Cosmetic Surgery—Procedures We Offer

Known as mammoplasty, breast augmentation involves placing implants under breast tissue and usually partially under chest wall muscles. Breast augmentation is done to improve shape and increase size. Augmentation can add natural-looking size and fullness, as well as restore volume lost from weight reduction or pregnancy. Together, you and your doctor will determine the best implant type (saline/silicone), size and shape, placement of incision, and location of implant to meet your specific desires.

Known as mastopexy, a breast lift is a surgical remedy for the effects of time and gravity. Excess skin is removed and surrounding tissue tightened, rejuvenating and firming sagging breasts and restoring a more youthful contour. As with all cosmetic surgery, the best results depend upon good communication between you and your surgeon. A variety of procedures and incision patterns can be used to accomplish desired lift, depending upon skin laxity. At Virginia Mason Franciscan Health, you and doctor carefully choose the best options to meet your unique desires and accommodate unique anatomy.

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.

Several surgical options are available to correct and contour nipples and areolas. These specific procedures can be performed alone or in combination with other procedures such as breast lifts and augmentation.

• Inverted nipples: This problem occurs in up to 2 percent of women and can affect one or both sides. Surgery involves exposing and selectively dividing whatever is pulling the nipple inward while leaving healthy milk ducts intact. In some cases, the ability of the patient to breastfeed may be preserved.
• Large areolas: While there is no ideal areola size, contouring areolas to meet specific desires is a relatively simple outpatient procedure. Areola reduction is often performed along with breast reduction.
• Nipple/areola tattooing: The final artistry of breast reconstruction is realized in the finishing step of nipple and areola tattooing. The procedure is done in our office and is effective in recreating a natural look for those who have undergone breast reconstruction. Often we're able to reference photos from before your surgery to recreate natural pigmentation or create a new pigment of your choice.

Revisional surgery fixes various complications resulting from breast implants. While implants can remain intact for decades in the body, all such devices will fail at some point. Leaks can be caused by degradation as well as external trauma. They can also cause a range of reactions that require follow-up surgery.

• Implant leaks: Leaks can be caused by degradation of the implant shell, chest trauma, damage during implantation, and in rare cases from the pressure of mammograms. Saline implants have a failure rate of 2 percent per year, while silicone gel implants have a lower failure rate of 0.5 percent per year. When saline implants break, they usually deflate quickly and noticeably and can be easily removed. When silicone gel implants break, they do not usually deflate, but the silicone can leak and require implant removal.
• Capsular contracture: Capsules of tightly woven fibroblasts can naturally form as the body's response to an implant. They can also be caused by contamination, rupture, or leakage and bleeding. This complication can be painful and distort breast shape. Correction requires removing the implant and scar tissue, and reinserting the implant. There is increased risk of capsular contracture with silicone gel implants as well as implant placement above the muscle (subglandular) or insertion of the implant via the nipple.
• Double-bubble deformity: There are two types of double-bubble deformity, one in which the breast tissue hangs below the implant ("waterfall deformity"), and one in which the implant rides below the fold of the breast. Either deformity can occur shortly after breast augmentation, or result over time from pregnancy, weight loss, or gravity. Surgical correction involves changing the position of the implant or lifting breast tissue or both.
• Symmastia: Also known as "uniboob," this complication is uncommon. It occurs when an implant is placed too far medially and both implants meet at the midline. Symmastia can be corrected by changing the implant pocket location and reinforcement with an acellular dermal matrix (ADM) such as Strattice.
• Bleeding/hematoma/infection: Bleeding leading to hematoma or bruising can occur after breast augmentation surgery and may require surgical correction to control or correct. Implant surgery can cause infection, which can usually be treated with antibiotics alone, although serious infections require removal of the breast implant and about a 90-day wait before reimplantation.
• Implant rippling: The chances of rippling can be lessened by using an implant with a smooth shell or silicone gel implant. Placement, either submuscular or subglandular, can also have an effect. However, ripping of the implant capsule can still occur and require surgical removal and correction.
• Breast sagging (ptosis): After augmentation surgery, increased sag can sometimes occur. Correction may require mastopexy (breast lift), as implants alone are ineffective as a lifting mechanism.
• Bottoming out: Due to lack of sufficient tissue coverage, downward migration of implants may occur over time, causing areolas and nipples to appear too high. The corrective procedure to bottoming out is called capsulorrhphy. Also known as an "internal bra" or pocket correction, it involves closure of a portion of the breast pocket using internal sutures to correct implant displacement. It's done after careful measurements are made from areola to the new mammary fold. Often an ADM is used to provide additional strength to the tissue to prevent recurrence.
• Outward falling: A similar occurrence to bottoming out is when breast implants fall outward toward axilla (armpits). Likewise, correction involves capsulorrhaphy, using internal suturing to keep implants in the correct position on the chest wall.
• Implant scarring: Every skin type is different, and thus every implant patient bruises and scars differently. Scarring can be minimized through corrective follow-up surgery shortly after initial procedures. Post-surgery, scars should be kept moist and out of sunlight.

