bring back, refashion and restore to wholeness
the features that nature gave but chance destroyed,
not that they may be an advantage to the living
soul, not as a mean artifice but as an alleviation
of illness, not as becomes charlatans but
as becomes good physicians and followers of
the great Hippocrates. For though the original
beauty is indeed restored . . . the end for
which the physician is working is that the
features should fulfill their offices according
to nature's decree.
What is reconstructive
It's estimated that more that one million
reconstructive procedures are performed
by plastic surgeons every year. Reconstructive
surgery helps patients of all ages and types
- whether it's a child with a birth defect,
a young adult injured in an accident, or
an older adult with a problem caused by
The goals of reconstructive surgery differ
from those of cosmetic surgery. Reconstructive
surgery is performed on abnormal structures
of the body, caused by birth defects, developmental
abnormalities, trauma or injury, infection,
tumors, or disease. It is generally performed
to improve function, but may also be done
to approximate a normal appearance.
Cosmetic surgery is performed to reshape
normal structures of the body to improve
the patient's appearance and self-esteem.
Although no amount of surgery can achieve
"perfection," modern treatment
options allow plastic surgeons to achieve
improvements in form and function thought
to be impossible 10 years ago.
This will give you a basic understanding
of some commonly-used techniques in reconstructive
surgery. It won't answer all of your questions,
since each problem is unique and a great
deal depends on your individual circumstances.
Please be sure to ask your doctor to explain
anything you don't understand. Also, ask
for information that specifically details
the procedure you are considering for yourself
or your child.
HAS RECONSTRUCTIVE SURGERY?
There are two basic categories of patients:
those who have congenital deformities, otherwise
known as birth defects, and those with developmental
deformities, acquired as a result of accident,
infection, disease, or in some cases, aging.
Some common examples of congenital abnormalities
are birthmarks; cleft-lip and palate deformities;
hand deformities such as syndactyly (webbed
fingers), or extra or absent fingers; and
abnormal breast development.
Burn wounds, lacerations, growths, and aging
problems are considered acquired deformities.
In some cases, patients may find that a procedure
commonly thought to be aesthetic in nature
may be performed to achieve a reconstructive
goal. For example, some older adults with
redundant or drooping eyelid skin blocking
their field of vision might have eyelid surgery.
Or an adult whose face has an asymmetrical
look because of paralysis might have a balancing
facelift. Although appearance is enhanced,
the main goal of the surgery is to restore
Large, sagging breasts are one example of
a deformity that develops as a result of genetics,
hormonal changes, or disease. Breast reduction,
or reduction mammaplasty, is the reconstructive
procedure designed to give a woman smaller,
more comfortable breasts in proportion with
the rest of her body.
In another case, a young child might have
reconstructive otoplasty (outer-ear surgery)
to correct overly-large or deformed ears.
Usually, health insurance policies will consider
the cost of reconstructive surgery a covered
expense. Check with your carrier to make sure
you're covered and to see if there are any
limitations on the type of surgery you're
planning. Work with your doctor to get pre-authorization
from the insurer for the procedure.
SURGERY CARRIES SOME UNCERTAINTY AND RISK
When reconstructive surgery is performed by
a qualified plastic surgeon, complications
are infrequent and usually minor. However,
individuals vary greatly in their anatomy
and healing ability and the outcome is never
As with any surgery, complications can occur.
These may include infection; excessive bleeding,
such as hematomas (pooling of blood beneath
the skin); significant bruising and wound-healing
difficulties; and problems related to anesthesia
There are a number of factors that may increase
the risk of complications in healing. In general,
a patient is considered to be a higher risk
if he or she is a smoker; has a connective-tissue
disease; has areas of damaged skin from radiation
therapy; has decreased circulation to the
surgical area; has HIV or an impaired immune
system; or has poor nutrition. If you regularly
take aspirin or some other medication that
affects blood clotting, it's likely that you'll
be asked to stop a week or two before surgery.
