Reconstructive Procedures

We want you to look and feel whole again. 

Our physicians are skilled in reconstructive surgical techniques to restore appearance or function following surgery, trauma or illness. 

Read on to learn about some of the reconstructive procedures we perform:
 

Craniofacial reconstruction

Procedures are used to repair or reshape deformities of the head and face.

  • Facial trauma – The goal is to repair an injury to the face, including soft tissue  lacerations, facial bone fractures  and facial nerve repair.
  • Facial re-animation (smile surgery) – The goal is to restore the ability to smile for those who have lost their smile due to illness or trauma or are born without the ability to smile. The restoration of facial expression and a beautiful smile takes several steps and can include nerve transfers/grafts, transfer of viable muscle from another area of the body (functional muscle transfer) as well as additional procedures to protect the eye (gold weight placement) and improve speech and oral competence.
  • Migraine surgery – This surgery aims to reduce or prevent migraines in men and women suffering from chronic migraine or nerve compression headaches. The procedure targets the release of nerve compression (“trigger”) points in the face, head and neck area.
     

Breast

Breast reconstructive surgery is used to reshape or rebuild the breast after breast cancer surgery, such as a lumpectomy or mastectomy.

  • Oncoplastic surgery – This combines breast conservation therapy (lumpectomy) with plastic surgery techniques to restore breast shape and symmetry. The removal of the tumor and breast reshaping is often done at the same time, limiting recovery time.
  • Tissue expander reconstruction – This is often the first step in implant-based breast reconstruction. A balloon-like devise is inserted beneath the skin and chest muscle to stretch the skin and muscle over time to make room for a permanent implant. When expansion is complete, a second surgery removes the breast tissue expander and replaces it with a permanent breast implant. 
  • Direct to implant reconstruction – In patients with small to moderate sized breasts with minimal ptosis or sagging of the breast, implant reconstruction can often be performed without having to place a temporary tissue expander.  A direct-to-implant reconstruction involves reconstructing the breast with permanent implants at the time of a mastectomy, limiting the number of surgical procedures that the patient undergoes.
  • Latissimus dorsi – The latissimus dorsi flap is a pedicled flap. That is, it stays connected to its donor site. This procedure transfers the latissimus dorsi muscle and a patch of overlying skin from the back to the mastectomy site to provide additional coverage to the reconstructed breast. 
  • Microsurgical reconstruction – Microsurgical reconstruction utilizes free tissue transfer where tissue from one part of the body is disconnected from the body and reconnected to a new blood supply at the recipient site using specialized microscopes and instrumentation. 
    • DIEP Flap – The DIEP flap is a muscle sparing variation of the free TRAM flap. With this procedure, the tissue is harvested from the lower abdomen, similar to a “tummy tuck.”
    • SIEA Flap –The SIEA flap also involves harvesting tissue from the lower abdomen but relies on a superficial system of blood vessels that reside beneath the skin. Due to the superficial location of the blood supply, the rectus muscle and its overlying fascia are left untouched.
    • TUG Flap – Tissue is removed from the medial thigh  
    • SGAP – Tissue is removed from the upper buttock region
  • Autologous fat grafting - Fatty tissue can be harvested via liposuction and transferred from one area of the body (e.g., abdomen, thighs, buttocks) to the reconstructed breast. This technique can help to improve breast shape and contour.
  • Nipple reconstruction – Nipple reconstruction is performed under local anesthesia using a variety of techniques to rearrange the breast skin and produce a 3 dimensional, projecting nipple. In some circumstances, the nipple can be reconstructed by 3D tattooing, using shading techniques to create the appearance of a projecting nipple.
  • Areolar tattoo – Once nipple reconstruction is complete, the areola is reconstructed by either tattoo of the skin or skin graft from the abdomen or groin region. In some circumstances, the nipple can be reconstructed by 3D tattooing, using shading techniques to create the appearance of a projecting nipple.
 

Skin

Surgery is the primary treatment for most skin cancers.

  • Skin cancer excision (most commonly basal cell or squamous cell) – A common procedure, this involves the surgical removal of basal cell or squamous cell skin cancer.  To minimize the amount of normal tissue removed but to still reduce the risk of recurrence, we perform a specialized intra operative technique to assure the margins are free of cancer.
  • Skin cancer reconstruction – reconstruction after skin cancer removal may involve a layered plastic surgery closure for small defects, local tissue rearrangement (local flap), perforator flaps or skin grafts. In cases of very large tumors reconstructive microsurgery may be indicated to restore form and function. 
  • Melanoma surgery – The type of procedure depends on the extend of the cancer.  Early stages are treated with a simple excision including a small amount of surrounding normal skin. Intermediate stages may require a wider excisions which removes an additional margin of normal skin for deeper tumors. Sampling of draining lymph nodes is also performed in many cases.  Surgery for metastatic melanoma is usually done to alleviate symptoms and improve quality of life.

Lymphedema

Lymphedema occurs when normal lymphatic flow is interrupted and fluid is retained in the tissue, which can result from cancer, surgery, radiation, trauma or infection. Patients often experience swelling, a feeling of heaviness or pain, and recurrent infections of the affected limb. 

Reconstruction of the lymphatic system uses microsurgical and super-microsurgical techniques, such as:

  • Vascularized lymph node transfer (VLNT) – This involves transplanting a few lymph nodes from a donor site to the affected area to restore lymphatic function. 
  • Lymphovenula anastomosis (LVA) – Using super-microsurgical techniques, this procedure connects dilated lymphatic channels to very small veins to improve lymphatic drainage. 
  • Lympho-lymphatic anastomosis – This procedure transplants lymphatic collectors from a leg donor site to the affected limb to drain the lymphatic fluid back into the system.
  • Lympho-liposuction – This technique is somewhat similar to liposuction, and involves removing tissue to reduce the volume of the effected area. Although the technique does not restore lymphatic function, it can make the condition more manageable.