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Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition.
| | This article needs additional citations for verification .(December 2011) |
Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition.
Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery. [1] In regard to training, plastic surgery is a recognized medical specialty and a surgeon can be a "board-certified" plastic surgeon by the American Board of Plastic Surgery. [2] However, reconstructive surgery is not a specialty and there are no board-certified reconstructive surgeons.
More accurately, reconstructive surgery should be contrasted with cosmetic surgery. Reconstructive surgery is performed to
Separately, the patient must be healthy enough so that the benefits of the procedure outweigh the risks of complications or death. A procedure could be considered reconstructive but not medically necessary due to the risk to the patient.
In addition, Section 1862(a) (1) (A) of the Social Security Act directs the following: "No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." [4] Therefore, outside clinical interpretation and carrier guidelines, there is a federal statute that "improving functionality and restoring appearance" are covered as reconstructive and medically necessary. [5]
This definition is contrasted with cosmetic surgery performed to improve aesthetics or the appearance of a body part. [6] A plastic surgeon can perform both reconstructive and cosmetic procedures. Some procedures, such as a panniculectomy (aka tummy tuck) can be considered as cosmetic by one insurance company and reconstructive by another. The surgeon may not be using the Medicare or reimbursement criteria when referring to a procedure as reconstructive or cosmetic. Plastic surgeons, maxillo-facial surgeons and otolaryngologists do reconstructive surgery on faces to correct congenital defects, after trauma and to reconstruct the head and neck after cancer. [7]
Another good example is repair of a cleft palate, or cheiloplasty, which surgically corrects abnormal development, restores function to the lips and mouth and produces a more normal appearance. [8] This meets the definition of reconstructive surgery and is mandated by state laws in at least 31 states, but could be denied as cosmetic by individual insurance companies in the remaining states. [9]
Other branches of surgery (e.g., general surgery, gynecological surgery, pediatric surgery, plastic surgery, podiatric surgery) also perform some reconstructive procedures.
Reconstructive surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. [10]
Reconstructive surgeons use the concept of a reconstructive ladder to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion, and free flaps.[ citation needed ]
Reconstructive surgery procedures include breast implant removal, reduction mammoplasty, breast reconstruction, surgical correction of birth anomalies, congenital nevi surgery, and liposuction for lipedema. [11] [12] Cosmetic surgery procedures include breast enhancement, reduction and lift, face lift, forehead lift, upper and lower eyelid surgery (blepharoplasty), laser skin resurfacing (laser resurfacing), chemical peel, nose reshaping (rhinoplasty), reconstruction liposuction, Nasal reconstruction using a paramedian forehead flap, as well as tummy tuck (abdominoplasty). [13]
Recent literature in medline also has noted implementation of barbed suture in these procedures. [14]
Biomaterials are, in their simplest form, plastic implants used to correct or replace damaged body parts. Biomaterials were not used for reconstructive purposes until after World War II due to the new and improved technology and the tremendous need for the correction of damaged body parts that could replace transplantation. The process involves scientific and medical research to ensure that the biomaterials are biocompatible and that they can assume the mechanical and functioning roles of the components they are replacing.[ citation needed ]
A successful implantation can best be achieved by a team that understands not only the anatomical, physiological, biochemical, and pathological aspects of the problem, but also comprehends bioengineering. Cellular and tissue engineering is crucial to know for reconstructive procedures. [15]
An overview of the standardization and control of biomedical devices has recently been gathered by D. G. Singleton. Papers have covered in depth the U.S. Food and Drug Administration (FDA) Premarket Approval Process (J. L. Ely) and FDA regulations governing Class III devices. Two papers have described how the National Institute of Standards and Technology, American Dental Association, National Institute of Dental and Craniofacial Research, and private dental companies have collaborated in a number of important advances in dental materials, devices, and analytical systems.[ citation needed ]
Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. It involves using autologous tissue, prosthetic implants, or a combination of both with the goal of reconstructing a natural-looking breast. This process often also includes the rebuilding of the nipple and areola, known as nipple-areola complex (NAC) reconstruction, as one of the final stages.
Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims to improve the appearance of it. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.
Mammaplasty refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are two main types of mammoplasty:
Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augementation mammoplasty is applied to correct congenital defects of the breasts and the chest wall in other cases it is used purely as a cosmetic surgery, primary breast augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.
Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the patient's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the patient's self-image, and of the patient's mental health.
Oral and maxillofacial surgery is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the oral cavity (mouth), head and neck, and jaws, as well as facial cosmetic surgery/facial plastic surgery including cleft lip and cleft palate surgery.
