Specialty Reconstruction Procedures

Reconstructive Surgery, the Ultimate Plastic Surgeon’s Challenge

Even though most people are familiar with plastic surgery because of aesthetic and cosmetic procedures, there’s also a lot more to know about such a rich and wide surgical specialization such as plastic and reconstructive surgery. The most complex, physically demanding and technical challenging procedures on the plastic surgery field are those related to reconstructive surgery because on such procedures, both the aesthetic result and functionality are equally important.

From the outside, it may be hard to realize how people can suffer from such conditions that require reconstruction of an anatomical area. However, from the inside, at the Plastic Surgery Arts Center, this is an everyday task.

Many patients suffering from massive trauma, as those seen in car or burn accidents and others because of wide, mutilating surgeries, especially because of cancer, search everyday for plastic surgeons’ offices, looking to remove visible scars from a previous accident or surgery and recover lost function.

Plastic surgeons such as Dr. Garcia from the Plastic Surgery Arts Center, take things very seriously and understand it is not always just a matter of appearance, but instead it’s about giving patients their lives back.

With more than 30 years of experience, Dr. Garcia is aware that reconstructive surgery is the ultimate challenge in his specialty because each patient is different from one another, hence a tailored approach for each patient’s needs is mandatory to achieve the best possible results.

Reconstructive surgery is so wide that virtually each single anatomical area could be reconstructed; nevertheless, the most common operations are performed on the breasts, maxillary and hand areas.

Reconstructive Breast Surgery

It used to be the case that patients who underwent breast cancer surgery suffered not only from the cancer itself but also because of the physical consequences of required surgeries to treat the disease. In fact, breast cancer survivors had to deal with the cancer and also the dramatic changes to their bodies that lead to critical changes on their self esteem, confidence and even behavior.

Today, such situations are just memories from the past because plastic surgeons work together with oncology surgeons to achieve two main goals on breast cancer treatment: total control of the cancer and minimal changes on body appearance, even after total mastectomy procedures.

This is possible only with experienced plastic surgeons as Dr. Garcia who are able to totally rebuild breasts to a normal configuration despite the addition of cancer surgery.

To achieve this goal, there are two main approaches; one is using a patient’s own body structures while the other involves the use of prosthetic material.

Depending on each patient, either of the approaches may be the most suitable.

In the first scenario, the breast may be reconstructed using a flap of abdominal muscles, fat and/or skin. Flaps are taken from the abdominal wall and used to build up a new breast. The so-called TRAM procedure is one of the first procedures used on reconstructive breast surgery but due to scars on the abdominal wall, many surgeons prefer to use prosthetic material.

In this scenario, a skin flap from the torso is used to cover a breast implant which must be chosen accordingly to the adjacent breast size. At the end of the procedure, scars will be almost invisible and breast configuration will be very close to normal. There is a possibility of having an issue with the lack of areola, however, this is usually not a huge concern since the Plastic Surgery Arts Center may tattoo the areola, leaving almost no signs of a breast reconstruction.

Maxillary Reconstructive Surgery

Besides breast reconstruction, plastic surgeons also have to deal with facial reconstruction, especially after car accidents and major trauma where sometimes more than one surgery is required.

Talking about facial reconstruction is to talk about dozens of bones, hundreds of tiny blood vessels, a myriad of muscles and many vital structures such as nerves involved in relatively narrow areas.

Considering the aforementioned, it’s not a surprise that maxillary and facial reconstructions are among the most demanding, complex and time-consuming surgeries performed by plastic surgeons. Sometimes it’s even necessary to perform more than one surgical intervention to achieve an optimal result.

Facial trauma is usually associated to high energy impacts such as car accidents, thus multiple fractures, skin loses and muscles abductions are frequent. Furthermore, facial trauma is associated to dental trauma as well, thus intervention not only of plastic surgeons but also dental surgeons may be necessary.

With that said, there’s no a “standard” approach and therapeutic decisions are made according to patients needs.
One of the first things needed to check for is assurance of the airways followed by stabilizing fractures, and many times can be accomplished by using metal plates fixed with screws which is then covered with muscles and skin.

Usually after the first surgery and once all fractures have healed, it’s necessary to work on soft tissue, creating flaps and using skin expanders to have enough healthy skin to cover scars, meanwhile maxillofacial and dental surgeons may need to work on dental implants as well any other oral problem associated to the trauma.

Results can be magnificent and even when it may several surgeries, long hospital stays and rehabilitations hours, at the end of the process, it’s amazing to see how there are almost no signs of massive trauma.

Reconstructive Hand Surgeries

But… what about hands? Hand surgery is always demanding because there’s few second chances to achieve optimal results meaning both a good aesthetic outcome but also preservation of function.

Patients requiring reconstructive hand surgery usually suffer from occupational accidents such as industrial machines crushing or cutting leading to extensive fractures and soft tissue damage.

As in facial trauma, there’s not a standard procedure and the treatment must be tailored to each patient’s needs according to basic protocols that include the needs to: Control Blood Loses, Limit Tissue Damage and Prevent Infections.

Once blood loss is controlled and debris cleaned, it’s time to start reconstruction which usually involves fixing broken bones with both external devices or internal fixation plates. When necessary it’s may be mandatory to repair major hand blood vessels and nerves, followed by tendon repairs and finalized by covering everything with skin.

Reconstructive hand surgery is a very demanding procedure usually requiring two interventions; the first one to control damages, stabilize fractures and repair noble structures and the second to suture tendons, muscles and other structures lying over the healed bones, to cover everything with skin flaps.

Plastic surgery is much more than just breast implants and aesthetic procedures, and in fact, encompasses a wide range of surgical specializations where doctors have to deal with all kinds of dramatic situations on very complex anatomical areas. However, with Dr. Garcia, the goals are always the same: preserve optimal function and restore normal appearance while limiting sequalae and giving patients’ back their lives.