RISKS OF SURGERY

Every surgery comes with some risks 

There are risks associated with any type of surgery. While most people who undergo surgery experience no complications, there are a few cases where complications do occur. There cannot be any guarantees about the outcome. Every type of surgery should be performed to the highest standard by a qualified and experienced plastic surgeon in a safe facility.

Risk to benefit

You should weigh the risks and benefits of undergoing surgery before you make a decision. You should take the time to understand and read about each possible complication. Also, try to compare the risks to the benefits for yourself.

A process of informed consent

Your surgeon should inform you about the risks and possible complications of any surgery.

You can seek another consultation to clarify any questions. You can also take note of any concerns or issues you may have so you can share these with your surgeon.

Complications and their impact

Surgery can cause inconvenience and there is always a risk of complications. This could cause an extended recovery time and, in certain cases, may require further surgery. Sometimes complications can impact on the final cost of surgery.

Financial risks

Financial risks can be associated with any surgery. Private insurance is strongly recommended. Your surgery may be more expensive if you have additional complications.

General health risks

Your general health will impact the potential risks of surgery. While many risks associated with surgery can be predicted accurately, your overall health will have a major impact on the outcome of your procedure. Over 50s are more at risk for any surgery. Being overweight increases your risk of complications following surgery.

Other medical conditions such as high blood pressure, high cholesterol, and diabetes may increase your surgical risk. Smoking can significantly increase the risk and complications of any type of surgery.

What are the other factors?

Other factors that are not obvious can also have an impact on the outcome of your surgery. The risks are beyond anyone’s control.

SPECIFIC RISKS IN BRACHIOPLASTY

Scars 

Brachioplasty commonly results in scarring. This area is susceptible to poor scarring, even after careful surgery. These scars can become large, thick, and raised. They may not settle well with time. The scars may be visible even though they are on the inside of your arm.

You may want to undergo additional surgery to fix abnormal scars 12 months after your initial procedure.

Deformity

If more skin is removed from the central portion of the upper arms than the lower and upper part,  a “dumbbell” defect may develop. To correct this, you may need liposuction.

Change in skin sensation

After any body procedure, including Brachioplasty, your skin sensation can change or be lost. In most cases, normal skin sensation will recover after a time. It may take up to 2 years for the sensation to return. Permanent sensations such as numbness and loss of sensation may occur.

Skin irregularities

After arm reduction, you may experience depression and irregularities of the skin. Puckering can be small or permanent. Additional surgery may be necessary to correct larger or more persistent irregularities.

Asymmetry

Body surgery may not produce a symmetrical appearance. Asymmetry can be caused by factors such as the tone of your skin, fat deposits, bony prominences and muscle tone.

Seroma/Pseudobursa

Seromas, or fluid accumulations, are rare. 5 in 100 patients experience seromas. A compression dressing and repeated needle drainage will be necessary if a seroma develops. If a seroma is not recognised or drained, it may cause a pseudobursa (enclosed cyst), which will need to be treated surgically.

Inadequate lifting/Long-term effects

Limitations in skin and tissue may restrict the extent of arms reduction. Alterations in the body can also result from ageing, weight gain or loss, or pregnancy. In some cases, additional surgery may be necessary.

BEFORE YOUR OPERATION

Ensure you are organised for the first few days following your surgery

• Organise a trusted friend or relative to transport you to and from hospital

• Arrange for someone to stay with you at home for the first few days following hospital discharge

• Get help with shopping, laundry, chores around the house, pets etc.

• Organise leave from work

Your health

Anaesthesia and surgery can cause stress to your body. How well your body handles stress will determine the state of your health. You should be active, non-smoking, and have regular checkups with your GP to ensure that hypertension, diabetes, and other conditions can be managed.

Smoking

Post-operative complications can be increased by smoking. It is strongly recommended that you quit smoking 4 weeks before your surgery, and do not smoke for 4 weeks afterwards.

Talk to your GP if you need assistance with quitting smoking. Your GP can prescribe medication for you. Talk to your chemist about nicotine replacement therapies or call the national QUITLINE on 13 18 48.

