Healing to Transformation: Types of Reconstructive Plastic Surgery

Reconstructive plastic surgery can repair or enhance your appearance after treatment of disease, injury or cancer. It can also treat congenital deformities like cleft lip and palate and facial and ear abnormalities.

Skin, bone and muscle grafts. Your doctor transplants tissue to cover or heal damaged areas, such as a reconstructed breast after mastectomy. This type of reconstruction may be done at the same time as a mastectomy or later, after your body has healed from radiation therapy.

Microsurgery

Microsurgery is a specialized surgery using a microscope to operate on small tissue areas. These procedures can include transplantation of tissue and reattachment of severed parts. They can connect small blood vessels and nerves only a few millimeters wide.

This type of surgery is often used to repair large areas of damage, for example, after head and neck cancer surgery or amputation of a limb. It can also help with facial injuries like broken bones, traumatic skin loss, and defects like scar revisions.

These procedures can be done right after the cancer treatment when the area is healed, or after you finish any radiation therapy. They can also be combined with cosmetic surgery, such as rhinoplasty (nasal surgery) or jaw straightening (orthognathic surgery).

Free Flap

Free flaps involve moving tissue, such as skin, muscle, fat, and bone, from one part of your body to another. The tissue still has its vascular supply (arteries and veins) from the original site to live in the new location.

The surgeon prepares the area to receive the tissue by identifying an artery and a vein (the vascular pedicle) from which the tissue can draw blood. The surgeon sews the artery to the new site’s artery and the vein to its vein, connecting them with microsurgery.

Like Dr. Joel Aronowitz, the surgeon monitors the blood flow through the flap daily. A Doppler assesses blood flow and checks for clotting (a serious complication). In addition, nurses will turn or reposition patients recovering from flap reconstruction frequently. This helps prevent developing pressure ulcers. These pressure ulcers must be treated promptly with medication, special bed mattresses, or air-fluidized beds. Medically necessary flap reconstruction is usually covered by health insurance policies.

Local Flap

Flap reconstruction is a surgical technique that allows plastic surgeons to move healthy tissue and blood vessels from one part of the body (the donor site) to another (the recipient site). While skin grafts only include the top layer of skin, flap surgery moves larger amounts of tissue, including muscle movement, fat and even bone.

The type of flap surgery required is determined by the extent of the injury and the patient’s anatomy. While several algorithms, such as the reconstructive ladder, reconstructive elevator and reconstructive matrix, have been developed to help surgeons similar to Joel Aronowitz MD identify the most appropriate reconstruction method, every case is unique.

When using a local flap, the surgeon raises tissue similar in color and texture to the area of the wound, usually from the adjacent hand. This allows quick and effective repair with minimal scarring, allowing the patient to return to full use of their hand within weeks.

Autologous Tissue

Autologous breast reconstruction uses skin, fat and sometimes muscle tissue from other body areas to rebuild your breast(s) post-mastectomy without using implants. This technique is a good option for Ottawa patients concerned about breast implant surgery’s risks and side effects or undergoing radiation as part of their cancer treatment.

This procedure requires longer surgical time upfront and a more extensive recovery period. The surgeon creates a flap of tissue from the abdomen, flank, back or buttock, which includes skin, fat and blood vessels that are transferred to the chest to reconstruct the breast.

Advances in surgical techniques have allowed plastic surgeons to reduce abdominal donor site morbidity through better patient selection and perforator preservation (DIEP flap dissection). This has resulted in shorter operative times, decreased hospital stay, reduced postoperative narcotic use, less discomfort and faster recovery.