University of Illinois, 840 Wood Street, Chicago, Ill. 60607, firstname.lastname@example.org
I am happy to see that the popularity of the posterior axillary incision for brachioplasty is on the rise.1 Over the past 8 years of using this incision, there appear to be two issues of significance: the distal component of the scar and the quality of the scar.
If one prolongs the posterior marking with the arm at 90 degrees to the body, the distal tip of the ellipse is pointing toward the olecranon. In this location, when the arm is down, and one looks at the patient from the back, the scar is visible. Patients have complained about the visibility of the scar, and it has reduced the value of the procedure in their eyes.
In contrast, when the arm is against the body, the medial epicondyle is where the tip of the ellipse should point to; but when the arm is abducted 90 degrees from the body, the scar becomes visible. The best compromise is a point between the olecranon and the medial epicondyle. There, the scar is visible but not noticeable (Fig. 1).
The second issue is the quality of the scar. It is related directly to the tension on closure. One needs to remember that some laxity is the norm in any woman older than 30 years. I recommend marking the points (A and A′) where the fingers fall on pinching the excess skin and marking the excision, moving from points A and A′ on the front and back by a distance equal to half the distance between the thumb and index finger as they pinch the excess tissue (Fig. 2).
I have always felt accurate, systematic markings are the key to reliability of result and continued improvements.
M. Vincent Makhlouf, M.D.
University of Illinois
840 Wood Street
Chicago, Ill. 60607
1. Nguyen AT, Rohrich RJ. Liposuction-assisted posterior brachioplasty: Technical refinements in upper arm contouring. Plast Reconstr Surg.
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