When you think of plastic surgery you may immediately think of cosmetic procedures and celebrities who may have had “work done.” While this is a subset of plastic surgery, you may be surprised to learn that the field of plastic surgery encompasses a wide range of problems, from reconstruction after burns, to traumas, and cancer. Depending on a specific surgeon’s practice, other areas of plastic surgery may include hand surgery and craniofacial surgery for congenital defects such as cleft lips.

Goals and diversity

Plastic surgeons are trained to restore function and form as best as possible to help re-establish a patient’s quality of life and sense of normalcy. The sense of balance is essential for a patient to feel whole again. As such the field of plastic surgery covers all regions of the body: face, eyes, nose, breast, trunk, abdomen and extremities. Examples include reconstruction after a mastectomy for breast cancer and even facelift for aging changes. Neither one scenario nor the other is about simple vanity. Both are efforts to match how the patient feels internally with how they are externally. Both operations allow a patient to live a higher quality of life.

Reconstruction

Much of the plastic surgeon’s reconstructive work is related to defects caused by cancer or treatments of it. Common issues include skin cancers on the face, eyes, nose, limbs, chest, and back. The plastic surgeon frequently can biopsy or completely remove the lesion with the least noticeable scar possible. The priority is first to cure the patient of disease and next to leave the best aesthetic repair as possible. This would not be a cosmetic procedure, but rather an insurance covered procedure for cancer treatment.

Another major area of reconstruction is the breast after mastectomy. The incidence of breast cancer stands at one in eight U.S. women, and many choose to pursue breast reconstruction. With numerous surgical options available, a candidate should discuss with her plastic surgeon the one that best fits her. Options may include breast implant based reconstruction or soft tissue transfer from the patient herself (from the back or abdomen) to rebuild the breast.

Cosmetic

The most familiar side of plastic surgery is the cosmetic one. Many patients have concerns that their appearance does not match the way they feel internally. For example, women after pregnancy or breast-feeding may opt to have an abdominoplasty (tummy tuck) or breast lift to rejuvenate the body to better fit their self-image. Patients may feel that a particular body part is in disharmony with the rest of their body and image. Areas include the face, neck, nose, eyes, breasts, and abdomen. Options besides an operation may include: topical skin care, laser skin treatments, or injectable agents to reduce fine lines or restore tissue volume.

Safety

Whether a patient is having a reconstructive or cosmetic procedure, the plastic surgeon is committed to the highest level of patient safety. The doctor and patient should discuss the possible risks, benefits, goals and alternatives of a planned procedure. Issues involving hypertension, diabetes, blood thinners and nicotine use will be addressed. Nicotine in any form, from smoking, gums or patches, may be prohibitive and need to be discontinued fully prior to proceeding and also avoided during the recovery. A patient may need to be medically evaluated by a primary care physician to be medically optimized prior to anesthesia. Labs and tests ordered beforehand help the providers make sure that a patient is in the best condition possible. Using this sequential pre-operative list the plastic surgeon and the rest of the medical team keep the risks as low as possible.

Consultation

When seeking a consultation, a patient should discuss his/her needs and goals. Questions to ask include:

What is the surgeon’s experience in performing the treatment or procedure?

What training (residency/fellowship) or qualifications does the surgeon have?

What complications are possible?

If there is a complication, how will it be addressed?

Who else may be helping with the procedure?

What kind of results can be expected?

Will insurance cover the procedure?

The plastic surgeon and team should answer questions and see that the patient has the safest and most comfortable experience possible.

David C. Yao, M.D., is a plastic surgeon practicing at Albert Lea Medical Center and Owatonna Clinic — both part of Mayo Health System. To schedule an appointment with Dr. Yao call (507) 379-2130.