Hospital

It may be beneficial to spend the night in the hospital, depending on your pain tolerance. 

You may be given fluid drips while you are in hospital. Before you are discharged from the hospital, dressings may be removed.

Fasting, fluids, food

Fasting means you can’t eat or drink anything after midnight on the night before surgery. Anaesthetic can pose a danger if you have a full stomach. This can cause your procedure to be cancelled or delayed.

Adults who fast should not eat anything solid for six hours before an operation. Up to one glass of water may be consumed per hour for up to three hours before surgery. A sign will be placed on your hospital bed that reads “fasting”, “nil by mouth” or “NBM” when you are in hospital.

Take your morning medications as usual, with a glass of water at 6am.

If you brush your teeth in the morning, spit out any water; do not swallow.

Do not take diabetic medication or insulin while fasting. 

Medications

List all medications by writing down their names, doses, and days taken. If you find this difficult, your regular doctor can help you make a list. You should also bring your medication to the hospital.

Keep taking all your regular medications until you are admitted to the hospital. Blood thinners like warfarin/coumadin should be avoided. You must stop taking these medications 5 days prior to surgery. Discuss these medications with your surgeon.

Before surgery, tablets such as aspirin, plavix and astrix must be stopped for 10 days. Your surgeon can provide advice if you are unsure about the effects of medications on your surgery.

Diabetes mellitus

Before you are admitted, you should inform your surgeon if you have diabetes. At the time of admission, you must inform the staff. If necessary, special arrangements will be made.

From the moment you begin fasting, your blood sugar levels will continue to be monitored until normal eating begins. You should not take any diabetes medication the morning before your surgery.

Skin preparation

Before your surgery, you may need to wash your body with antibacterial soap. You can also use the same soap after surgery.

A responsible person

After surgery, you will need to ensure someone responsible can accompany you home and assist you in the first few days following surgery. A responsible person is an adult who can understand and help you follow post-operative instructions.

Travel 

After your surgery, you will need to arrange for someone to drive you home. A taxi is acceptable provided you also have a responsible person with you (not just the driver). You cannot take public transport such as buses.

General exercise

You should keep your fitness up and continue with your regular activities even after your surgery. You can increase your fitness gradually if you have the time. Your overall recovery from surgery will be aided by your fitness. Walking is a great way to improve your fitness.

Pain relief in the hospital

After your surgery, it is normal to feel some discomfort and pain. Individuals will experience pain differently.

Pain relief is achieved by using narcotics (morphine and pethidine as well as fentanyl). The pain relief that is provided by narcotics is not addictive. You may receive a PCA (Patient-controlled Analgesia) if the pain cannot be controlled with tablets.

PCA lets you control the medication you take to manage your discomfort. You simply push a button to send a pre-prescribed amount of narcotic via your intravenous drip.

Intravenous medication, such as morphine or pethidine, will help to manage any initial pain or discomfort. The removal of drains and tubes usually results in a significant decrease in pain. Before discharge from the hospital, the PCA machine is often replaced with pain relief tablets.

Pain relief once you arrive home

Even after you are discharged from the hospital, you will likely experience pain, aches and discomfort. This may last for several weeks. You should manage your pain and discomfort at home.

Pain relief drugs come in different strengths and can be correlated to the severity of pain. However, remember that people have different responses to pain medication.

Here is a guideline and information to help you understand the range of drug strengths from weakest up to strongest:

Mild pain relief is required for mild pain. These pain relievers include Panadol and paracetamol as well as Panamax, Panamax, and Panadeine.

Moderate pain relief may be possible with medications like Panadine Forte, Codeine, Endone, Plexia, or Tramadol. Some pain relievers can cause nausea and vomiting, and may also lead to constipation after surgery.

When combined with mild pain relievers, anti-inflammatory drugs like Celebrex and Mobic can provide effective pain relief. If you have any persistent pain, do not hesitate to speak to your doctor.

Constipation

You will need to bring any medication you take for bowel issues to the hospital. After surgery, constipation is common. We begin constipation prevention the day after surgery and continue until bowel movements return to normal. This is usually when medication can be stopped.

