My arm looks awful after brachioplasty

I really freaking hate my arm lift recovery. I am nearly 4 weeks post op and the darn axilla are still open and I have a limited range of motion. I finally managed to put on a shirt today that went over my head. I still have not attempted makeup or hair. My husband is doing all the cooking and my laundry and changing my bed linens - yes, I am still in the guest bed because sleeping on my sides is nearly impossible due to the arm pain. Just needed to vent! Argh!!! Yes, I know it will be worth it in the end... but the end look so far away when you are at the beginning!!!

Hello,

I know that you trust your surgeon, but have you ever thought about having someone else look at your arms? I'm a bit concerned. I know that you stated that it looks worst than it feels, but you are in pain. I'm scheduled to have one in January, and now I'm a bit afraid. Any thoughts on the reason(s) for this? Were your arms pulled too tight? Did you resume activity too fast? I''m so so sory that you are dealing with this. 

Hi there! I have posted some pix below taken at 29 days post op. To me the arm wound looks as it is healing but the axilla (arm pit) openings look worse.  I sent the pix to Dr. Capella and he says everything is healing. So I've asked him to clarify for me what I am looking at. I am not sure if it is better to have fibrin (the white tissue) or granulation tissue (the red tissue). Based on his comment, I think the red is preferred, which would show they are healing. I also have an opening in the right groin and he said that is healing, too. 

Dr. Capella asked me to do the wall crawl with my fingers to stretch my arms above my shoulders. My skin is so tight that I cannot lift my arms much above my shoulders at this point. Of course, the pain in the axilla has been making me keep them down! Ouch!!! It is the axilla that are painful not so much the wound. 

As well, my right thigh is so tight that I have to walk to stretch it out. I cannot extend the leg as far as I should be able and I walk a bit encumbered. It gets painful, particularly at the knee and the inside of the thigh just above the knee and the top innermost part of the thigh. With the swelling the top inner thigh feels like it will explode. The knee and lower inner thigh feel like... hmm hard to describe... for a long time I could not fully straighten the knee as the skin was too tight, now I can straighten it but it just feels wrong is the best way I can describe it. Still too tight, but improved.

I know this all sounds scary, but skin does stretch so I think that I just need to give it time and be sure to walk and do the wall crawl as he said. As for the arm wound and axilla opening, they also need time to heal. 

I followed my post op instructions. As for the axilla, they open in about 25% of cases. I can tell you of the five patients I know whom have had brachioplasty that all but one had the axilla open. So it is a pretty common occurrence. Just go in with the awareness that it might happen to you. I pretty much figured that I would not skate on this one and I was not surprised when it happened.

Dr. Capella told me the right arm wound skin necrosis and dead cells that are sloughing off happened because of how tight he pulled me. I asked him if a CG would have prevented this from happening and he said he did not think so. You asked did he pull me too tight? I do not think so but I will ask him when we do my 6-week follow-up. What I do know is that pre-operatively when we discussed complications both he and Scott (his PA) told me if the arm opened it would be in the axilla not the incision line. But to be clear, Dr. Capella told me this is not skin dehiscence (opening) but rather necrosis because the blood supply was cut off at a surface level. The skin underneath is intact and healthy. 

I have been in contact with Dr. Capella a lot via phone and email. He sees photos and is keeping an eye on this. I recently asked him if going to my PCP would help so that the PCP could be his eyes and hands. My concern was that I might not be relaying something to Dr. Capella that was important (for example I did not tell him about the problem with the range of motion in the arms and leg until a clinician told me that I should not be like this at 4 weeks post op) as well as Dr. Capella is only able to see one dimension in the photograph. He was completely fine if I wanted to do that and said it might be interesting to hear how another doctor would approach healing. Dr. Capella just asked that I run anything past him before doing it. He really does keep on top of his patients post op when there is a problem. 

I do not want to leave you or anyone reading this with the impression that Dr. Capella did something wrong or that I was too active. Sometimes these things just happen, setbacks happen with the most amazingly skilled surgeons, as well as the most compliant patients! Dr. Capella in fact knows that not only am I sharing this complication on social media sites but also that I have written a formal article about it that was published on HealthCentral where I have 55,000 unique monthly readers. He thought it was important that people see and understand some of the complications that can happen with the surgery. 

Right axilla opening and arm wound

Left axilla opening

It does seem better, although I can't imagine how he is ever going to fix that scar on over tightened skin.  I guess I am in the minority because other them a tiny stitch pop that healed over in a couple of days my arms healed without any issues and no swelling and no range of motion issues.  My surgeon used a zigzag scar which isn't pretty but was meant to prevent keloiding which is common in arm surgery.  And just so you understand my position, I never got my legs done because of the horror stories I have heard about the scars and the inability to stretch your legs without pain.  I was afraid of any scars in my groin area.  I am scared for you, you know I felt it was too much surgery done together with a surgeon I am still unimpressed by for an extremely high price.  I have seen Dr L's work and it seems superior in every way.  Obviously he can't weigh in here for obvious reasons but I would be interested to hear his take on your results.  I like the fact he reads and posts on he boards.  I think he did all of Laura's surgery and I have seen a few others also and his skills do impress me, obviously he is in Texas and not near me but as full price American surgeons rate, he gets my vote.

