Reconstructive Surgery
Reconstructive plastic surgery corrects physical abnormalities caused by trauma, infection, developmental dysfunction, congenital anomalies, disease and aging. While the primary goal is to improve body function, reconstructive surgery can also have psychological benefits for the patient by restoring a more natural appearance, thereby improving self esteem.
The Emory Plastic and Reconstructive Surgery Center is a local, regional and national referral center for the following reconstructive procedures:
Abdominal Wall Reconstruction
Reconstructive surgery can restore the integrity of the abdominal wall fascia, muscle or skin that has been adversely affected by trauma, tumors or hernia. Procedures may include using synthetic mesh, local sliding muscle and fascial flaps, or transferring vascularized tissue from another part of the body.
Thoracic Reconstruction
Many of the muscle flaps pioneered by Emory plastic surgeons can be used to cover and reconstruct chest wall defects following resection for cancer, wound healing problems or radiation damage.
Breast Reconstruction
Depending on the patient's overall health, breast reconstruction can either be a component of the original mastectomy procedure or performed later. It may also involve more than one operation, though follow up procedures are often performed on an outpatient basis. Occasionally surgery is performed on the natural breast so that it will look similar to the reconstructed one.
The four methods of breast reconstruction practiced by Emory surgeons are:
- Skin Expansion with Breast Implant
This is the simplest of breast reconstructions and involves a tissue expander placed under the skin of the affected breast. Blood transfusions are not required, pain is often minimal and recovery is fairly quick. Upon the removal of sutures, saline is added to the expander on a weekly basis, gradually stretching the skin. When sufficient stretching has been achieved, the expander is removed and replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure.
- Latissimus Dorsi Myocutaneous Flap
In this procedure, the triangular, flat muscle covering the lumbar region and the lower half of the thoracic region known as the latissimus dorsi is moved to the chest along with the overlying skin from the back to create a new breast mound. If necessary, a breast implant can be placed under the flap to balance any difference in size between the breasts. The incision is usually made along the bra line to conceal the scar. Blood transfusions are typically not required and nipple reconstruction is done later.
- Rectus Abdominus Myocutaneous Flap
Considered the most complicated reconstructive procedure, often involving approximately four-to-five hours of surgery, this method involves the tunneling of the rectus abdominus (the paired muscle that runs vertically on each side of the anterior wall of the abdomen) and its overlying skin up to the chest. The breast mound is then created to match the opposite breast. A blood transfusion may be required. Implants are usually unnecessary since the tissue is generally adequate to match the size of the other breast. If the opposite breast is large or pendulous, a simultaneous breast reduction can be done. Contouring of the new breast mound may also be performed and a synthetic mesh placed over the area where the muscle is moved to strengthen the abdominal wall and minimize the chance of hernia formation. Nipple reconstruction is done as a second procedure.
- Nipple Reconstruction
This simple outpatient procedure is often performed with local anesthesia and takes about one-to-two hours, the goal being to recreate a nipple using skin from the patient's breast that will match the appearance of the opposite breast.
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Reconstruction Following Surgery for Skin Cancer, Including Moh's Surgery
The different techniques used in treating skin cancers can be life saving but may leave patients with compromised cosmetic or functional results. Depending on the location and severity of the cancer, the consequences may range from small scarring to permanent changes in facial structures. In the latter case, the plastic surgeon can be an important member of the treatment team. Reconstructive techniques ranging from simple scar revision to the complex transfer of tissue flaps from elsewhere on the body can often repair damaged tissue, rebuild body parts and restore acceptable appearance and function.
One of the more common procedures for combating skin cancer is Moh's surgery, involving slices of cancerous skin being shaved away by a dermatological specialist. As each layer is removed, the surgical margins are checked for abnormal cells. Emory plastic surgeons are often involved in reconstructing any defects that occur as a result of such tumor removal in the facial area, individualizing closure techniques to each patient to minimize scarring as they attempt to repair any aesthetic damage caused by the surgery.
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Facial Scars
While scars can't be completely removed, it is possible to modify them and restore bones to their normal position. Facial scars are often repaired with tiny sutures, leaving a thinner, less visible scar that can be even more indistinguishable with dermabrasion or laser resurfacing.
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