A variety of body contouring treatments can help those who have experienced major weight loss regain firmness and eliminate loose skin and tissue. You and your surgeon will determine the best options to achieve your desired result.

• Arm lift: 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.
• Breast lift or breast reduction: 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.
• Lower body lift: 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.
• Medial thigh lift: 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: 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.
• Tummy tuck: 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.

Popularly known as "Brazilian butt lift," buttock augmentation can be achieved through fat grafting, much like grafting for breast enhancement, using tissue harvested from your own body. Fat grafting avoids the risks of implants such as rupture, leakage, malposition, and infection. The procedure also produces a natural shape with no edges. Since contouring depends upon the amount of available fat tissue, several rounds of liposuction and grafting may be required to achieve total satisfaction.

Also known as suction lipoplasty, liposuction removes unwanted fat from a variety of areas, including abdomen, waist, legs, arms, chin, and neck. Ideal candidates are those who have lost all the weight they want to lose except for problem areas. Note that liposuction is not a weight-loss procedure, but a tool to contour specific, resistant fat regions.

New techniques include ultrasound-assisted lipoplasty and the tumescent technique. You and your surgeon determine in consultation the best approach to achieve desired results with minimal risks.

Mommy makeovers encompass a variety of cosmetic therapies to reverse the effects of childbearing and breastfeeding, and they enable moms to reclaim their pre-pregnancy form. Procedures include breast lift, breast augmentation, tummy tuck, and liposuction. You and your surgeon determine the best combination of treatments to achieve desired results.

Known as abdominoplasty, a tummy tuck tightens abdominal wall muscles and overlying abdominal skin. Like liposuction, a tummy tuck is not a weight loss procedure, and won't make an obese person skinny. It can be a good option for those who want to tighten their abdominal skin and improve body contour. Women and men in good shape, but who have loose skin and resistant fat around their midsection, can see dramatic results unattainable through exercise and diet. As with all cosmetic procedures, satisfaction depends upon realistic expectations.

Eyelid surgery, known as blepharoplasty, reduces the signs of aging, including puffiness in upper and lower eyelids and eyelid drooping, which can also interfere with peripheral vision. Excess tissue, such as skin and fat, is removed or repositioned, and surrounding muscles and tendons may be reinforced.

Known as otoplasty, cosmetic ear surgery can contour the ear and lobe in a variety of ways. Ears can be brought closer to the head (commonly called ear pinning), reduced in size, or reshaped for more elegant profile. Deformed or absent ears can be reconstructed.

Ear surgery can involve a combination of moving, reshaping, adding or removing structural elements. The operation usually takes two to three hours and requires the surgeon to make a small incision behind the ear to expose ear cartilage.

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.

Prior to surgery, we conduct a physical assessment and review medical history for any signs of underlying medical causes of breast enlargement. You and your doctor determine the best course of treatment to achieve desired results.

Liposuction has become one of the most popular cosmetic procedures for men. The procedure is especially effective at treating the traditional male bane of "love handles." After a physical evaluation, you and your doctor will decide whether liposuction is the best option to achieve your desired results.