I had Dr. Lomanaco quote on the rest of my surgery after I had a bad experience with Dr. Capella after my tummy tuck. It was nothing to do with the surgery or aftercare, but rather his bedside manner. I ultimately went with Dr. Capella for several reasons - he does the surgery in a hospital, he does the pie crust incision, he was cheaper, he has more experience, he did a great job with my TT surgery. Dr. L seemed very good, in every regard, and he has several patients on this board who love him. Laura's work is fabulous and I do not think she had any complications. 

I have not heard of anyone having range of motion issues like I am having with my arms and leg. My forearms also hurt when I extend them. That is probably what concerns me the most at this point. Followed by the axilla not yet healed although he said that would take 3 weeks - so another week and a half. The arm wound, which looks worst of all, is the least of my concerns right now. It is supposed to be healed in another 1.5 weeks but I do not think I am healing as fast as that. But It will get smaller and close up more, meaning that the scar will not be as large as the original wound. I had wondered about that, too, just as you said pulling skin tighter when there is none to spare. Dr. Capella is not the only one who told me this can be fixed. I am friends with a plastic surgery PA and she has advised me. She is concerned about the ROM issue, though. 

I always have the option to post my photos and questions to surgeons on realself. But in the past they have not given me good advice so I believe it would do more harm than good. I also can see my PCP, which is what I plan to do. I agree with you that it would be nice to hear DR. L weigh-in on this. I respect his opinion. Also Dr. Fisher on this board has helped me in the past when I had issues after my tummy tuck. As you might suspect, there is no way in freaking hell I am going to a plastic surgeon here. At least I trust my PCP.

A few months ago my ObGyn asked me if Dr. Capella pulled my original mons lift too tight. I had complained to my ObGyn (and to Dr. Capella and to Dr. LoMonaco as well as posted on this forum) that I could not have a clitoral ****** after my surgery. It never did resolve on its own. But now that I had my mons lift revised in this surgery, the problem, whatever it was, was resolved. 

You know that by now I have a lot of respect for Dr. Capella's surgical skills. I would be crushed to find out he did something incorrectly after holding him on a pedestal for so long. I do not think that is the case, though, but with so many people raising questions on this board and on RealSelf, it does give me pause. If things are not resolved or close to being resolved by my 6-week post op then I will be concerned, but I will be patient until then and trust all that my doctor is telling me. Why? Because he has never been wrong in the past with me, and because I know that in regard to post op complications he takes patient aftercare very seriously. So there is no reason to believe he would do something that was not in my best interest.

Okay I am going to sit patiently for another few weeks and hold back my final judgement, but right now it stands at unimpressed by Capella. 

But just for a point of reference here is a pic of my arms before, 3 days after and 12 days after and some before and afters.

Before

After ( I thought you would get a kick out of this one, the dress I will never wear, it is a size 8 though.  lol)

Okay a better before and after

I never get notifications anymore when you post to me. It is so frustrating and so know that if I do not reply to you it is because I did not come to the site and manually look for your posts. Hopefully whatever is wrong will be resolved with the new site launch.

I have always loved your transformation. You are an absolutely adorable woman who radiates ***** - I like that  - and you have not had that much surgery to get to be the beauty you are. 

Your arms look good but I am not a fan of that zig zag incision. I know you hate the pie crust incision but I really like it a lot. My arms also are thinner than yours. I know you think mine are too thin compared to my elbows and for that I will have to wait until the swelling goes down before I can comment. I think your arms look nice and proportioned with your body in the bathing suit pic.

Not every patient will be impressed by any one surgeon. There is a very prominent and expensive plastic surgeon whom I abhor. I do not say that lightly. Yet he has patients whom adore him. 

Good call on never wearing that white dress... as I told you privately and will now state publicly, I do not believe in love. It is ephemeral not ever-lasting as the fairy tales we were raised on would have us believe. But that doesn't mean we cannot have a happy ending. Companionship and sex are great and don't have all the bull**** involved in a marriage. That's what I believe in. 

Yes the zig zag scar is ugly but as you can see I have a lot of stretch marks under my arms, my poor body was never meant to be so MO, so the underside looks not so good, but they are nice from the top.  I guess I still don't get the point of the pie crust incision, it looks lumpy to me.

As for notification, my posts have to be approved by a moderator because I broke their tos and called someone out for being a fat hater and bully.  So nothing I post appears until the powers that be let it go.  Whatever, it's not my site so how can I complain.

As for fairy tale love I still believe, I will always believe, life isn't perfect but I can never stop believing in true love.

OnesityHelp did that to me a few months back, too. They do not moderate you for too long.

i think the purpose of the pie crust incision is the same purpose of the zig zag incision - to reduce tension on the actual incised skin and thereby make a lesser scar. They are very lumpy but they do flatten. Some parts of mine are flat but I think it will take another month before all have flattened.

i really do look like FrankenBarbie with all these lumpy incisions all over my body.