Reconstructive Procedures
Dr. Fealy is experienced in reconstructive techniques including precision wound repair, skin, cartilage and bone grafts, local vascularized flaps and microsurgical free tissue transfer. The most appropriate technique to achieve the best restoration of aesthetic form and function is selected for each reconstruction case.
Reconstructive procedures include:
- ⊕ Skin cancer removal and reconstruction
- ⊕ Breast Reconstruction with expander/implant, latissimus or TRAM flaps
- ⊕ Breast Reduction with standard and limited scar techniques
- ⊕ Facial, extremity and body trauma reconstruction
- ⊕ Congenital facial and hand deformity reconstruction
Skin Cancer Treatment
Skin cancer includes melanoma, basal cell carcinoma and squamous cell carcinoma. Surgical treatment includes resection with appropriate margin control and histological evaluation confirming diagnosis, followed by reconstruction of the defect. Skin cancer treatment can be performed in a staged process or at one surgical setting. Reconstruction techniques include skin grafting, local tissue flaps, and microsurgical free tissue transfer.
Breast Reconstruction
Several techniques are available to restore a woman with breast cancer to normalcy after cancer surgery. Reconstruction can be performed immediately in conjunction with beast cancer surgery, or in a delayed procedure. Techniques include tissue expander with subsequent implant exchange, pedicled muscle skin flaps from the back or abdomen and microsurgical free tissue transfer of back and abdomen tissue (buttock or shoulder are also sometimes used). Following breast mound reconstruction, the nipple and areola are then reconstructed with local tissue, grafts and tattooing.
Breast Reduction
Breast reduction surgery is considered reconstructive and medically necessary when associated with symptoms, and size, shape and weight are excessive. Breast reduction surgery to improve appearance is considered cosmetic and insurance plans do not cover the procedure under those circumstances. To qualify for insurance covered breast reduction, patients must meet height, weight and body mass index criteria. The amount of breast tissue removed must meet minimal weight requirements in order for many insurance plans to pay for the procedure.
The procedure is performed as an outpatient and usually takes between 2 1/2 and 4 hours. Several surgical techniques are available which produce different scars and breast shapes, and are used depending upon individual patient characteristics. Drains are occasionally used, and surgical pain is minimal and lasts a few days. Scars occasionally thicken, darken and widen, and scar revision surgery is sometimes required. Properly performed breast reduction surgery using pedicled techniques without nipple grafting does impair breast feeding, though the reduction in breast volume may reduce the amount of milk produced. Some patients do experience temporary, or in rare cases, loss of, nipple sensation.
Trauma Reconstruction
Many plastic surgery techniques are available to reconstruct defects resulting from trauma. Commonly performed procedures include local tissue re-arrangement, skin grafts, and composite pedicled local tissue flaps. Bone, cartilage, tendon and nerve grafts are used to reconstruct loss of these structures, and in severe defects tissue transplantation is now being used in select cases. Many trauma defects are treated in a single stage. Subsequent revision procedures such as scar revision or contracture release may be necessary. Severe defects may require staged or multiple procedures to achieve the final desired result.
