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Monday, June 07, 2010

Can You Fly With Those Wings?

Bat Wings After Massive Weight LossBy Kaye Bailey

That hanging flapping upper arm of the song leader in the second grade was a great source of jokes for many of us as children. But after massive weight loss when we look in the mirror only to see our own arm flap waving back at us it is no laughing matter. A surgical procedure called brachioplasty may be the solution to correct what surgeons politely call "skin redundancy and laxity" following massive weight loss.

Recently, as thousands of people are losing significant amounts of weight with bariatric weight loss surgery, we are hearing more about bat wings and the reconstructive surgery many are turning to for skin removal and arm contouring. Bat wings might be fine if they could help us fly, but excess upper arm skin is a nuisance and embarrassment. While in most cases, post-bariatric patients undergo brachioplasty for cosmetic reasons, there are functional complaints resulting from the deflated flap of skin left behind by weight loss. Patients report rashes, skin breakdown, pain from skin pinching, and difficulty in finding clothing to fit the smaller torso while accommodating excessive arm girth. Patients also report embarrassment over the waving arm flap saying they preferred the more common embarrassment of morbid obesity to the stare-getting physical deformity of flapping bat wings.

Ideally a bariatric patient will have achieved weight loss and be maintaining a healthy weight in the Body Mass Index (BMI) "normal" range of 18.5 to 24.9 before seeking surgical treatment for bat wings. The skin should be deflated with very little subcutaneous fat remaining. The medical comorbidities common before bariatric surgery should be in remission such as diabetes, sleep apnea, cardiac disease and asthma and nutritional status should be favorable. In addition, before brachioplasty surgery is scheduled the patient must clearly understand the outcomes of the surgery.

Brachioplasty effectively removes excess skin following massive weight loss, however it unavoidably leaves a perceptible scar on the underside of the arm from armpit to elbow. Patients must understand they are trading unsightly excess skin for what some may consider an unsightly surgical scar. According to Dr. Michele A. Shermak, FACS, of Johns Hopkins School of Medicine in Maryland, "There are no effective scarless or minimally invasive techniques that can adequately reduce the skin laxity and excess associated with massive weight loss. Neither liposuction nor laser or light-based tightening therapies typically apply to the post-bariatric upper extremity."

The most commonly performed procedure is traditional brachoplasty in which a "T" incision spans from the armpit to the elbow. Skin is removed and the remaining skin is smoothed and closed with surgical sutures. A drain is placed in each arm and is typically removed after one week. Postoperatively the patient should be followed for wound and scar management. Brachioplasty may be performed as an outpatient, stand-alone procedure. However, it is often included with other procedures for excess skin management following massive weight loss, such as a lower body lift.

As with all surgical procedures there are risks. With brachioplasty the arm is prone to having more issues with wound healing due to the extreme need for mobility, leading to stress and shear forces. Other complications associated with brachioplasty may include discomfort, bleeding, postoperative relaxation of the skin leading to re-currrent laxity. Due to the risks of brachioplasty surgery and the overall complexity of the arm, it is critical to have the surgery performed by a board-certified plastic surgeon who is familiar with the anatomy, surgical procedure, and postoperative management.

Kaye Bailey 2010 - All Rights Reserved

Article Source: Can You Fly With Those Wings? Bat Wings After Massive Weight Loss

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