title: The L brachioplasty: an innovative approach to correct excess tissue of the upper arm, axilla, and lateral chest.
abstract: BACKGROUND
  Brachioplasty is aesthetic reshaping of the upper arm after removal of excess medial skin and fat. Massive weight loss patients evolve a severe arm deformity that extends through the axilla and onto the chest. Prevalent operations are incomplete and leave conspicuous scars along the bicipital groove that end as Ts or Zs in the axilla. The L brachioplasty starts with a long ellipse centered over the lower half of the inner arm that sweeps up to the deltopectoral groove. A shorter ellipse is connected at right angles through the axilla onto the chest. The V flap formed between the ellipses is advanced across the axilla to raise the posterior axillary fold. An improved arm, axilla, and chest have an L-shaped zigzag crossing the axilla.
  
  
  METHODS
  L brachioplasty, along with upper body lifting, was applied to 24 female weight loss patients over the last 2 years. Ultrasound-assisted lipoplasty was also performed in five patients. All patients were interviewed. Follow-up ranged from 6 to 28 months.
  
  
  RESULTS
  All 22 patients were improved and pleased. One patient requested and received a limited scar revision. Three patients had delayed healing at the tip of the triangular flap. Four seromas near the elbow responded to multiple aspirations. One hypertrophic scar was improved with intense pulsed light.
  
  
  CONCLUSIONS
  The L-shaped brachioplasty is an innovative, effective, reliable, aesthetic, and safe technique. Integrating the brachioplasty into the upper body lift improves the contours of the axilla, breast, and upper lateral chest, contributing to improved harmonious body contour.
authors.affiliation: Department of Surgery (Plastic), University of Pittsburgh Medical Center, Pittsburgh, PA, USA. drhurwitz@hurwitzcenter.com
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hurwitz
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Holland
mesh_terms: D001132:Arm / Q000601:surgery*; D001365:Axilla / Q000601:surgery*; D050110:Bariatric Surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D013909:Thorax; D015431:Weight Loss