Plastic Surgery – Farrer Park Hospital
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What is Plastic Surgery?
​Plastic surgery is a medical specialty that employs surgical techniques to mold various tissues of the body to either replace a defect caused by disease or trauma, or to enhance certain areas of the face and body. These two major areas are known as Reconstructive Surgery and Aesthetic or Cosmetic) Surgery.
Conditions
Increasingly women are being diagnosed with breast cancer at a younger age. There are different types of breast cancer; the most common type arise from the milk ducts (intraductal carcinoma). Other less common types include tumours that either arise from the gland of the breast (lobular carcinoma) or from the supporting tissue (stromal carcinoma). 
 
The usual presentation of breast cancer is a breast lump. Increasingly however, breast cancers are diagnosed from screening mammography and ultrasonography.
 

Skin Cancers
Skin cancers can occur in any part of the body, and often occur in sun-exposed areas. The common types of skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma. 

Facial Injuries
The face can be injured via a variety of ways, including accidental falls, motor vehicle accidents, sports-related incidents, animal bites and assault. Any component of the face may be injured – skin, soft tissue, facial skeleton, and specialised areas like the nose, eyelids, lips and ears.  

Limb trauma
Arms and legs are often injured in accidents or by disease. The trauma sometimes result in large wounds, like in degloving injuries, or open contaminated fractures.

Necrotizing fasciitis, or the so-called “flesh-eating diease”, is a serious skin and soft tissue infection that spreads quickly and often destroys wide swathes of the body’s soft tissue.
 
An abscess is a collection of pus, and it can sometimes occur in the face. They can occur when a cyst becomes infected, or as a result of bad oral and dental hygiene. Some patients may develop facial absesses following cosmetic procedures like filler injection or placement of implants like nose, chin and cheek implants.
 

Pressure Sores
Pressure sores are chronic wounds that are caused by prolonged pressure at specific parts of the body. Pressure sores occur in people who lie on the same area for prolonged periods of time. They sometimes result in large gaping wounds that require reconstructive surgery to cover the defect.

Treatments
​The treatment of breast cancer often involves several specialists. Depending on the stage and type of breast cancer, different types of treatment are offered, including surgery, chemotherapy, immunotherapy, hormonal therapy and radiation therapy.
Surgery may involve removal of parts of the diseased breast tissue (known as breast conservation surgery) or removal of the entire breast (mastectomy). Following mastectomy, various breast reconstruction options are available, and these include the use of breast implants, and the use of the body’s own tissue.
 
The mainstay of treatment of skin cancers in many instances is surgical removal. Depending on the size and location of the skin cancer, removal can be done under local anaesthesia or it may be necessary to be done under general anaesthesia.
 
When the skin cancer is on the face, the Plastic Surgeon will ensure that incisions are placed in the correct directions to minimize scarring during the healing process. Where the cancers occur in “specialized” structures like the eyelids, nose, ears, and lips, accurate realignment of the structures is essential to ensure that there is minimal disfigurement.
In cases where the skin cancer has become more extensive, and skin and underlying tissue may need to be removed surgically, reconstructive surgery may be necessary to reconstruct the defect.
 
The principles of treatment of facial injuries remain the same, regardless of the seriousness of the injury. Firstly the airway, breathing and circulation must be ensured. Other injuries are looked for and excluded. Adequate and appropriate anaesthesia is administered. For minor cuts, local anaesthesia will suffice. For more extensive injuries, general anaesthesia is often necessary.
 
The wounds are cleaned thoroughly, and the injured tissue is brought together as close to the original alignment as possible. If the facial skeleton is broken, the bones are fixed with titanium implants first. Nerves are repaired where necessary, followed by muscle and then skin.
 
Fractures of the limb that are accompanied by skin loss sometimes require either skin grafting or flap coverage. Flaps can either be turned in from the surrounding local tissue, or taken from another part of the body and its blood supply rejoined using microsurgical techniques.
 
Treatment of necrotizing fasciitis involves the use of antibiotics and also removal of infected and dead tissue. Often large areas of skin and soft tissue need to be removed. Reconstructive surgery is then needed to replace the tissue that has been lost.
 
The mainstay of treatment for facial abscesses is antibiotics together with surgical drainage of the pus. When large abscesses occur in the face, and head and neck area, a plastic surgeon is often called in to help in the surgical treatment so as to minimise the disfigurement that may occur as a result of the infection.
 
