Plastic and reconstructive surgery

What is it?

According to the ABPS and AMA FREIDA: plastic surgery is concerned with "the repair, reconstruction or replacement of physical defects of form or function" of the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast, trunk and external genitalia, or the aesthetic enhancement of these areas; according to the ABPS the surgeon uses the principles of cosmetic surgery to enhance appearance and to improve the results of reconstructive operations. According to the ASPS: "reconstructive surgery can improve abilities, function and quality of life" when body structures are affected by congenital or developmental defects or by injury or disease. MedlinePlus states that surgeons can change the appearance of parts of the body through cosmetic surgery.

Conditions it covers

According to the ASPS, reconstructive procedures include: breast reconstruction, breast reduction, repair of cleft lip and palate, congenital deformities, surgery for early fusion of the skull sutures, removal of giant birthmarks, hand surgery, treatment of lymphoedema, microsurgery, corrective jaw surgery, abdominoplasty, scar revision, septoplasty, skin cancer removal, tissue expansion and others. MedlinePlus lists common cosmetic procedures relating to the breast (enlargement, reduction or lift), the ears, eyelids, face (wrinkles and acne scars), hair, nose and abdomen.

Related pages on this site: breast cancer, the skin, general surgery, oncology and ear, nose and throat. According to MedlinePlus: if a woman needs a mastectomy she can choose to have the breast reconstructed at the same time or later, it is advised to talk to a plastic surgeon before the mastectomy even if reconstruction is later, the most suitable type of reconstruction depends on age, body shape and the type of cancer surgery, and "a plastic surgeon can help with the decision". The ASPS states that the goal of breast reconstruction is to restore the breast to a near-normal shape, appearance, symmetry and size after total or partial mastectomy, using implants or the patient's own tissue, often in stages. The ASPS states that skin cancer removal (such as basal cell carcinoma and melanoma) is performed with techniques that preserve health and appearance, though "there is no surgery without scars". FREIDA states that independent residency in this specialty follows a full residency in general surgery, ear, nose and throat or others. The references of this page do not name the dermatologist's role.

Common tests and procedures

This page does not cover lists of pre-operative tests. The ABPS states that the specialty requires skill in grafts and flaps, free tissue transfer, replantation, wound care and implanted materials. MedlinePlus states that breast reconstruction may use implants filled with saline or silicone gel, or tissue transferred from the abdomen, back or buttocks, and the doctor may suggest waiting until radiation therapy has finished if it is part of the plan. Risks of reconstruction with implants according to MedlinePlus include: implant rupture or leakage requiring further surgery, capsular contracture (tightening of scar tissue around the implant), infection that may require removal of the implant, implant displacement and change in shape, asymmetry between the breasts, and loss of sensation around the nipple and areola. It states that the patient and surgeon decide together on reconstruction and its timing.

When to see one

For safety the ASPS suggests that the patient ask their surgeon: Are you certified by the board of plastic surgery? Were you specifically trained in plastic surgery, and for how many years? Do you have privileges at the hospital to perform this operation? Is the surgical facility accredited by a recognised accrediting body? How many times have you performed this procedure? Am I a suitable candidate for it? What is the expected recovery period? What are the risks and complications, and how are they treated? What are my options if I am not satisfied with the result? It stresses that the best results are achieved when the patient and surgeon communicate frankly and work together towards "realistic goals". The ASPS states that its members complete at least six years of surgical training after medical school, including at least three years in plastic surgery, and perform operations in accredited or licensed facilities; the ABPS states that certification means completing specific training requirements and passing examinations, that it expires every 10 years, and that the public can verify it. (American standards; licensing and accreditation systems in your country may differ.)

Referral to the specialist is usually decided by the primary care provider according to the condition (MedlinePlus). MedlinePlus advises a woman considering breast reconstruction to talk to a plastic surgeon before the mastectomy, even if she plans reconstruction later.

Common questions