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It is only since the mid-1960s that doctors wishing to specialise in plastic and reconstructive surgery have been able to train in Australian and New Zealand plastic surgical units, and be examined for competence by surgeons appointed by the Royal Australasian College of Surgeons. The College now governs the training of plastic and reconstructive surgeons in this part of the world and, through its agencies, (Specialist Training Boards) selects trainees, plans the curriculum and at the end of a five-year training period, examines the trainees. The New Zealand Board of Plastic and Reconstructive Surgery is responsible for the oversight and delivery of the Plastic and Reconstructive Surgical Education and Training programme in New Zealand. The NZAPS office provides the Administrative support of the programme.

Plastic and Reconstructive Training

Most doctors who train in plastic and reconstructive surgery in this country have two or three years of experience in general surgery, orthopaedics, or ear, nose and throat surgery (ENT) after completing a basic medical degree. Then they enter a competitive selection process in which only two or three of the twenty applicants are selected each year for a further five years’ training in plastic surgery.

The training standards in Australia and New Zealand are as good as, if not superior to, those in the United States, the United Kingdom and Europe. The examination set by the Royal Australasian College of Surgeons tests clinical and theoretical knowledge as well as operating expertise. The examination is known for its rigorous nature and its reputation of rejecting those trainees who do not meet its standards.

After completing the full period of training and passing the final examination, a diploma is awarded – the Fellowship of the Royal Australasian College of Surgeons (FRACS). Plastic and reconstructive surgeons are examined in cosmetic surgery as part of the requirement for the FRACS. This fellowship is the benchmark of a fully trained plastic and reconstructive surgeon in New Zealand. Most other surgical or cosmetic surgical qualifications purporting to be equivalent are unrecognised by statutory bodies either here or in the United States or United Kingdom.

The scope of plastic and reconstructive surgical training is very broad and does not limit itself to a particular anatomical area. For example, orthopaedic surgery limits itself to the musculo-skeletal system, whereas plastic surgery embodies a philosophy of reconstruction with maximum “cosmesis”, that is, the repaired areas should not only work well but look good as well. This means plastic and reconstructive surgery has contributions to make to ENT surgery, orthopaedics, general surgery, cancer surgery and other areas. None of these specialities can reach their full potential without the use of plastic surgical techniques.

Innovators in plastic and reconstructive surgery

Plastic surgeons have historically been quick to grasp new techniques and apply them, and it is noteworthy that many of these advances have come from Australian and New Zealand surgeons. Sir Harold Gillies developed the tube pedicle flap, and many of the basic techniques used in plastic surgery; Archie MacIndoe established the scientific basis for burns surgery; Ian Taylor of Melbourne was among the first to develop free flaps as a viable method of tissue transfer; New Zealand’s Sir William Manchester was internationally renowned for his work with cleft lip and palate; Auckland’s Michael Flint was a world authority on wound healing biology and scar management; and John Williams, also of Auckland, has worldwide recognition for his work with penile abnormalities.

Training in Cosmetic Surgery

Plastic surgical training in this country has always included all aspects of cosmetic plastic surgery. In fact, until financial constraints were forced on the public sector, much cosmetic surgery was performed in the regional plastic surgical units.

Cosmetic surgery is also taught to trainees in this country by established plastic and reconstructive surgeons working in private hospitals where most cosmetic plastic surgery is now performed. This provides very good hands-on training where patient safety is guaranteed by the presence of a senior surgeon; and the trainee is gradually introduced into decision-making, both before, during and after an operation. The trainee gains considerable supervised experience before establishing his or her own practice.