After Your Operation
You will have dressings and bandages on your arms. Your arms may be placed on pillows for elevation and comfort.
You can expect to have some discomfort when you wake up after brachioplasty. You will be placed in a position where your head is elevated and your arms will be on pillows.
You will need to remember to move your legs to keep the circulation flowing and to take deep breaths to expand the lungs.
Care should be taken when moving around in bed. Rolling from side to side is preferable to lifting your body. Lifting your body may place stress on the suture line because you will use your arms to help lift your body. Lifting or carrying objects should be avoided.
You will be fitted with TED stockings before your brachioplasty surgery and you will wake from surgery with the stockings on.
TED stockings help to prevent blood clots from forming in the legs. TED stockings should be worn whilst you are immobile and you may be required to wear the stockings for up to 2 weeks following surgery.
You will need to take painkillers as provided. It is recommended that you avoid aspirin or aspirin based products, as they will promote bruising and bleeding.
The usual medications given in the postoperative period consist of panadol, panadeine, panadeine forte, panamax, digesic, and endone. These medications may be combined with anti-inflammatory medications such as vioxx, celebrex, or brufen.
Make sure that you have a postoperative pain regime at the time of discharge and that you understand the medications that you are taking and what they are designed to do for you.
One or two sleeping tablets (normison, temazepam, ativan) may be taken at night, if necessary, to help with sleeping in the first few days after surgery.
Your surgeon may prescribe a course of prophylactic (preventative) antibiotics.
Nausea and vomiting
Nausea and vomiting may be due to the anaesthetic or post-operative medication (like pain killers or antibiotics).
Apart from being unpleasant, vomiting will cause pain in the arms around the suture line.
Medication to prevent nausea and vomiting may be required.
If prolonged, nausea and vomiting may be related to a complication like infection and may cause dehydration. You need to inform your surgeon of prolonged nausea and vomiting.
Bruising of the arms after brachioplasty surgery is usually maximal at approximately 48 hours after surgery. Most bruises will resolve by 2 weeks. Gentle massage with a moisturising lotion (sorbolene), or arnica cream may help to dissipate bruising.
Bleeding or ooze
There may be ooze of blood from any of the suture lines on the arms.
Any ooze should resolve within 24 to 48 hours. Persistent or offensive ooze should be reported to your surgeon.
Swelling can occur for 4 to 6 weeks after brachioplasty and sometimes, intermittent swelling may take up to 12 months to settle. Please ask your surgeon how long swelling should take to resolve. Swelling lasting longer than this time may be due to a complication, and should be reported to your surgeon.
At home a mouldable cold pack or a small bag of frozen peas wrapped in a tea towel may help to reduce swelling, bruising, and pain. Cold packs can be applied to the arms (for 20 minutes every 1 to 2 hours) in the first 48 hours after surgery to help minimise swelling and bruising. The cold packs should not hurt.
If cold packs are uncomfortable, don’t use them as often. After a few days gentle daily massage with a bland moisturising cream after your shower will help to resolve bruising and any lumpiness.
Dressings and drains
Dressings following brachioplasty may be removed as early as 24 hours after your surgery. Please ask your surgeon how long the dressings need to stay on.
Steri-strips or tapes may be present on the suture line and will need to be changed regularly. Check with your surgeon if you are able to shower.
Sutures may be beneath the skin and will absorb with time. The aim of absorbable sutures beneath the skin is to provide wound support for a longer time than skin sutures, so that scar stretch can be minimised.
Occasionally the body will want to extrude these sutures. A sore or a pimple on the suture line may indicate an underlying suture trying to break through the skin. This suture can be removed as soon as it breaks through the skin. Antibiotic ointment or betadeine may be required along with a small dressing until the area heals. Infrequently a lump forms related to a suture that has not dissolved (a stitch granuloma). This stitch granuloma may need to be excised as a local anaesthetic procedure.
Sutures or staples may be present in the skin. These sutures or staples will require removal at some stage after your surgery. The normal time frame is anywhere between 5 days to 14 days. Suture removal is usually arranged with the surgeon.
Some surgeons place Steri-strips over the suture line. Steri-strips are meant to stay intact and are usually removed one week after surgery. You may be able to shower.
Blistering from Steri-strips may occur. If this happens the Steri-strips will be removed and an alternative dressing will be applied.