Pharmacies sell medications for constipation like Coloxyl, senna, or lactulose. These do not require a prescription. Additionally, get more fibre, eat fresh fruits and vegetables, and slowly increase your exercise. Water is essential; make sure you are drinking plenty, provided you are not for any reason on restricted fluids.

What else?

While you are in the hospital, it is important to maintain your normal identity. Ask as many questions as you need. Please share your concerns with your doctors, nurses, and other professionals involved in your care.

AFTER YOUR OPERATION

Waking from your operation

You will have your arms covered with bandages and dressings. Pillows can be used under your arms to elevate them and provide comfort.

Discomfort

Brachioplasty can cause some discomfort. Your head will be elevated, and your arms on pillows. To keep your circulation going, you will need to keep moving your legs and take deep inhalations to expand your lungs.

Be careful when you are moving about in your bed. If you wish to move, roll from one side to the other, rather than trying to lift your body. Avoid lifting or carrying heavy objects.

T.E.D. Stockings

Before brachioplasty surgery you will be fitted with TED stockings. When you wake up from surgery, the stockings will still be on. TED stockings are designed to prevent blood clots from forming in the legs. It may be necessary to wear these stockings for up to two weeks following surgery, particularly while you are immobile.

Pain relief

You will need to take painkillers as prescribed. Avoid aspirin and aspirin-based products as they can cause bleeding and bruising. In the postoperative period, you will be prescribed panadol and panadeine for pain relief. You may combine these medications with anti-inflammatory medications such as Celebrex and Mobic.

You should have a postoperative pain regimen in place at discharge. Also, make sure you fully understand all the medication you are taking as well as their intended effects.

Sleeping pills

If necessary, you may take one or two sleeping pills (Normison, Temazepam,) at night to aid in sleeping during the first few days after surgery.

Other medications

Your surgeon might recommend a course of prophylactic (preventative) antibiotics.

Nausea and vomiting

Nausea or vomiting could be caused by anaesthesia or post-operative medication (such as painkillers or antibiotics).

Not only is it unpleasant but vomiting can also cause pain in the armpits, particularly around the suture lines. You may need medication to prevent nausea and vomiting.

Nausea and vomiting that lasts for a prolonged period of time may indicate an infection or dehydration. It is important that you inform your surgeon if nausea and/or vomiting persists.

Bruising

Swelling and bruising is a normal part of recovery. It is usually at its maximum 48 hours after surgery.

Most bruises will disappear in two weeks. A gentle massage with a moisturising lotion (sorbolene), arnica cream, or a gentle rub may diminish bruising.

Bleeding, or ooze

The suture lines may leak blood. This should last no more than 24-48 hours post-surgery. You should notify your surgeon if the oozing persists.

Swelling

Brachioplasty may cause some swelling, which usually lasts 4-6 weeks following surgery. 

In some cases, it can take 12-18 months for intermittent swelling to resolve.

Ask your surgeon for advice on how long it should take for swelling to settle. If swelling is persistent, it may be an indication of a complication and should be reported immediately to your surgeon.

Ice packs and cold compresses

An ice pack may help to relieve pain, bruising, and swelling whilst you recover at home. 

Apply a cold pack for no more than 20 minutes (per arm) every 1-2 hours in the first 48-hours after surgery to reduce swelling and bruising. Stop if you feel any pain. 

If you do not wish to use ice packs, an alternative solution is to gently massage with a mild moisturising cream after showing.

Dressings and drains

Brachioplasty dressings may be removed within 24 hours of your surgery. Ask your surgeon for advice on how long you should keep the dressings on.

You may have steri-strips or tapes that are present at the suture line. These will need to be replaced regularly. Ask your surgeon for guidance on showering.

Sutures

Sutures might be under the skin and will absorb over time. Absorbable sutures under the skin support wounds for a longer period of time than skin sutures. This can minimise scarring.

Sometimes, the body may want to reject these sutures. An underlying suture may be trying to penetrate the skin by causing a sore or pimple at the suture line. It is possible to remove this suture as soon as the skin breaks down.

