars and only minor complications. There have been 8 scar revisions, including two Z-plasties for contrac- ture. The rationale and results compare favorably with contemporary techniques. L-brachioplasty is our procedure of choice for the massive weight loss patient and can be selectively applied to the aging arm.