Having a shower and getting your sutures wet may be permitted by your surgeon after the dressings have been removed. An antibacterial soap (sapoderm, gamophen) may be recommended.
You will need to pay attention to washing the suture line. Suture lines should be carefully dried with a clean towel. If your suture line has steri-strips or tape, wash over the tape and dry it.
Occasionally the suture line may become red and ooze. Antibiotic ointment or betadeine may be required. Your surgeon may prescribe antibiotics as well.
Some surgeons will prefer you to keep the sutures dry. Please check with your surgeon and ensure you follow your surgeon’s instructions about wound care.
Brachioplasty is performed under general anaesthesia and can be performed as day surgery.
If you are going home after day surgery a family member or friend must drive you because you have had an anaesthetic and someone should stay overnight with you for the same reason. You may need help from a relative or friend at home during the first few days after your brachioplasty.
If you have any questions about these matters, please speak to your surgeon.
The effects of an anaesthetic may still be present 24 hours after your procedure, even if you do not feel them. Your reflexes will be slower and you are at risk of injury. It is illegal to drive while under the influence of a drug (even a prescribed one) and you could be charged.
Do not make important decisions or sign legal documents for 24 hours after an anaesthetic. Take care with alcohol intake after surgery because medications and alcohol may interact with the residual anaesthetic. Discuss your normal medications with the anaesthetist.
Readmission to hospital
Rarely you may need to be re-admitted unexpectedly to hospital. The most common cause is persistent nausea and vomiting, anxiety, the need for unexpected additional pain relief or for treatment of unexpected complications of surgery such as bleeding, wound problems or infection.
Too much activity too soon will risk delays in healing or increase the risk of complications. Try to sleep with pillows beneath the arms for two weeks after surgery. Try to avoid lifting, carrying or pushing objects as this will put stress on the suture lines.
You may go to the bathroom, walk around the house sit and watch TV, etc., but no matter how good you feel do not clean the house, engage in heavy manual work, go to the gym etc. for 4 weeks following your surgery. This also applies to sexual activity.
Slow walking on the flat for exercise is often therapeutic in the early post-operative period. Your body will dictate whether you are able to safely recommence your exercise program. More strenuous exercise like fast walking or running may commence after 4 to 6 weeks.
Other exercise that involves using the arms like tennis, swimming or contact sports can commence after 6 to 8 weeks. As a general rule: if it hurts, don’t do it. Please ask your surgeon when you can start exercising.
Localised sore areas are not uncommon and are usually due to the deep sutures under the skin.
If fresh scars are exposed to the sun, they will tend to become darker and take longer to fade. Sunscreen on sun-exposed scars can help to fade scars. Take extra care and precautions if you are planning to tan, as some areas of your body may be temporarily numb after surgery and you will not “feel” a sunburn developing.
Your post-operative diet should consist of fluids initially then soft food that is easy to prepare. If you have any postoperative nausea, carbonated sodas and dry crackers may settle the stomach. You will tend to feel fuller sooner after your surgery so small frequent meals may be more suitable and comfortable.
Although not proven, there is some suggestion that multivitamins prior to and after surgery may aid in wound healing. Avoid mega dosing on vitamins prior to surgery.
Smoking reduces capillary blood flow to the skin and may result in delays to wound healing or complications of your brachioplasty. Smoking not only affects wound healing; it also increases the risk of bleeding, wound infections, post-operative chest infections.
Any coughing may disrupt the muscle repair. Smoking also increases the risk of developing a blood clot in the legs that can travel to the lungs. It is recommended that you cease smoking at least 4 weeks prior to your surgery and for 4 weeks after.
Medications and alcohol may interact with the residual anaesthetic and prescription pain medicine.
Alcohol also dilates blood vessels and may increase the risk of postoperative bleeding.
It is recommended that you avoid alcohol for the first three days after surgery and restrict your alcohol intake for the first month.
It is recommended that you do not drive for several days after a brachioplasty.
To be able to drive safely you must have full use of your reflexes to drive, and any post-operative discomfort will inhibit your reflexes.
If pain will inhibit them, don’t drive. In the interest of safety whilst driving, and legally, you must wear a seat belt across the chest.
You may resume driving when you feel you are able, but it is advisable to discuss this with your surgeon or check with the road traffic authority first.
