What is Plastic Reconstructive Surgery?

The term plastic surgery is derived from the Greek word ‘plastikos’, meaning to mould or shape.

While there are records of plastic surgery procedures as early as 300 AD, plastic reconstructive surgery remained in its infancy as a surgical specialty until the First and Second World Wars, when unprecedented numbers of soldiers sustained horrific and maiming injuries. Plastic surgery units were set up to treat severe burns, face and jaw injuries, gaping wounds and missing body parts.

Dunedin-born Sir Harold Gillies is widely considered to be the ‘father of plastic surgery’. Trained as an ear, nose and throat surgeon, he turned his considerable talent to skin grafts and reconstruction – especially facial reconstruction – and brought plastic surgery into mainstream medicine.

There are two branches of modern plastic reconstructive surgery:

• Reconstructive surgery is concerned with repairing damaged tissues, or replacing absent ones, in order to improve function. For example, repairing a cleft palate will allow a baby to swallow and feed, and to develop normal speech. Another very important function is how we look, which shapes our ability to be part of a community or society without embarrassment or stigma. Reconstructive problems are highly varied, and can be the result of accidents, birth defects, infection, disease and cancer. Common reconstructive procedures include replacing missing tissue following cancer surgery or trauma, skin grafts for burns, breast reconstruction following mastectomy, cleft lip and palate surgery, and emergency reattachment of severed body parts.
• Aesthetic surgery, also known as cosmetic surgery, builds on the principles of reconstructive surgery. Using similar techniques, but on uninjured healthy anatomy rather than injured or abnormal tissue, a patient’s features can altered or reshaped to better meet a patient’s “ideal” self image. This is not simply vanity, as well-chosen aesthetic surgery can improve psychological wellbeing as well as appearance. Such surgeries include those to change crooked or large noses, protruding ears, abnormal or asymmetrical body contours (including breasts of very different sizes and shapes), facial aging, loss of abdominal tone after childbirth, and birth marks.

Reconstructive surgery and aesthetic surgery are therefore closely related, and often cross over. A major philosophy of such specialists is that the repaired areas should not only work well, but look good as well. The skills of plastic reconstructive surgeons are therefore often combined with other surgical specialties, including ear nose and throat surgery, orthopaedics and cancer surgery.

The Medical Council of New Zealand’s Statement on cosmetic procedures defines ‘cosmetic procedures’ as: “Operations and other procedures that revise or change the appearance, colour, texture, structure or position of normal bodily features with the sole intention of improving the patient’s appearance or self-esteem.” (Note: the statement does not cover procedures which improve a patient’s physical health and safety other than by improving their appearance and self-esteem. The Council has produced a brochure for consumers: What to expect from your doctor when you have a cosmetic procedure.

Five hospitals in New Zealand have plastic surgery units – Middlemore, Waikato, Hutt, Christchurch and Dunedin. However plastic surgeons are routinely called on to operate in other large public hospitals as part of combined surgical teams, and there are visiting services in other peripheral centres.