What is reconstructive surgery?
Physical injuries and genetic defects can take a toll on the appearance of the human body. From simple scars, to large deformations, when physical trauma happens to a person, he or she is never the same again. Some will just let the injury stay, regardless of how it negatively affects their appearance. To those who cannot emotionally and psychologically bear the appearance of the injury, it is a whole different story.
Some scars can be hidden by makeup, but larger injuries are not so easily dealt with. And these injuries can restrict, or even dictate the way a person lives his or her life. Burns will be covered by long clothing, misshapen breasts will prevent women from wearing a bikini, or putting on sexy lingerie. All these can really restrict a person’s happiness.
Fortunately, however, those who wish these defects corrected can turn to reconstructive surgery. Plastic reconstructive surgery is the collective term referring to surgical procedures that are aimed to reconstruct or repair any damaged areas on the patient’s body. These surgeries can turn the defective areas of the body to near, sometimes even perfect condition, depending on the severity of the case and the skill of the surgeon.
The benefits of reconstructive surgery
Most people will immediately point to the aesthetic benefits of reconstructive surgery, and they have good reason to do so. A perfectly executed reconstruction can return most areas of the body to near perfect condition. Reconstructive surgery also serves a practical purpose.
Areas of the body that serve an important function can be severely hindered from doing their job due to physical trauma or a birth defect. Take, for example, the nose. A misshapen, broken, or injured nose, not only causes a negative aesthetic impact, but can prevent the patient from breathing properly, can cause “whistling” noises, and can cause nasal leaking, which is not only embarrassing, but also unhygienic. Doing a reconstruction of the nose can solve all of these problems at once, on top of the fact that doing so will make the face look more pleasing.
The nose is just one of the areas of the body that can be reconstructed. Many procedures, both for male and female patients, are available to help repair not only their bodies, but also their lives.
The different kinds of reconstructive surgery procedures
Scar tissue removal – Scarring is one of the most common skin problems that people want addressed. Some scars are small and can easily be hidden by makeup. Some scars, like from a surgical operation or an injury, are so large that it is impractical, if not impossible, to totally hide them from view. Scar tissue removal is the answer to this problem. This plastic reconstructive surgery procedure has many variants, from using traditional surgical methods, to using modern, non-invasive tools, like lasers.
Traditional scar removal requires perfectly placed incisions, and pulling of skin to either remove excess scar tissue, reposition the scar to conform into a more natural line in the body, or both. A procedure called a Z-Plasty is a surgical technique that can reposition the scar to conform to natural lines and creases of the skin. It is called a “Z-Plasty” because the procedure requires incisions on each side of the scar, and overlapping small triangular flaps of skin to form a “Z” shape. This procedure can severely lessen the scar’s visibility, but not totally remove them.
Certain scars will require another procedure, called skin grafting. This procedure, usually reserved for areas with diminished functionality, will require skin to be taken from a donor site (usually an area not normally visible) and to replace it in the damaged area.
An alternative to skin grafting is flap surgery, in which fat, skin, blood vessels, sometimes even the muscles, are moved from a healthy part of the body to the scarred and damaged areas. This procedure, like skin grafting, is reserved for more severe cases, but can usually yield better cosmetic results, as well as functional results, than skin grafts.
RECONSTRUCTIVE BREAST PROCEDURES
Breast reconstruction and reduction – Breast reconstruction is among the most common plastic reconstructive surgery procedures, simply because there are a lot of patients that need them. Breast injuries and defects can be caused by many reasons, but among the most common are breast cancer, breast implant malfunctions, and physical injuries.
Any injuries and defects to the breasts can cause severe negative emotional impacts to women, especially because the breasts are usually placed in high regard as a symbol of femininity. Breast reconstruction fixes these problems, and in the best cases, breast reconstruction results in near perfect repair.
Depending on the problem and severity of the case, many different methods are available to perform a breast reconstruction surgery. Two of the most popular are the tissue expander/breast implant and flap reconstruction methods.
