General Reconstruction

Each year, plastic surgeons perform approximately one million reconstructive procedures on patients of all ages and backgrounds. Reconstructive surgery is designed to address numerous concerns, including birth defects, injuries and accidents, and conditions related to aging.

Unlike cosmetic surgery, which is intended to enhance the patient’s appearance and improve self-esteem, the purpose of reconstructive surgery is to improve both the form and function of the face and/or body. Reconstructive procedures performed by our skilled plastic surgeon, Dr. Neal Goldberg, can address a multitude of structural issues, which may be caused by developmental abnormalities, injury or trauma, disease, infection, birth defects, or tumors. In addition to correcting functional problems, these procedures can often help patients restore a more normal appearance.

Advances in treatment methods make it possible for our plastic surgeon to achieve dramatic results that were not previously attainable even ten years ago. While no surgery can achieve perfection, modern approaches have made great strides in form and functional improvement.

If you have questions, or if you wish to schedule a consultation with Dr. Goldberg, please contact our office today.

Who is a Candidate for Reconstructive Surgery?

Reconstructive surgery procedures can be divided into two primary categories: congenital deformities and developmental deformities. Patients with congenital deformities, also known as birth defects, are born with their condition. Developmental deformities occur as a result of an external event or influence, usually trauma, infection, aging, or disease.There are a multitude of examples of congenital conditions that typically can be corrected with reconstructive surgery, including cleft-lip and palate deformities, extra (polydactyly) or absent fingers, webbed fingers (syndactyly), or other hand deformities, and abnormal breast development.

Developmental and acquired deformities include burn wounds, growths, lacerations, and certain conditions related to aging. Some common aesthetic treatments may be covered by insurance as reconstructive if the perceived issue impacts function. For instance, patients experiencing vision problems due to excess or drooping skin of the eyelids may be qualified to have reconstructive blepharoplasty (eyelid surgery). Similarly, an individual with asymmetrical facial features due to paralysis potentially could be treated with a balancing facelift. Reconstructive procedures may enhance the cosmetic appearance of the patient; however the first purpose is to restore function.

Genetics, hormonal changes or imbalance, and disease can play an important role in developmental deformities. Women who have overly large, heavy breasts may desire a breast reduction, also called reduction mammoplasty, as a reconstructive procedure to reduce the volume of their breasts to a more comfortable and proportional size. Another example is overly prominent or deformed ears. Reconstructive otoplasty, also called ear surgery, can be performed to reduce the size and improve the shape of the ears on children and adults.

Many health insurance policies include partial or full coverage for approved reconstructive surgery. Patients should acquire preauthorization from their insurer in advance of the procedure. They should also confirm which treatments and expenses will be accommodated and what the potential limitations may be to develop a clear understanding of the costs involved.

What are the Risks of Reconstructive Surgery?

Although complications are rare and typically minor, the outcome of a surgical procedure is never 100 percent predictable. Every patient’s anatomy and rate of healing is unique; however, selecting a qualified, board-certified plastic surgeon may help to limit potential risks.

Some of the possible complications that could occur as a result of an operation include bleeding (such as hematomas, wherein blood pools under the skin), infection, bruising, wound-healing difficulties, and problems associated with anesthesia or surgery.

Some factors may contribute to a higher risk of complications during healing, such as smoking, poor nutrition, or an impaired immune system. If the patient has a connective-tissue disease, decreased circulation in the surgical area, or damaged skin due to radiation therapy, this can also increase the possibility for difficulties. Individuals are urged to stop taking aspirin and other blood thinning medications at least a week or two prior to surgery.

Preparing for Reconstructive Surgery

The patient’s condition will be measured according to the complexity of treatment required; this metric is known as the reconstructive ladder. At the lowest rung of the ladder are the simplest procedures, such as wound closures. At the top of the ladder are comparatively complex operations, such as microsurgery to reattach severed limbs. Our plastic surgeon evaluates the issue with the intention of providing the least-complicated approach, working from the bottom rung upwards to achieve the desired result.

