Brachioplasty

Anesthesia Implications

Position: Supine, arms extended
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Approach – GLMA. An ETT may be needed if the procedure is combined with other plastic procedures that require position changes.

IV access – Avoid antecubital IVs. These placements will be too close to the surgical site. Typically hand placement is best.

Surgical Preparation – Generally, plastic surgeries such as these will recommended to quit smoking for a minimum of 4 weeks and avoid taking anti-inflammatory drugs, aspirin, and herbal supplements, as they can increase the risks of postoperative complications and delay healing.

Tumescent (general considerations): Maximum safe dosages of tumescent lidocaine are 28 mg/kg without liposuction and 45 mg/kg with liposuction. Peak serum concentrations typically occur 13–14 hours. This long peak implies that Local Anesthetic Toxicity (LAST), which is the primary concern of tumescent, could occur well after the procedure. Lipid emulsion therapy should be readily available. Tumescent solution also contains epinephrine and sodium bicarbonate. Epinephrine is a vasoconstrictor and delays the systemic absorption of the lidocaine. Epinephrine in high doses can cause hypertension, tachycardia, and arrhythmias. Sodium bicarbonate serves a few purposes: It buffers the solution, reducing the level of pain on injection, and also reduces the onset time of lidocaine.

Patients who undergo this procedure often have had gastric bypass surgery and experienced significant weight loss. Other reasons for the procedure include post-pregnancy changes and the effects of aging. It’s especially common in those who have shed over 150 pounds.

This surgery is typically performed for patients who notice a bat-wing appearance of their upper arms. It reshapes the upper arm from the back of the arm to the elbow and improves the contour of the upper arm/axilla. Depending on the presence of fatty tissue, the surgeon may use liposuction as well to eliminate any excess fat. Tumescent technique will be used to suction out the fat through the incisions.

A long incision will be made and only the superficial fat will be resected to preserve the medial brachial cutaneous and medial antebrachial cutaneous nerves. A minimally invasive brachioplasty, with an incision limited to the axilla, can be performed if the patient has skin ptosis of less than 12 cm.

The incisions will then be brought together and a sterile dressing and compression garment will be applied.