Reconstructive Surgery—Procedures We Offer

With breast implant surgery, surgeons restore the size and shape of breasts with silicone implants. Your individual skin quality, history of radiation treatments, and surgical results from mastectomy will help determine whether this is a good option for you. Sometimes supplemental tissue is needed to help cover the expander and implant. In this case, tissue and muscle from the back, called a latissimus dorsi flap, can be moved to the chest. Because other muscles normally overlap the latissimus muscle, women experience very little if any loss of strength or motion.

Over several weeks, the expander is gradually filled with sterile saline through a small valve to create the final breast size and shape. The expander is then removed, and the permanent implant is placed, both through the same incision created during mastectomy.

In one to three months after placing the implant, the nipple is reconstructed by shaping a small skin flap at the nipple site. Once healed, the created nipple is tattooed for proper color or to match the opposite breast.

Autologous breast reconstruction surgery uses tissue from your own body to recreate the breast. Also called tissue flap surgery, the new breast volume is created entirely with living tissue for a natural, long-lasting result.

Two techniques are used for positioning the tissue flap to create the new breast:

• Pedicle flap: In this procedure, tissue is moved to the chest without cutting the original blood supply by tunneling the flap under the skin and attaching in the chest area.

• Free flap: Because the tissue is cut free, the surgeon moves the flap to the chest and attaches the blood vessels in the new location.

There are a number of options for flap surgery, identified by the areas of the body that provide the tissue.

• TRAM flap: TRAM (Transverse Rectus Abdominis Myocutaneous) uses skin, fat and rectus muscle(s) from the lower abdomen to form breast tissue. Historically the most commonly performed flap-based procedure, TRAM removes the same tissue as for an abdominoplasty (tummy tuck), producing similar scarring and contouring as with a tummy tuck.

• GAP and TUG flap: For women with insufficient abdominal tissue for breast reconstruction, GAP (Gluteal Artery Perforator) flaps are tissue and skin taken from the buttock area, and TUG (Transverse Upper Gracilis) acquires tissue and muscle from the inner thigh, near the groin.

• DIEP flap: The DIEP (Deep Inferior Epigastric Perforator) flap is similar to TRAM in that the tissue comes from the lower abdomen but works without removing muscle. Preserving the abdominal muscles prevents weakening of the area and the chance of developing hernias. In DIEP flap surgery, very small arteries and veins are separated from the abdominal muscle for reattachment in the chest, leaving the muscle intact.

Chest wall reconstruction for breast cancer survivors who opt to stay flat after mastectomy rather than pursue breast reconstruction. The goal of flat closure is to restore a normal anatomic contour to the chest using plastic surgical techniques such as removal of redundant skin, liposuction, and fat grafting.

Breast reduction surgery removes excess tissue and skin to make breasts smaller and more proportional to your body. The procedure gives relief to those suffering from chronic back and neck pain due to stress from excess breast weight. It can also rejuvenate breast shape and firmness. There are a variety of techniques and incision patterns to achieve breast reduction. You and your doctor can determine the best options for you during your personalized consultation.

Gynecomastia or enlargement of male breast tissue is a common condition in men of all ages. Causes include weight gain, hormonal changes, and use of steroids and specific drugs. The condition is resistant to diet and exercise and can cause discomfort and difficulty with self-esteem. Some patients can be treated with liposuction alone with minimal scarring. Those with more excessive, thicker breast tissue may require liposuction in combination with skin reduction and tightening.

Known as brachioplasty, arm lifts remove fatty tissue and tighten skin of the upper arms, problem areas for many women. This procedure involves a combination of liposuction and skin tightening to achieve smaller, firmer arms.

Most people develop severe looseness (ptosis) of their breasts following major weight loss. A breast lift restores firmness in patients happy with their current breast volume. Some patients also require breast reduction to alleviate back and neck pain and restore proportionality to the newly smaller body. Several medical indications qualify breast reduction for insurance coverage.

A lower body lift is a combination of procedures that remove loose skin around the abdomen, waist, lateral thighs and buttocks. The procedures—tummy tuck, lateral thigh lift and buttock lift—can be performed together or in multiple surgeries. Through physical assessment, the surgeon can determine whether a patient is a good candidate.

A medial thigh lift removes excess fatty tissue and skin on inner thighs, which occurs in many patients after major weight loss. The procedure is often performed in combination with one or more other body contouring surgeries.

Panniculectomy is the surgical removal of excess fat and skin. Pannus is a layer of dense overhanging fat that occurs in patients after major weight loss or pregnancy. Unlike a tummy tuck, panniculectomy, or removal of the pannus, specifically addresses associated medical problems such as skin irritation and erosion. Because of its medical indications, the procedure usually qualifies for insurance coverage.

In the state of Washington, if a patient has had gastric bypass or lap band surgery, some insurance companies may cover the cost of a panniculectomy if it is deemed medically necessary. We recommend you call your insurance company to discuss exactly what your plan covers.

The front abdomen is the most problematic area after major weight loss, with many patients left with significant laxity in musculature and skin. A tummy tuck is a cosmetic procedure that tightens skin and restores firmness to abdominal muscles. However, it is not a weight loss procedure, and it has little impact on waist and buttocks. Patients desiring contouring in these areas typically require a lower body lift.

Mohs surgery is an effective way to treat skin cancer. However, surgically removing the area of cancerous tissue from your face and body may result in the need for reconstructive surgery. Virginia Mason Franciscan Health's plastic and reconstructive surgeons specialize in wound closure and reconstruction following Mohs surgery.

Virginia Mason Franciscan Health's plastic and reconstruction surgeons are experts in skin cancer removal and the reconstructive surgery that follows. They work hard to give patients the best appearance and function after cancer surgery.

Malignant melanoma is a serious type of skin cancer, affecting more than 60,000 Americans each year. The plastic and reconstructive surgeons at Virginia Mason Franciscan Health specialize in the surgical removal of melanoma, sentinel lymph node biopsy, and lymph node dissection. A multidisciplinary team of providers contribute to the collaborative care of patients with localized or advanced metastatic disease.