A small dressing and an antibiotic ointment, or betadine, may be necessary until the wound heals. A stitch granuloma is a form of a knot that has not been dissolved. This can cause a lump. The stitch granuloma might need to be removed as a local anaesthetic procedure.

The skin may have sutures. These will need to be removed at some point after surgery. Your surgeon will usually arrange for the removal of the suture, usually 5 to 14 days after surgery.

Steri-strips are sometimes placed over the suture line. Steri-strips can be left in place and removed within a week. You can shower with them.

Steri-strips can cause blistering. If this occurs, strips will be removed and an alternate dressing will be applied.

Cleaning

After dressings are removed, your surgeon may allow you to take a shower or get your sutures wet. A soap that is antibacterial (sapoderm or gamophen), may be recommended. 

Attention must be paid to how you wash the suture line. You should dry the suture line by gently patting with a clean towel. Wash the tape or steri-strips from your suture lines and dry them.

Sometimes, the suture line can become reddened and ooze. You may need to apply betadine or antibiotic ointment. Your surgeon might also prescribe antibiotics. Some surgeons may advise you to keep your sutures dry. Speak to your surgeon to ensure you have a full understanding of their instructions. 

Travel

Brachioplasty can be done under general anaesthesia as a day operation. A friend or family member must take you home after your day of surgery. Someone should also stay with you overnight during your first night at home.

In the initial days following Brachioplasty, you may need to have help from a friend or relative at home.

Anaesthetic effects

Even if you don’t feel the effects, they may still be present 24 hours later. You may experience slower reflexes and be more at risk of injury. Driving while you are under the influence of any drug, even a prescription drug, is illegal and could result in  a charge.

After an anaesthetic, do not make any important decisions or sign any legal documents. Be careful with your alcohol intake following surgery as medications and alcohol can interact with the residual anaesthetic. Talk to your doctor about any other medications you are taking.

Hospital readmission

You might need to be admitted again unexpectedly to the hospital. This is rare, however the most common causes are persistent nausea and vomiting, anxiety, sudden need for additional pain relief, or treatment for unexpected complications after surgery like bleeding or wound problems.

Activity

Exercising too quickly can cause delays in healing and increase the likelihood of complications.

For the first two weeks following surgery, you should sleep with pillows under your arms to keep them raised. Avoid lifting, carrying, or pushing any objects for two weeks after surgery as it will stress the suture lines.

While you may use the bathroom or walk around the house while watching TV, it is important that you do not clean the house or engage in manual work for 4 weeks after your surgery. This also includes sexual activity.

Sport

In the initial postoperative period, slow walking on a flat, stable surface is often a good way to exercise and regain mobility.

Your body will decide if you can safely resume your exercise program. You may be able to start running or fast walking after four to six weeks.

You can also begin other exercises that use the arms, such as swimming, tennis or contact sports, after 6-8 weeks. However if it causes pain, stop immediately.

Speak to your surgeon about when you are able to start exercising. Localised sores are common and usually result from deep sutures underneath the skin.

Sun exposure

Exposure to the sun can cause fresh scarring to darken. Sunscreen can be used to help fade scars that have been exposed to the sun. If you plan to tan, take extra precautions.

Some areas of your body might temporarily be numb following surgery which means you may not feel a sunburn developing. Take extra care when exposed to the sun. 

Diet

Ensure you keep up your fluids, and then gradually introduce soft solids.

Carbonated sodas or dry crackers can help to settle nausea. You may feel more comfortable eating smaller meals more frequently as opposed to two or three large meals. 

Vitamins 

Multivitamins before and after surgery might aid in wound healing, although this is not a proven fact. Avoid excessive vitamin intake before surgery.

Smoking

Smoking reduces capillary blood flow to your skin, which can impact healing. It can also increase the risk of bleeding and wound infections. Additionally, coughing can impact the muscle repair process.

Smoking also increases the risk of developing blood clots in the legs. We recommend stopping smoking a minimum of four weeks before surgery and also for four weeks after. 

Alcohol

We recommend avoiding alcohol for the first three days following surgery.

It can mix with prescription pain medication and residual anaesthetics. Alcohol can also dilate the blood vessels which can lead to bleeding.