Prosthodontics, also known as dental prosthetics or prosthetic dentistry, is the area of dentistry that focuses on dental prostheses. It is one of 12 dental specialties recognized by the American Dental Association (ADA), Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland, Royal College of Surgeons of Glasgow, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. The ADA defines it as "the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth or oral and maxillofacial tissues using biocompatible substitutes."
Chin augmentation using surgical implants alter the underlying structure of the face, intended to balance the facial features. The specific medical terms mentoplasty and genioplasty are used to refer to the reduction and addition of material to a patient's chin. This can take the form of chin height reduction or chin rounding by osteotomy, or chin augmentation using implants. Altering the facial balance is commonly performed by modifying the chin using an implant inserted through the mouth. The intent is to provide a suitable projection of the chin as well as the correct height of the chin which is in balance with the other facial features.
Lip augmentation is a cosmetic procedure that modifies the shape of the lips using fillers, such as collagen or implants. The procedure may be performed to increase lip size, correct asymmetry, create protrusion, or adjust the ratio of the top and bottom lips. The procedure typically involves surgical injection, though temporary non-surgical alternatives exist.
A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.
Pediatric plastic surgery is plastic surgery performed on children. Its procedures are predominantly conducted for reconstructive purposes, although some cosmetic procedures are performed on children as well. In children, the line between cosmetic and reconstructive surgery is often blurred, as many congenital deformities impair physical function as well as aesthetics.
A DIEP flap is type of breast reconstruction where blood vessels, fat, and skin from the lower belly are relocated to the chest to rebuild breasts after mastectomy. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. This is a type of autologous reconstruction, meaning one's own tissue is used.
Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, liposuction is the most common cosmetic surgery.
John Bradford Fisher is an American plastic surgeon who pioneered suction fat removal, or liposuction.
Aesthetic medicine is a branch of modern medicine that focuses on altering natural or acquired unwanted appearance through the treatment of conditions including scars, skin laxity, wrinkles, moles, liver spots, excess fat, cellulite, unwanted hair, skin discoloration, spider veins and or any unwanted externally visible appearance. Traditionally, it includes dermatology, oral and maxillofacial surgery, reconstructive surgery and plastic surgery, surgical procedures, non-surgical procedures, and a combination of both. Aesthetic medicine procedures are usually elective. There is a long history of aesthetic medicine procedures, dating back to many notable cases in the 19th century, though techniques have developed much since then.
MIRA is a multidisciplinary and complementary method for treating many chronic diseases. The MIRA Procedure is a result of combining efforts from different medical fields developed in the University of Chicago in 1992. It basically consists in medically grafting live rejuvenated tissue in the form of autologous adipose adult stem cells to a damaged organ in order to restore it and improve its function. This method is currently approved by the U.S. Food and Drug Administration (FDA).
New York Plastic Surgical Group (NYPS Group) was founded in April 1948 and is the oldest and largest private academic plastic surgery practice in the United States. The group currently has 10+ offices within the New York Metropolitan area, including Garden City, East Hills, Babylon, Huntington, Manhattan, Queens, Brooklyn, Westchester, and Connecticut. The practice operates with over 20 plastic and reconstructive surgeons who were trained at institutions including Memorial Sloan–Kettering Cancer Center, Cleveland Clinic and Massachusetts General Hospital. NYPS Group is composed of nine Centers of Excellence: Breast Reconstruction Surgery and Microsurgery; Burns and Complex Wound Management; Cosmetic Surgery of the Face, Breast, and Body; Facial Reanimation Treatment; Hand Surgery and Peripheral Nerve Repair; Non-Invasive Cosmetic Procedures; Pediatric Plastic and Craniofacial Surgery; Post-Weight Loss Cosmetic and Reconstructive Surgery; and Skin Care and Age Management.
Lipotuck is a procedure trademarked in 2006, by Dr. A. H. Ahmadi. The procedure is a single cosmetic surgery combining abdominoplasty and liposuction.
The Overseas Plastic Surgery Appeal is a registered charity in the UK, that exists to provide free facial surgery for poor children and young adults in Pakistan. The OPSA team operate on facial abnormalities including cleft lip and palate.
Culture of cosmetic surgery is a set of attitudes and behavior regarding making changes to one's appearance via plastic surgery. World War I left thousands of soldiers with unprecedented levels of facial damage, creating a massive need for reconstructive surgery. Harold Gillies of New Zealand developed methods to restore function and structure to the faces of soldiers and these processes rapidly gained popularity. During the 1940s and 50s, personal appearance became more emphasized in the United States. As beauty standards changed, new products and techniques were developed to meet those demands.
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