Arm Contouring in Patients With Massive Weight Loss: A Literature Review.

Background: A wide variety of brachioplasty approaches and modifications have been described to make the procedure safer and more appealing to patients and surgeons alike. There is, however, no consensus on the most appropriate surgical approach. The current report aimed at identifying the technique that yields optimal aesthetic outcomes and scar quality associated with highest patient satisfaction and lowest scar visibility and complication rates, in the growing population of patients with massive weight loss. Methods: A PICO PubMed, Embase, and Web of Science literature search was conducted to identify clinical cohort studies published since 1974 about post-bariatric patients undergoing brachioplasty. Results: Fifteen studies satisfied the inclusion criteria and were retrieved for review. Two main methods for excess skin and fat removal, en bloc sharp excision or liposuction-assisted brachioplasty, and 2 final scar placements, medial and posteromedial, with some variations, together with various axillary scars, have been reported. Higher overall complication rate was associated with excisional brachioplasty. Two main scar placements have also been reported: primarily medial, with various extensions to excise additional tissues in the axilla or the elbow region, and posteromedial. Conclusions: Each described technique has advantages and disadvantages. Although quantitative analysis was not possible to conduct, it seems logical that combining advantages of liposuction-assisted brachioplasty with reduced posteromedial scar visibility, in addition to a stepwise "cut-as-you-go" approach, would be most favored, allowing safe procedure execution with optimal aesthetic outcomes and lowest complication rates.