Plastic and Reconstructive Surgery

The plastic surgeons at Johns Hopkins in Baltimore, Maryland, do two different kinds of arm lifts:

• In a minimal incision arm lift, the plastic surgeon will make a small incision near the armpit if there isn’t much sagging skin to remove. In that case, your plastic surgeon will make the incision and do liposuction to remove excess fat.
• For people who have lost large amounts of weight or have more sagging skin for other reasons, the plastic surgeon will do a regular brachioplasty, making a longer incision that stretches from the elbow past the armpit. In this procedure, your surgeon will not only do liposuction but will also remove and tighten the excess skin.

For either kind of arm lift, you may receive local anesthesia and sedation so that you will be comfortable, or you may receive general anesthesia so that you will be asleep throughout. An arm lift generally takes from one to three hours. You will have a drainage tube for each arm, and this may be removed in one week. Pain is generally not significant. 

It is an outpatient procedure so you can go home the same day. You will likely be able to see the results of the arm lift immediately. Swelling should begin to disappear in a matter of weeks and resolve completely in a few months.

While there may be some scarring, it is likely to be minimal and not visible to others.

• Brachioplasty

Many women opt to have breast augmentation surgery in order to improve their body image by changing the shape of their breasts or increasing their fullness. For some women who have had children or lost a great deal of weight, breast enhancement can restore lost volume.

The plastic surgeons at Johns Hopkins, in Baltimore, Maryland, are current on the safest implants and latest surgical techniques. They have been trained in a number of kinds of breast surgeries, including the latest techniques in breast reconstruction.

You may decide to have a breast lift at the same time. A breast lift reduces the breast sagging that can occur as a result of aging or after pregnancy. If you opt for the combined procedure, your surgeon will remove some breast tissue, tighten the skin and lift it, and insert an implant.

Most often, the procedure is outpatient and done under local anesthesia with sedation so that you are comfortable. Your plastic surgeon may recommend general anesthesia. Depending on exactly what type of procedure you are having done, it will take from one to three hours. 

Kristen Parker Broderick, M.D.
Assistant Professor of Plastic and Reconstructive Surgery

Salih Colakoglu, M.D.
Assistant Professor of Plastic and Reconstructive Surgery 

Damon Sean Cooney, M.D., Ph.D.
Clinical Director, Face Transplant Program, Johns Hopkins Comprehensive Transplant Center
Assistant Professor of Plastic and Reconstructive Surgery

Michele Ann Manahan, M.D.
Department Vice Chair for Faculty and Staff Development and Well-Being and Past Department Director of Patient Safety
Professor of Plastic and Reconstructive Surgery

Sashank Kurapati Reddy, M.D., Ph.D.
Assistant Professor of Plastic and Reconstructive Surgery

Gedge David Rosson, M.D.
Director of Breast Reconstruction
Associate Professor of Plastic and Reconstructive Surgery

Mohammed Abdullah A Alrakan, M.B.B.S.

• Breast Augmentation
• Think You Can’t Breastfeed After Implants? Think Again

Breast Reduction

Some people experience neck strain, headaches, aching shoulders, low back pain, chronic infections under the breast fold, and other problems associated with large breasts.

Whether you wish to alleviate those symptoms or reshape your breasts to make them more pleasing to you, breast reduction, also called reduction mammaplasty, can help. In fact, breast reduction surgery has one of the highest rates of satisfaction of all cosmetic surgery procedures. Many times, health insurance will cover this procedure if you meet certain criteria.

Men may also opt for breast reduction for treatment of a condition called gynecomastia, characterized by excess breast tissue or fatty tissue in one or both breasts. 

Breast Lift

Whether because of aging, pregnancy, natural causes, or other reasons, some women wish to change the size or shape of their breasts. You may opt for cosmetic procedures to make your breast size and/or shape more pleasing to you. One possibility is breast augmentation, which involves implants or fat grafting to enhance the size of the breasts. The other two are a breast lift, sometimes called a mastopexy, or breast reduction. 

As specialists in breast reconstruction surgeries of all kinds, the board-certified plastic surgeons at Johns Hopkins are experienced in these kinds of procedures.

A breast lift, also called mastopexy, offers women the opportunity to raise and firm their breasts. The procedure raises the breasts by removing excess skin, tightening the tissue, and moving the nipples up.

What to expect during breast lift surgery

The procedure, which is usually done on an outpatient basis, will take anywhere from 1-3 hours. It’s likely that you will receive general anesthesia to put you to sleep while the procedure is done.

Pain is typically minimal and well tolerated. There may be minor bruising and swelling is normal. Your doctor will prescribe pain medication and give you specific directions for taking care when you go home.

Recovery from breast lift surgery

After several days you’ll be able to move around comfortably, though your plastic surgeon will likely tell you to avoid straining, bending and lifting for a few weeks after the surgery. You may need to sleep on your back for several weeks and you will need to wear a special support bra for a period of time. It’s likely that you will need to stay home from work for a few days to a week.

Swelling should begin to disappear in a matter of weeks and resolve completely in a few months. However, you can expect to see scars for as long as a year and they will likely never fade completely.

Kristen Parker Broderick, M.D.
Assistant Professor of Plastic and Reconstructive Surgery

Damon Sean Cooney, M.D., Ph.D.
Clinical Director, Face Transplant Program, Johns Hopkins Comprehensive Transplant Center
Assistant Professor of Plastic and Reconstructive Surgery

Michele Ann Manahan, M.D.
Department Vice Chair for Faculty and Staff Development and Well-Being and Past Department Director of Patient Safety
Professor of Plastic and Reconstructive Surgery

Gedge David Rosson, M.D.
Director of Breast Reconstruction
Associate Professor of Plastic and Reconstructive Surgery

Mohammed Abdullah A Alrakan, M.B.B.S.