The treatment option chosen and number of procedures required will depend on several factors, including the size, nature, and degree of the injury or deformity. Reconstructive surgery often involves a series of procedures that may need to be performed in specific stages. Typically, complex planning will be necessary.

Young children who are still developing may require regular follow-up visits over an extended period of time due to the unpredictable effect of growth on the results. As the child matures, additional procedures may be required.

The healing process is unique to each individual, so our plastic surgeon cannot determine the exact moment a patient can resume normal activities in advance of the procedure. However, he often can estimate when noticeable improvement should begin to occur.

Options for Wound Treatment

Dr. Goldberg will carefully evaluate several elements when determining how to treat a wound, such as the size, severity, and distinguishing features. Some examples of indicators he will look for include damage to the nerves, muscles, and/or skeletal structure.

Dr. Goldberg and the patient will develop a surgical plan together, so it is essential for the individual to be well-informed about what the procedure and recovery will entail. The initial consultation and follow-up visits offer an excellent opportunity to ask questions and voice any concerns prior to surgery.
During the procedure, Dr. Goldberg will work to minimize the appearance of scars and provide as aesthetically pleasing a result as possible. For instance, skin surface wounds, such as a clean cut with straight edges, usually will receive direct closure.

Reconstructive options for wound treatment include:

Skin Grafts

Skin grafts involve the removal of healthy skin from one area of the body and using it to improve the appearance of an existing wound. This is a very common procedure and has proven successful for burn wounds, skin cancer reconstruction, and other conditions.

Tissue Expansion

Tissue expansion is designed to carefully stretch the skin near the area affected by the wound. This technique can be very beneficial for scalp repair treatments and other procedures.

Advanced Wound Care: Flap Surgery And Microsurgery

For severe injuries and disfigurement, advances in flap surgery and microsurgery make it possible for Dr. Neal Goldberg to provide significantly improved results, although each patient’s unique situation and experience will vary. Due to progressive techniques and state-of-the-art technologies, such as the operating microscope, our plastic surgeon may be able to reattach amputated fingers or transplant large sections of bone, muscle, and/or tissue (a flap) from one area of the body to another while maintaining the original blood supply.

Other Reconstructive Procedures

Dr. Goldberg offers treatment for a wide variety of conditions, from simple cuts and surface wounds to cancerous and noncancerous growths, as well as concerns related to the deeper supportive structures of the body.

Tumors and cysts come in many varieties, and the severity and rate of recurrence are unique to each patient. The method of treatment for these growths, whether benign or cancerous, will depend on the type, stage of development, and location on the body.

Most growths and minor skin cancers can be removed by excision and direct closure, with only a fine, small scar remaining. However, major surgery may be required for larger or spreading cancers; in these cases, flap tissue may be utilized to reconstruct the treated area.

Hand Surgery

Using advanced hand surgery techniques, our plastic surgeon can treat numerous types of congenital and acquired hand conditions to help patients regain mobility, comfort, and a more natural appearance. Some common acquired hand defects include:

  • Carpal Tunnel: A painful condition usually affecting the wrist or elbow, typically caused by pressure on the nerves.
  • Trigger Finger: Swelling of the flexor tendon causing the affected finger to permanently bend.
  • Ganglion Cysts: Generally the result of a poorly healed wound or burn that then restricts mobility and causes the fingers to curl, often as a result of benign growths and scar tissue contracture.
  • Dupuytren’s Disease: A gradually developing condition of the connective tissue that leads to hand contracture.

Common congenital hand defects include syndactyly (webbed fingers) and polydactyly (extra fingers). Syndactyly typically can be corrected by creating a zig-zag incision between the affected fingers to separate them, adjust the tissue, and, in children, prevent future growth issues. Polydactylism can be a more complicated procedure, as once the vestigial digits are removed there will be a need to balance the tendons and stabilize the remaining joints to achieve the most normal function possible. Furthermore, our plastic surgeons can reconstruct lost fingers and thumbs to help regain full hand mobility.

If you have additional questions, or if you would like to speak with Dr. Goldberg in person, please contact our office today.