The management of pressure sores depends nursing care. Most small pressure sores respond to proper wound dressing and a strict patient – turning regime. Larger sores may require removal of dead tissue (called debridement) and use of negative pressure suction devices. Extensive sores that result in continued loss of body fluids, may require flap surgery to cover the defect.     
 
Aesthetic (Cosmetic) Surgery
Aesthetic or cosmetic surgery is performed to enhance or rejuvenate the appearance of the face and body in the absence of physical disease. The following are common aesthetic surgical procedures:
 
- Droopy eyelids or absent double eyelid: Eyelid surgery can be performed to rectify droopy eyelids or create double eyelid folds (upper blepharoplasty)
 
- Eye bags: Lower blepharoplasty is the procedure that removes eyebags. It is done either through an incision on the skin crease (subciliary incision), or through the lining of the eye (transconjunctiva, so-called “scarless” technique).
 
- Crooked, flat or too prominent nose: A “nose job”(or rhinoplasty) is surgery to reshape the nose. It is used to either increase or decrease the profile of the nose in order to improve the balance of facial features. Different parts of the nose, like the shape of the tip, the bridge, or the nostrils, can be modified surgically.
 
- Aging face: This is a major surgical procedure to tighten the sagging skin of the face and neck. Different variations of face lifts are possible. Face lifts may or may not be combined with laser resurfacing to tighten the skin to achieve a more youthful look.
 
- Flat breasts: Breast enlargement (or augmentation) uses surgical implants to increast the size of the breasts or to restore breast volume after weight loss or pregnancy.
 
- Oversized breasts: Breast reduction is a procedure to address the discomfort and pain associated with excessively large breasts. This procedure removes excess fat, glandular tissue and skin to achieve a brast size that is in proprotion to the rest of the body.
 
Body Contouring
Body contouring procedures include liposuction, tummy tuck, arm tucks and buttock lifts.
 
Liposuction is a surgical procedure whereby excess fat is removed from various areas of the body, like the thighs, buttocks, abdomen, and the flanks. Various techniques of liposuction are available, including ultrasound-assisted liposuction.
 
A tummy tuck is a major surgical procedure and is indicated in individuals who have an excessive abdominal apron. It is often combined with tightening of the midline muscles of the abdomen that have been loosened during childbirth.  
  
Following massive weight loss (for example, in obese patients who have undergone Bariatric Surgery), some patients have large areas of loose and saggy skin, particularly in the upper arms and thighs. This excessive skin can be surgical removed (arm tuck or brachioplasty).   
 
Reconstructive and Aesthetic Surgery
In many instances, the plastic surgeon has to combine both reconstructive and aesthetic elements in the surgical procedures. The two areas in which both these aspects overlap considerably are facial surgery and breast reconstructive surgery.
 
Facial Surgery
The face is crucial to a person’s identity as it best distinguishes one from another individual. Damage such as scarring from disease or injuries, or other deformities have an impact that transcends mere physical inconvenience. For example, for the patient with a cleft lip, performing a proper lip repair achieves both functional (pursing of the lips and sucking) and undeniably important aesthetic goals.
 
In cases of trauma to the face, like fractures of the facial bones, the accurate alignment of fractures allows restoration of proper function as in eyeball alignment for proper vision, and jaw alignment for proper chewing, in addition to ensuring that there is minimal disfigurement to the face.
 
Where skin cancers need to be removed from the face, the main goal is to clear all the cancer cells. But just as important is the reconstruction of the resultant defects in a manner that tries to preserve the facial features as much as possible.
 
Breast Enhancement and Reconstruction
The breasts are meant to be naturally beautiful, apart from its mammary functions. Placement of breast implants by a qualified and properly-trained plastic surgeon remains one of the safest and most effective ways to enhance these assets. There are many techniques available and present-day third generation silicone implants are currently approved by the Food and Drug Administration of the United States for use for aesthetic purposes.    
 
Breast cancer is also becoming more common. Whilst it was previously a disease of older women, increasingly younger women are being diagnosed with breast cancer. For those who opt for mastectomy or removal of the breast, more patients are requesting immediate breast reconstruction. At present the standard is to offer a skin-sparing mastectomy with immediate breast reconstruction with a flap comprising the skin, fat and all or part of a muscle in your lower abdomen. Breast reconstruction has been very successful in enabling the patient to return to as near normalcy in all spheres of her life as possible.
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