The tissue expander method uses what’s called a tissue expander, a temporary implant that is inserted beneath a pocket under the major pectoral muscle of the woman’s chest. Sometimes, the muscles are actually released to form a bigger pocket, depending on the amount of work needed. In this procedure, an acellular human or animal dermal graft is used to increase the coverage of the implant.
And then, saline solution is injected to constantly expand the overlaying tissue. It is a process that can take many weeks, even months. Once the expanded tissue has reached the needed size, a permanent implant replaces the temporary one, and areola and nipple construction, if needed, is performed after the skin has stretched to the intended size.
Flap reconstruction employs a different method, using tissue from other areas of the patient’s body, like the buttocks, thighs, back, and abdomen. The flaps from the donor site are surgically detached, in the shape needed to facilitate the repair. Usually, if the tissue flap donor is near the original site, its original blood vessels can be tunneled under the skin to the breast area. If not, new blood connections will be made at the target site.
Either way, once the flaps are detached, they are moved to the site, where incisions are made to attach to. Depending on the size, implants will be used in conjunction with the flap. In some cases, like when a back flap is used, enough volume can be harvested to reconstruct smaller sized breasts without using an implant.
Like the tissue expander method, areola and nipple reconstruction is done when the reconstructed breasts have healed up some. This is so that it is ensured that the nipples and areola are placed in the precise position.
There are several methods to do nipple reconstruction. Nipple-Areola Composite Graft method is employed if the nipple and areola of the target area is of sufficient size, and uses tissue that is harvested from donor areas to reconstruct the nipple. Local tissue flap method creates a nipple by raising a small flap in the target area and raised, producing a nipple. The areola is created by a circular incision, and then the nipple and areola color can be tattooed.
Reconstructive hand surgery – One of the most important plastic reconstructive surgery procedures available is reconstructive hand surgery. Because of the importance of the hands in day to day living, this is one procedure that should be availed by anyone with a hand defect or injury, because not only does reconstructive hand surgery improve the appearance of the hand, but its primary function is that of restoring the hand’s functionality, allowing the patient to live a nearly perfectly normal life.
Depending on the repair needed, there are many types of hand reconstructive surgery procedures available.
Tendon repair is one of the most common hand reconstruction surgeries. It involves reconnecting severed tendons, usually torn through injuries to the hand, to restore the movement and function of the hand.
Webbed fingers, an example of birth defect corrective surgery, is also another example. Depending on the birth defect, the surgeon will employ other surgical procedures that are used in many other reconstructive surgeries, like a Z-plasty to provide bending and flexing to areas of the hand that are not able to due to the birth defect.
Carpal tunnel hand surgery is done for people who suffer carpal tunnel syndrome, which prevents further movement of the wrist and hand due to nerve and tendon inflammation. The surgical procedure involves creating an incision from the palm to the wrist, releasing the pressure on the carpal tunnel.
Another is trigger finger surgery, used when a condition known as the trigger finger, causes one of the fingers to become locked in a bent, “shooting” position, caused by inflammation of the tendons. Surgery is done if normal methods of treating the condition, like rest or finger exercises, do not work, and done so by creating small incisions in the palm to release the finger’s pulley system.
Ganglion cyst removal is the process of draining, extracting, or treating what’s known as ganglion cysts, benign lumps that are usually found in the wrist and preventing movement that causes pain.
Many other conditions of the hand can be treated through hand reconstructive surgery.
Appendage reattachment surgery – some of the most advanced reconstructive surgeries available today involve reattachment surgery. Advances in medical technology and techniques have dramatically increased the success rates of reattachment surgeries that involve fingers, toes, ears, even whole limbs, like hands, feet, arms, and legs.
Reattachment surgeries involve cleaning up the severed appendage or body part, in order to preserve it for reattachment. If the body part includes a bone, like a finger, it is usually shortened and stabilized, sometimes using what’s known as K-wires, which are specialized sutures, and pins, that are secured to the bone. Once the bone is prepared, the two amputated bone areas are reconnected. Next, tendons are repaired, which is critical because any nerves, arteries, and veins, are only connected if there is no tension to the appendage. Tendons, arteries, veins, and nerves are reattached using sutures, but for veins that are damaged beyond reattachment, vein grafts are done.
