Reconstructive surgery - Find a specialist

Plastic surgery performs shape-changing or reconstructive operations on visible tissue, body parts and organs.

The aim of reconstructive surgery is to restore the original condition for medical reasons. Aesthetic surgery, on the other hand, aims to improve the appearance for non-medical reasons.

This is why plastic-reconstructive surgery is also called reconstructive surgery and plastic-aesthetic surgery is called cosmetic surgery. Burn surgery and hand surgery occupy a special position.

This article deals with surgical procedures to restore function and/or appearance after injuries, burns and tumor operations.

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Reconstructive surgery - Further information

A brief excursion into the history of plastic surgery

Plastic surgery is almost as old as medicine itself. In India, for example, reconstructive nose operations were performed as early as 1200 BC. A flap of tissue was removed from the forehead and transplanted. The ancient Egyptians also mastered such complicated procedures, as mummy finds prove.

At the end of the 16th century, an Italian doctor described a surgical technique that forms the basis of modern plastic surgery.

The two world wars with their dramatic injuries massively advanced the progress of reconstructive surgery. Another milestone in the field was the introduction of silicone implants in 1962.

What are the tasks of a plastic and reconstructive surgeon?

Reconstructive surgery deals with the restoration of tissue and organs that have been damaged or disfigured.

This can be done in the following ways:

  • Accidents
  • Removal of tumors and
  • injuries

As a result of accidents and operations, bodily functions no longer work smoothly or at all. The appearance of the person affected is also usually disfigured. This is a major psychological burden and often leads to social withdrawal.

Experienced surgeons therefore aim to restore bodily functions and appearance as far as possible. This improves the quality of life for those affected.

Hand surgery is specifically concerned with restoring important functions of the upper extremity. Doctors reconstruct ligaments, muscles, tendons, bones and soft tissue so that the patient can use their arm and hand again.

Rekonstruktive Chirurgie: HandchirurgieReconstructive surgery: Hand surgery @ Chinnapong /AdobeStock

In burn surgery, doctors alleviate the consequences of severe burns, including chemical injuries, by performing skin grafts.

Rekonstruktive Chirurgie: HandchirurgieReconstructive surgery: Burn surgery @ kajasja /AdobeStock

A common treatment is breast reconstruction, for example after breast cancer surgery. However, gynecomastia (breast augmentation in men) in adulthood is also a condition that experts in reconstructive surgery perform.

Other areas of application are

  • Tissue reconstruction after tumor removal
  • Correction of scars
  • Treatment of lipoedema (fat distribution disorder) and lymphoedema (tissue fluid drainage disorder)
  • Treatment of the consequences of accidents
  • Treatment of wound healing disorders, for example in diabetic feet
  • Aesthetic and functional facial reconstructions following operations and accidents
  • Reimplantation of severed limbs

A common method in reconstructive surgery is autologous fat transplantation. Doctors remove fatty tissue from one part of the body and transplant it to another (damaged or disfigured) area.

This procedure is used, for example, for

  • Mastectomy (breast removal)
  • Breast-conserving therapy
  • Congenital or acquired breast malformations
  • Chronic wounds
  • Genital surgery/transsexuality
  • Locally circumscribed (limited) scleroderma (proliferation of connective tissue)
  • Soft tissue deficits and
  • Aesthetic procedures, such as hand rejuvenation, breast corrections, changes to the shape of the nose and contour irregularities after liposuction
Rekonstruktive Chirurgie: BrustvergrößerungReconstructive surgery also deals with improving the shape and function of the breast @ nenetus /AdobeStock

    Reconstructive surgery often involves microsurgical procedures in which doctors also connect blood vessels.

    Plastic reconstructive surgeons work closely with experts from other fields, such as

    Breast reconstruction with autologous tissue or implants

    The majority of all breast reconstructions are carried out using artificial materials such as implants, expanders or meshes.

    Doctors can also remove the patient's own tissue in the form of a skin flap from the lower abdomen, buttocks or back. This is then transplanted as a new breast.

    There are basically two options for this autologous tissue transplant:

    1. The skin flap still contains the supplying blood vessel (so-called pedicled flap) or
    2. The vessel requires a microsurgical connection with a new vessel (so-called free flap)

    Training as a plastic surgeon

    Experts in reconstructive surgery are specialists in plastic and aesthetic surgery (plastic and aesthetic surgeons).

    Specialist training begins after completing medical school. This requires six years of experience. Two years of basic training in the field of surgery and four years to become a specialist in plastic and aesthetic surgery. During this time, the doctor must carry out a specified number of diagnostic procedures and therapies.

    In this way, the prospective plastic surgery specialist acquires knowledge, experience and skills for visibly impaired body functions and body shapes.

    Aesthetic plastic surgery is constantly evolving. For this reason, even after years of training and practice, doctors must regularly undergo further training and exchange information with other specialists.

    References

    • Bundesärztekammer (2013) (Muster-)Weiterbildungsordnung 2003 in der Fassung vom 28.06.2013. https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/20130628-MWBO_V6.pdf
    • Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) et al. (2015) Autologe Fetttransplantation. S2k-Leitlinie. AWMF-Leitlinien-Register Nr. 009/017. https://www.dgpraec.de/wp-content/uploads/2018/03/S2k_Leitlinie_Fetttransplantation.pdf
    • Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) et al. Leitlinien. https://www.dgpraec.de/aerzte/leitlinien/
    • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG) et al. (2015) Brustrekonstruktion mit Eigengewebe. AWMF-Leitlinien-Register Nr. 015/075. https://www.awmf.org/uploads/tx_szleitlinien/015-075l_S3_Brustrekonstruktion_Eigengewebe_2015-04.pdf
    • Deutsche Krebsgesellschaft e.V. (DKG) Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) (2012) Plastisch rekonstruktive Eingriffe; Brustrekonstruktion: Möglichkeiten, Indikationen. In: Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms. Leitlinienprogramm Onkologie. AWMF-Leitlinien-Register Nr. 032/045OL. https://www.dgpraec.de/wp-content/uploads/2018/03/S3_Leitlinie_Brustkrebs_Diagnostik.pdf
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