The author of this chapter presents his experience of arm reduction leaving a scar in the axilla only; minimal incision brachioplasty (MIB). The technique is a modification of the Pollack technique to treat axillary hydradenitis. It is suitable for patients at the slightly more modest end of the spectrum, i.e. not massive weight loss patients with massive bat wings. The cut off for the technique is a measured distance from mid humerus to lowest point of skin fold with arms abducted at 90 degrees in a standing position of 12cm or less. The caveats are if there is significant fat present, with an expectation that liposuction will reduce the distance, and if the excess is in the proximal third of the arm. Surgical markings, an ovoid shape, are clearly described with informative drawings to confine the scar to the axilla with no visible scar with the arm adducted. Intraoperative checks using the tailor-tack method are stressed. Resection is just below the apocrine glands plus liposuction or direct fat excision as required. Postoperative care is discussed, with restriction of shoulder mobility in the early phase. Complications based on a review of a series of 1200 patients are described. Adverse scars, 10-12% are revised at one year. This is essentially a personal series review; but it describes a simple technique to perform brachioplasty in the non-massive weight loss group, avoiding the traditional scars which no patients like and few accept. I suggest you read it!

Brachioplasty with limited scar.
Reed LS.
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Stuart Hamilton

NHS Lothian, UK.

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