• Breast Reduction Surgery

If you have lost a lot of weight or for those who have sagging skin on their thighs because of aging, the plastic surgeons at Johns Hopkins in Baltimore, Maryland, can do an inner thigh lift. A thigh lift offers a more toned and taut appearance. Liposuction can be done at the same time if excess fat needs to be removed from the area as well. 

The procedure is an outpatient procedure, which takes up to two to three hours. You will be given general anesthesia or “twilight” sedation. Your plastics surgeon will make an incision at the junction of the inner thigh and the pubic area so that excess skin and fat can be removed and the remaining skin tightened. You will have two drainage tubes in place and these will be removed one to two weeks after surgery. These are needed to remove excess fluid that your body produces in response to surgery.

Recovery from thigh lift surgery

The plastic surgeon will prescribe pain medication for a few days after the procedure is done. Swelling should begin to disappear in a matter of weeks and resolve completely in a few months. You should consult with your surgeon about how long you will need to take off work; it is likely to be at least a week but will depend on the nature of your work. The plastic surgeon will advise you to refrain from strenuous activity, including running and other types of exercise, for four to six weeks. You may also need to wear a compression garment for up to six weeks. 

You will have scars though the initial redness of the scars will begin to fade after two to three months, leaving much less visible white lines. Scars are generally well hidden by clothing. Therapies, such as laser, may minimize the visibility of scars.

Sometimes dieting and exercise alone does not remove fatty deposits in parts of the body, such as the thighs, hips, abdomen, and upper arms, which can be frustrating to some people. The plastic surgeons at Johns Hopkins, in Baltimore, Maryland, offer liposuction, or lipoplasty, a process that removes excess fat deposits.

Liposuction is also often done in conjunction with other procedures, such as facelifts, neck lifts, inner thigh lifts, and breast reduction for men and women.

Generally, whichever kind of liposuction is done, it can be done as an outpatient procedure if it is not being done in conjunction with a more invasive procedure. You will likely receive a local anesthetic and sedation to keep you comfortable.

Kristen Parker Broderick, M.D.
Assistant Professor of Plastic and Reconstructive Surgery

Damon Sean Cooney, M.D., Ph.D.
Clinical Director, Face Transplant Program, Johns Hopkins Comprehensive Transplant Center
Assistant Professor of Plastic and Reconstructive Surgery

Michele Ann Manahan, M.D.
Department Vice Chair for Faculty and Staff Development and Well-Being and Past Department Director of Patient Safety
Professor of Plastic and Reconstructive Surgery

Sashank Kurapati Reddy, M.D., Ph.D.
Assistant Professor of Plastic and Reconstructive Surgery

Gedge David Rosson, M.D.
Director of Breast Reconstruction
Associate Professor of Plastic and Reconstructive Surgery

Mohammed Abdullah A Alrakan, M.B.B.S.

• Liposuction

A lower body lift, sometimes called a belt lipectomy, combines a tummy tuck (abdominoplasty) with a thigh lift. People who have lost a lot of weight, often through bariatric surgery, sometimes want to have a lower body lift to remove excess sagging skin. Other people who want a tummy tuck may also opt to tighten the skin in their thighs at the same time.

The cosmetic surgeons at Johns Hopkins, in Baltimore, Maryland, will do a lower body lift to tighten loose sagging skin in the abdomen, posterior thighs, hips, outer thighs and anterior thighs.

The plastic surgeon makes incisions from the back around to the front of thighs to allow excess skin and fat tissue to be removed. The remaining tissue is used to stretch and smooth the lower body. The procedure can be an outpatient procedure.

Recovery from a lower body lift

You will have some discomfort, however, this is expected and typically easily controlled with pain medications. Discomfort will dissipate over a week or two after the surgery. Your doctor will prescribe pain medication for you to take after you return home. You will also need to wear a compression garment for a few weeks after the surgery, and your plastic surgeon may recommend that you follow a special diet.

You will need to take at least two weeks off of work and will have to restrict normal activity for 4-6 weeks. You will have to wait approximately 6-8 weeks before you can resume exercise. Swelling should begin to disappear in a matter of weeks and resolve completely in a few months. While the scars will be permanent, they will fade in about 12 months and can be hidden by clothing.

Tummy tuck procedures

After consultation with your cosmetic surgeon, you can decide between two procedures: a complete tummy tuck and a partial or mini tummy tuck.

• Complete abdominoplasty - In this surgery, the plastic surgeon places the scar very low in the “bikini line” in order to disguise it as much as possible. Excess skin and fat are removed, and sometimes the muscles are repaired to create a flat contoured abdomen.

• Partial or mini abdominoplasty - This procedure focuses on one part of the abdomen and requires a smaller scar. The surgeon may opt for endoscopic-assisted surgery, which is less invasive and reduces the procedure time. However, this is reserved for special cases of abdominal muscle weakness and laxity.

Depending on which abdominoplasty procedure you will have, surgery may take anywhere from 1-3 hours. You will receive general anesthesia or intravenous “twilight” sedation. This surgery may require an overnight stay, as well as standing and sleep modifications for up to a week. You will have drainage tubes in place in order to remove any excess fluid that your body produces. This is normal and the tubes will be removed over 1-3 weeks. 

• Tummy Tuck