RECONSTRUCTIVE PROCEDURES AT-A-GLANCE
Injuries, disease, and birth defects can all lead to deformities that can be repaired with reconstructive plastic surgery. However, although surgery can restore form and function to improve your condition, it can’t fulfill unrealistic expectations.
You will achieve the best results when you work closely with your plastic surgeon to set realistic goals. This web page presents an overview of the indications and applications for the following reconstructive plastic surgery procedures:
- Breast reconstruction
- Breast reduction
- Cleft lip repair
- Ear surgery
- Scar revision
- Skin cancer treatment
If you lost a breast or were disfigured by mastectomy, several surgical techniques can be used to reconstruct a new breast:
- Flap technique forms a natural breast shape using donor sites, which may include the abdomen, back or buttocks.
- Implants can create a new breast mound.
- Tissue expansion aids in the formation of new tissue when healthy tissue is inadequate to cover and support the breast implant after a mastectomy.
- Nipple and areola reconstruction (pigmented skin surrounding the nipple) is achieved through additional grafting techniques and tattooing to provide areola color.
Female Breast Reduction
- Surgery can correct disproportionately large, sagging breasts through the removal of excess fat and tissue to create a smaller, better-positioned breast. Depending on the size and position of your breasts, incisions may include a keyhole pattern, a vertical pattern or a circular pattern.
- Reduction in the size of an enlarged areola may also be performed. Your breast reduction surgery may be covered by insurance. Carefully review your policy to determine coverage.
Male Breast Reduction
- Over-developed male breast tissue and, in some cases, asymmetry of the male breast can be corrected with plastic surgery to create a flatter or more symmetrical contour of your chest. In most cases, correction of gynecomastia is not eligible for insurance coverage.
- Liposuction is used when fatty tissue is the primary source of breast over-development. Incisions are commonly hidden at the areola, in the underarm area or in the breast crease.
- Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia.
Cleft Lip Repair
A cleft lip is an incomplete upper lip formation, present at birth, that appears as a separation on one or both sides.
- Cleft lip repairs are initially performed when a child is at least ten weeks of age and ten pounds in weight and has a hemoglobin (or blood count) of at least ten.
- Correction of a cleft lip usually requires multiple procedures during a child’s growth and development. Intervention is recommended early because of other medical problems that can be associated with clefting, particularly ear infections.
Protruding ears on one or both sides can be corrected with plastic surgery.
Surgical techniques create or increase an under-developed ear fold or reduce enlarged cartilage to create a more normal appearance. Conditions that can be treated include:
- Overly large ears — a rare condition called macrotia
- Protruding ears occurring on one or both sides to varying degrees—not associated with hearing loss
- Adult dissatisfaction with previous ear surgery
Microtia is a complex, congenital ear deformity in which the outer ear is severely disfigured. Hearing is impaired to varying degrees. Reconstruction requires staged surgical procedures to create a more normal external ear and to improve hearing.
Less common ear deformities, which may or may not affect hearing ability, include: constricted ear, Stahl’s ear (an ear that is distorted in shape due to an abnormal fold of cartilage) and cryptotia (hidden ear). An individualized surgical plan is required to define goals and achieve desired results.
Excessive scar formation, which may cause restricted movement, can be repaired. Common scar formations include keloids, hypertrophic scars, and contracture.
Scar revision includes:
- Topical treatments such as gels, tapes or external compression can help in wound closure and healing or reduce the ability of skin to produce irregular pigment.
- Injectable treatments are often used to fill depressed or concave scars.
- Surface treatments, such as dermabrasion, laser or light therapy, chemical peel solutions, or skin bleaching agents, can improve scar appearance and texture.
- Excision to remove, narrow or change the direction of a scar.
- Pharmaceutical tissue substitutes may be used if ample, healthy tissue is not present for closure of a scar incision. Tissue expansion may be an alternative.
Skin Cancer Treatment
A variety of techniques are used to remove and treat malignant lesions of the skin.
Treatment of skin cancer with plastic surgery is designed to maximize cure rates and minimize any resulting disfigurement in appearance.
- Simple excision of the cancer with a surrounding rim of normal skin and tissue treats small lesions leaving a small, localized scar.
- Microscopic examination of the lesion during surgery assures complete excision of the cancerous tissue.
- Larger lesions and those affecting underlying tissue and structures require more advanced treatment. Reconstruction may use advanced flap techniques to repair the excision wound and restore a more normal appearance.
- Additional treatments to improve cure rates include radiation therapy.
Questions to ask my plastic surgeon
Use this checklist as a guide during your consultation
- Are you certified by the American Board of Plastic Surgery?
- Were you specially trained in the field of plastic surgery?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally or state recognized accrediting agency? Is it state licensed? Medicare-certified?
- How many procedures of this type have you performed?
- Am I a good candidate for this procedure?
- What will be expected of me to get the best results?
- Where and how will you perform my procedure?
- What shape, size, surface texturing, incision site, and placement site are recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if I am dissatisfied with the cosmetic outcome of my surgery?
- Do you have before-and-after photos I can look at for each procedure? What results are reasonable for me?