You must allow yourself adequate recovery time. You must also allow sufficient time for your body to recover from the effects of anaesthesia and surgery. You will have restriction to moving your arms for up to 2 weeks.
Too much activity too soon will increase the risk of complications such as bleeding, infection and delayed healing. It would be wise to ensure you have adequate time off work.
Discuss the expected time for recovery with your surgeon prior to your surgery and allow plenty of time for adequate recovery.
Everyone heals at a different rate. The ability to heal is variable and depends upon a number of factors such as your genetic background, your weight, your overall state of health and lifestyle (exercise, diet, smoking, drinking, etc.). Your attention to preparing yourself for surgery will be manifest in your post-operative recovery. Many people believe the surgeon “heals” the patient. Not one person can make another heal. Your cooperation and close attention to pre and post-operative instructions is extremely important and is in your best interest.
A major factor in the course of healing is whether you follow the instructions given by your surgeon and the nurses in the surgery. Such guidelines are designed to promote the healing process and to prevent the occurrence of anything that may interfere with your recovery.
It is imperative that you recognise that you are a partner in this process and have a responsibility to follow instructions carefully.
The instructions, based on broad experience, are designed to give you the best opportunity for healing without delay or surprise.
Depression is a normal reaction to surgery. The third day following your surgery may be the worst. You may be teary. It is not uncommon to experience a brief period of “let-down” or depression after any surgery.
You may subconsciously have expected to look and feel better “instantly,” even though you rationally understood that this would not be the case.
Day 3 post surgery may be the worst but as healing occurs, these thoughts usually disappear quickly.
If you feel depressed, understanding that this is a “natural” phase of the healing process may help you to cope with this emotional state.
Support from family and friends
Support from family and friends can be very helpful, but because they may not understand what constitutes a normal postoperative course, their comments may unintentionally create emotional turmoil for you.
The staff at the surgery and your surgeon will tell you honestly how you are doing and what to expect.
Please trust in your surgeon’s knowledge and experience when your progress is discussed with you.
Complications are infrequent. When complications occur, it is seldom a consequence of poor surgery or poor postoperative care. Complications are more likely to be a result of the variable healing capacity or a failure to follow post-operative instructions. You will be assisted in every way possible if a complication occurs.
Should the unexpected occur, please understand that it is important to follow the advice of your surgeon and nursing staff in order to treat it as effectively as possible. Your surgeon and the nursing staff will ensure that you have support and assistance during this difficult time
It is very important that you follow the schedule of appointments established for you after surgery. Appointments to see the nurse or the surgeon should be made before or immediately after discharge from hospital.
The review appointment may be the next day or up to one week following surgery.
If no appointment has been made, you must ensure that you contact your surgeon and make a follow up appointment. If you have any concerns don’t feel that you are bothering the surgeon or the staff.
If need be, you can be seen prior to any arranged review appointment to sort out any concerns.
Occasionally the result of your surgery may not be totally perfect. If you feel that you can focus on the overall degree of improvement instead of any small lack of perfection, then you will reap the benefits of the results of your operation. If small imperfections will prevent you focusing on the degree of improvement after your surgery you probably should not have had an operation.
Your surgeon will use their expertise and experience in their surgical techniques to achieve the best results and ensure their patients receive the most advanced surgical techniques available. They keep updated by attending, national and international aesthetic conferences and seminars regularly.
The surgery performed may not necessarily relate to the methods that are sometimes promoted, or advertised in popular magazines, newspaper articles or on television.
The rate of revisional surgery, even in the most skilled surgical hands, can never be zero because patient and surgeon can control only some aspects of the outcome.
Minor adjustments or additional revisions following cosmetic surgery may be necessary in up to 5% of patients.
Revisional surgery is performed after the first postoperative year (12 months after surgery) because resolution of swelling and stabilisation of the final appearance takes at least that long.
During the first year after surgery irregularities, asymmetries or poor contours may sufficiently improve without surgery, so very small imperfections following surgery should not be revised.
Revisional procedures are less predictable and involve more risks. You must consider any revisional surgery carefully after discussion with your surgeon.
If revisional surgery is required you may incur further surgical, anaesthetic, pathology and hospital fees.
These fees may be covered if you have private health insurance, depending on your level of cover.
These fees will be your responsibility and you will need careful financial planning you before you embark on any form of cosmetic surgery. Private Health Insurance is strongly advised for any cosmetic surgery.