It is important to avoid alcohol for three days following surgery and to limit alcohol intake for the first month.

Driving 

After brachioplasty surgery, please do not drive for seven days.

When you drive, you must be able to react and respond quickly using your reflexes. Post-operative discomfort impedes these reflexes which can prove dangerous. 

Additionally, you must wear a seatbelt in the car while driving, so if this causes pain, do not enter a car. 

Once you feel comfortable, you may resume driving, however we strongly recommend speaking to your surgeon first.

Time to recover

Allow yourself sufficient recovery time. It is important to allow your body enough time to heal from anaesthesia and surgery.

Your arms may be restricted from movement for as long as 2 weeks. Exercising too quickly can increase the chance of complications like bleeding, infection, and delayed healing. You should make sure you are able to take the time to rest from work.

Before you have your surgery, discuss the recovery time frame with your surgeon. Preparation and realistic expectations are critical. Give yourself plenty of time to recover.

Healing

Everybody heals differently. Your ability to heal depends on many factors, including your genetic background, weight, lifestyle, and smoking habits.

Post-operative recovery will depend on how well you prepare yourself. Many believe that the surgeon is the one who “heals” patients. This is untrue. The most important thing that you can do is cooperate with your surgeon and ensure you follow their exact instructions. Remember no question is too small, so never hesitate to reach out to your surgeon for support both before and after surgery. 

Follow your surgeon’s instructions

Following your surgeon’s instructions are crucial in your healing process. These guidelines are intended to encourage healing and prevent any complications. It is important to recognise that you are part of this partnership and that you have a responsibility for following instructions.

These instructions are based on extensive experience and are intended to provide you with the best chance for a comfortable healing process free from complications.

Depression 

Depression is a common reaction following surgery.

The worst day is typically three days following surgery. You may feel emotional. 

After any type of surgery, it is common to feel a short period of depression or “let down” afterwards. You might subconsciously expect to feel and look better immediately, even though this does not align with your realistic expectations.

This feeling usually fades quickly as the normal healing process continues. 

This feeling is a natural and common part of your recovery. We hope you will feel comfort knowing that many other patients will also feel this way, and that this feeling will subside.

Family and friends

Family and friends are a great support system. However, because they do not have intimate knowledge of the procedure and your post-operative journey, they may impact your emotions (albeit unintentionally). 

Your surgeon and the staff at your surgery will be honest with you about how you’re doing and what you can expect. When discussing your progress, please trust your surgeon’s knowledge and experience.

Complications

Complications are rare.

They occur primarily not due to surgery, but rather individual healing capacity or failing to follow care instructions.

If something unexpected happens, it is important that you follow your surgeon’s advice and the nursing staff to ensure the best possible outcome. You will be supported and assisted by your surgeon and nursing staff during difficult times.

Post-operative appointment

It is important to follow the appointment schedule after surgery. Before or immediately following discharge from the hospital, make an appointment to see your surgeon.

This appointment will typically take place within the first seven days following surgery. You must contact your surgeon if you have not made an appointment.

To address any concerns, you may be seen before any scheduled review appointment.

Revisional surgery

Sometimes, the results of your surgery might not be perfect. You will reap the rewards of your surgery if you are able to focus on the overall improvement, rather than small imperfections.

Your surgeon applies their knowledge and vast experience to ensure the best possible outcomes for you.

They continually develop their skills and knowledge as active participants in national and international seminars and aesthetic conferences.

The risk of revision surgery can never be zero, even with the most skilled surgeon. Patients and surgeons can only control certain aspects of the outcome. Up to 5% of patients may require minor adjustments or additional revisions.

In the 12 months following surgery, irregularities can be sufficiently improved without surgery. Therefore, small imperfections should not and often do not need to be corrected after surgery.

Revisional procedures can be more unpredictable and pose greater risks. After discussing with your surgeon, you should carefully consider revisional surgery.

Revisional surgery will incur additional hospital, surgical, and anaesthetic fees. These fees could be covered by private insurance depending on the level of your coverage. These costs are your responsibility so please think carefully before making any decisions. Private Health Insurance is highly recommended for plastic surgery.