**9.1 Asymmetries**

As with any other procedure where two sides of the body are treated, it is important to note and educate patients on any pre-existing asymmetries during the consultation process and prior to any procedure. The circumference of the arm is measured at two landmarked positions on each arm prior to surgery. The measurements are confirmed again intraoperatively prior to start of surgery and at the end of surgery to ensure relative symmetry. It is important for surgeons to remember, and educate patients, that it is not how much fat or skin excess is removed that needs to be similar but rather the tissue that remains should be symmetric.