The most critical part of any reattachment surgery is connecting the nerves. Advancements in techniques have increased the success rate of this portion of the surgery, allowing return of movement, feeling, and sensation to the reattached appendage.
Once the surgery is complete, the skin is sutured closed and covered with gauze in order to protect the surgery during the recovery process.
Some examples of reattachment surgeries include finger, ear, forearm, hand, foot, and penis reattachment.
There are many other plastic reconstructive surgeries available, which can treat any defect and damage to the area of the body. But before you opt for one, there are still a number of things that need to be considered.
Define your goals ahead of time
One of the first things that need to be done is to consult with the surgeon that will perform the plastic reconstructive surgery. Consultation sessions will allow the patient to detail what he/she wishes done, and what steps will be taken by the surgeon during the procedure. The surgeon can then tell the patient if the goals he/she wishes are realistic, because while there is a general idea of the possible results for each procedure, a lot still depends on the patient’s physiology, physique, and the extent of the repair that needs to be done.
Depending on the procedure, the duration of the surgery can last anywhere between a few minutes to a number of hours. Anesthesia is used, and the amount and potency varies depending on the surgery. Major surgeries will require the patient to be sedated, both for their safety and to prevent any major complications during the surgery itself. Some procedures will require patients to stay overnight for observation, before being sent home to start the recovery period.
Postoperative care and follow up
Surgeons will give patients a list of medication that needs to be taken diligently in order to facilitate proper recovery. These can include pain suppressants, anti-bacterial medication, and others. A certain amount of time will have be alloted for rest and recovery before any physical activity is allowed. This is to ensure that any incisions and sutures are not reopened, and extending the recovery period, or worse, undoing the surgery’s effects.
Follow up trips to the doctor will usually be needed, to allow the doctor to check up on the progress of recovery, and to immediately spot and fix any complications that might occur. It is important that the patient follows the schedule for check ups diligently.
Risks and possible complications
Like all surgical procedures, there are certain risks and possible complications involved with any given procedure. Infection is one of the biggest complications that a patient might experience. Procedures that require many incisions or have few but large incisions are prone to infection, depending on the patient’s own physiology, his or her diligence in taking the prescribed medication to combat infection, and the environment where the patient is recovering. Bruising and swelling are also common risks, and excessive swelling and bruising could indicate a more severe problem, and should immediately be brought to the attention of the doctor.
Costs of reconstructive surgery procedures
Like any plastic surgery procedure, the costs will vary depending on the area of the clinic, the amount of work needed to be done, and the surgeon’s fees.
Many insurance companies cover reconstructive surgery, but certain conditions must be met. Most important for many insurance companies is to know that the plastic reconstructive surgery is deemed medically necessary. Insurance companies will look at the reason why the procedure is performed. Is it to restore functionality? Or to alleviate pain? Or for cosmetic improvement? Generally, procedures will only covered if it is medically needed. For example, breast reconstruction after a masectomy due to breast cancer, or hand reattachment surgery after an accident.
Insurance coverage and levels of coverage vary from procedure to procedure, depending on the size and severity of the procedure that needs to be done. It is important to understand what is included in an insurance policy before the patient advances too far in planning for plastic reconstructive surgery. Usually, there are three cost sharing options. A deductible, which is the total amount covered that must be paid by the patient first before the insurance company pays benefits. A flat rate copayment which is a defined share of cost that the patient pays, with the company paying an amount based on the patient’s policy. The third is a percentage based copayment, which is a percentage share of costs that the patient pays, with the insurance company paying an amount based on the patient’s policy.
Patients should remember to bring their insurance cards when they visit the plastic surgeon’s office for the first time. This help the surgeon help the patient in assessing if the surgery needed is indeed covered by the insurance plan.