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INTRODUCTION

Cosmetic surgery of the upper arm, brachioplasty, has become one of the most common surgical procedures done today. According to the American Society of Plastic Surgeons statistical data, 338 upper arm lifts were done in 2000 and 14,059 upper arm lifts were done in 2008, an increase of 4059%. Although many variations of the procedure exist, the term generally implies the surgical resection of the skin and fat of the upper arm to improve the aesthetic contour of the upper arm. The surgical rejuvenation of the arm is a subject of much debate, which is why numerous procedures and combinations of procedures have been described. Brachioplasty was first introduced in 1954 by Correa-Iturraspe et al and since then has undergone a series of modifications, such as Z-plasties, W-plasties, curving S-incisions, and quadrangular flaps, to improve the appearance of the scar. The goal of any brachioplasty procedure is to approach the ideal, youthful, feminine arm which is lean and tapers smoothly from the axilla to the elbow. Glanz and Gonzalez-Ulloa used the coefficient of Hoyer to quantify the goals of brachioplasty more objectively. They state that the ratio of the distance from the top of the arm to the bottom of the humerus and from the bottom of the humerus to lower arm is 1:1 in a young girl and increases to 1:2.2 by age 70. The goal of surgery is to reapproach the 1:1 distance. Brachioplasty surgery has been plagued by large, often unacceptable, scars to obtain significant improvements in arm contour. Recent advances in brachioplasty surgery include more limited incision approaches combined with aggressive liposuction, which has been successful in some patients.

ANATOMY

A detailed knowledge of the anatomy of the upper arm is a prerequisite for a safe procedure. The entire operation is performed in the skin and deep subcutaneous layer superficial to the deep investing fascia of the arm. Surgeons should be aware of the anatomy of the upper extremity nerves, including the intercostobrachial, medial brachial cutaneous, and medial antebrachial cutaneous sensory nerves. The basilic vein accompanies the antebrachial cutaneous nerves as it emerges through the deep fascia in the lower half of the upper arm. The cephalic vein is generally much more radial and runs superficial to the deep fascia of the arm and should be out of the operative field. The brachial artery and nerve trunks of the brachial plexus are deep to the investing fascia and thus should not be encountered. The lymphatics are concentrated superficial to the investing fascia along the course of the basilic vein.

PATIENT EVALUATION & SELECTION

Women make up 98% of all brachioplasties in 2008 with the majority between the ages of 30 and 50 years old. Only 2% of all brachioplasties done in 2008 were on men. In general, there are two categories of patients who seek brachioplasty surgery: patients with a moderate amount of ptotic ...

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