Upper arm deformities are common after massive weight loss following bariatric surgery. In patients with enormous amount of soft tissue excess and skin, the sheer volume and its laxity can be anatomically disorienting. Soft tissue landmarks are blurred, axis points hard to locate and bony landmarks are over-padded. Many corrective procedures have been described and yet, the surgical outcomes are often marred by poor preoperative planning and preparation-leading to poor contour correction, webbing of the axillae, widened scars some of which require revision surgery. We describe a surgical approach using careful mathematical measurements of the deformity that allows the preoperative marking of the incision in the shape of a fish. This incision is specially designed to offset the problems routinely faced in brachioplasty. Mathematical measurements, anatomic marking and conduct of the operation have been described in detail. The 'fish-incision' brachioplasty provides a usable, simple method that is easy to follow and optimises aesthetic results. © 2005 The British Association of Plastic Surgeons.
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