In evaluating your condition, a plastic surgeon
will be guided by a se t of rules known as
the reconstructive ladder. The least-complex
types of treatments-such as simple wound closure-are
at the lower part of the ladder. Any highly
complex procedure-like micro-surgery to reattach
severed limbs-would occupy one of the ladder's
highest rungs. A plastic surgeon will almost
always begin at the bottom of the reconstructive
ladder in deciding how to approach a patient's
treatment, favoring the most direct, least-complex
way of achieving the desired result.
The size, nature and extent of the injury
or deformity will determine what treatment
option is chosen and how quickly the surgery
will be performed. Reconstructive surgery
frequently demands complex planning and may
require a number of procedures done in stages.
Because it's not always possible to predict
how growth will affect outcome, a growing
child may have to plan for regular follow-up
visits on a long-term basis to allow additional
surgery as the child matures.
Everyone heals at a different rate-and plastic
surgeons cannot pinpoint an exact "back-to-normal"
date following surgery. They can, however,
give you a general idea of when you can expect
to notice improvement.
IN WOUND TREATMENT
In deciding how to treat a wound, a plastic
surgeon must carefully assess its size, severity,
and features: Is skin missing? Have nerves
or muscles been damaged? Has skeletal support
As you and your plastic surgeon form your
surgical plan, it's important to have a clear
understanding of what will happen during the
procedure. Asking questions is key to making
an informed decision.
Direct closure is usually performed on skin-surface
wounds that have straight edges, such as a
simple cut. Maximum attention is given to
the aesthetic result, taking extra care to
minimize noticeable stitch marks.
Tissue expansion is a procedure that enables
the body to "grow" extra skin
by stretching adjacent tissue. A balloon-like
device called an expander is inserted under
the skin near the area to be repaired and
then gradually filled with salt water over
time, causing the skin to stretch and grow.
The time involved in tissue expansion depends
on the individual case and the size of the
area to be repaired.
The advantages of tissue expansion are many-it
offers a near-perfect match of skin color,
sensation, and texture; the risk of tissue
loss is decreased because the skin remains
connected to its original blood and nerve
supply; and scars are less apparent than
those in flaps or grafts. The expander temporarily
creates what can be an unsightly bulge,
making this option undesirable for some
In addition to correcting cuts and other surface
wounds, plastic surgeons also regularly treat
both cancerous and non-cancerous growths and
problems with the supporting structures beneath
Tumors, both cancerous and benign, vary widely
in type, severity and recurrence. The removal
method chosen will depend largely on the type
of growth, what stage it's in, and its location
on the body.
Skin cancers and growths are usually removed
by excision and closure, in which the growth
is simply removed completely with a scalpel,
leaving a small thin scar. If the cancer is
large or spreading, major surgery may be necessary,
using flaps to reconstruct the affected area.
Whether the defect is congenital or acquired,
plastic surgeons can usually restore comfort,
mobility, and normal appearance to patients
with hand problems. Acquired defects include
carpal tunnel and other painful conditions
caused by pressure on the nerves (usually
at the wrist or elbow); trigger fingers, a
condition caused by swelling of a flexor tendon
in the hand; ganglion cysts, a benign cystic
growth and scar contracture which occurs when
a wound or burn on the hand heals poorly and
forms scar tissue that curls the fingers or
restricts mobility. Dupuytren's disease causes
a similar problem of hand contracture.
Children born with syndactyly (webbed fingers)
can benefit from finger separation, where
a zig-zag-type incision separates the fingers
and rearranges the tissue between them, preventing
growth deformities. If a child had polydactyly
(extra fingers), correction is often more
than simply removing the extra digits. The
surgeon may also need to balance the tendons
of the hand and stabilize the remaining finger
joints so that the hand functions as normally
as possible. Plastic surgeons also reconstruct
missing digits, including the thumb, which
supplies half of the hand's function.