Reconstructive vs. plastic surgery: What’s the difference?

Doctor performing exam on female patient.

The foundation for reconstructive surgery has some commonalities with plastic surgery. But it is quite different. And Wilmington Health has one of the region’s top Reconstructive Surgery departments. 

Tor Ljung, MD, FACS, leads a team that specializes in both surgeries.

What is the difference?

Reconstructive surgery is for irregular structures of the body. It’s intended to repair and restore function to compromised tissue. This can be a result of:

  • Birth defects
  • Disease
  • Infection
  • Developmental abnormalities
  • Trauma or injury
  • Tumors

Patients get reconstructive surgery to enhance function and achieve a regular appearance. Cosmetic surgery shapes structures of the body to enhance the patient’s appearance. It’s important to note that no surgery can result in perfection. But the possibilities present today are encouraging.

Is reconstructive surgery right for me?

Two types of patients seek reconstructive surgery: The first are those with congenital deformities, or birth defects. And the second are those with developmental deformities resulting from an accident, aging, disease, or infection.

Congenital abnormalities can include:

  • Abnormal breast development
  • Birthmarks
  • Cleft-lip and palate deformities
  • Hand deformities such as webbed, extra, or absent fingers

Acquired deformities can include:

  • Aging problems
  • Burn wounds
  • Growths
  • Lacerations

Some surgeries can have both a restorative and a cosmetic effect. Surgery for drooping eyelid skin can block the field of vision. Surgery can correct this and give an enhanced appearance. 

Paralysis can leave a patient with an asymmetrical look. A balancing facelift can restore function, but also enhances appearance.

Types of reconstructive surgery

Conventional reasons for reconstructive surgery include:

Breast conditions: Full or partial mastectomies and breast reduction. Patients often pursue a procedure for:

  • Back pain
  • Discomfort
  • Rash under the breasts

Limb salvage: Patients facing amputation can seek reconstructive surgery. It can use tissue to fill in space. 

Facial reconstruction: Used after trauma or tumor resection. Orthognathic surgery, or jaw straightening, is an example.

Hand procedures: Some surgeons specialize in this sort of surgery. It can improve flexibility, function, and strength. It can also correct:

  • Carpal tunnel syndrome
  • Arthritis
  • Trauma
  • Webbed fingers

Other types of reconstructive surgery:

  • Cleft lip and palate repair
  • Craniosynostosis surgery (head reshaping)
  • Gender confirmation surgeries (transfeminine/transmasculine)
  • Lymphedema treatment
  • Migraine surgery (chronic headache relief)
  • Otoplasty (outer-ear surgery)
  • Panniculectomy (removal of flaps of fat after weight loss)
  • Rhinoplasty (fix breathing after a nose break)
  • Septoplasty (deviated septum correction)

Is reconstructive surgery inpatient or outpatient?

That depends on the type. Simple reconstructions, such as of an areola and nipple, can be outpatient. More complex processes might call for a night or more in the hospital. Surgeons can perform them in:

  • Clinics
  • Health care providers’ offices
  • Hospitals
  • Surgery centers

Surgeon evaluation

Your medical history, necessity, and wishes for results are all factors in the best care. Is the procedure crucial to restoring mobility? Is it affecting more than one body part? Other factors can impact success or healing after surgery. Some can put the patient at higher risk for complications. 

These include:

  • Areas of damaged skin from radiation therapy
  • Decreased circulation to the surgical area
  • If the patient is a smoker
  • Presence of connective-tissue disease
  • Taking aspirin or other medications that impact blood clotting

What is the reconstructive ladder?

It’s a set of rules meant to take the least complex route to the desired result. Lower rungs on the ladder are the least complex, such as simple wound closures. Microsurgery to reattach severed limbs is the highest rung.

Most surgeons start from the lowest rungs. They’ll opt for the most direct way to treat the situation. Much depends on the extent, nature, and size of the deformity or injury. 

Often, it requires planning and more than one stage of procedures. Growing children might require follow-up surgeries over the years. In most cases, it’s not easy to pinpoint a time of return to normal activity, but your surgeon can give you a good estimate based on your case.

What are the risks of reconstructive surgery?

Complications are possible, including:

  • Excessive bleeding, such as hematomas
  • Infection
  • Problems related to anesthesia and surgery
  • Significant bruising
  • Wound-healing difficulties

Breast reconstruction

Women can opt for reconstructive surgery after cancer treatment. In a mastectomy, surgeons remove one or both breasts. Reconstruction can create new breast mounds for many reasons:

  • Give a balanced appearance to the chest
  • Help clothes fit better
  • Preventing the need for an external prosthesis
  • Restore a sense of self

Surgeons can use implants or a patient’s own tissue. It’s called a flap if they use the patient’s tissue, and doctors can take it from many areas, including:

  • Back
  • Buttocks
  • Lower abdomen
  • Thighs

Flaps take longer in surgery and are inpatient procedures. Flaps can help breasts achieve a natural look. They won’t need future surgeries as would be the case with implants for maintenance.

What are the risks?

Surgeons will warn patients of risks, including:

  • Imperfections
  • Little or no feeling
  • Scarring
  • Unmet expectations

Healing takes time.

Wound care

Many factors affect the approach to wound treatment, such as:

  • Has skeletal support been affected?
  • Have nerves or muscles been damaged?
  • Is skin absent?
  • Size, severity, and features

Ask lots of questions during this surgical planning process. 

When are skin grafts necessary?

Wide wounds are often difficult to close. Those need a skin graft. That’s a patch of healthy skin taken from another area to cover missing or damaged skin. There are three types of skin grafts:

Split-thickness skin graft: This is used to treat burn wounds. It uses layers of skin closest to the surface only, from the least conspicuous parts of the body. Location, size, and skin color are factors in that determination. Skin grows back from the donor site, but often at a lighter tone.

Full-thickness skin graft: This is used to treat deeper, larger burn wounds. It covers jointed areas where skin must be elastic for body movement. The surgeon will lift all layers of skin from the donor site. Recipients can expect a thin line scar from the direct wound closure there.

Composite graft: This is used when a wound needs more underlying support. Skin cancer on the nose might need skin, fat, and sometimes cartilage from a donor site. The straight-line scar from the donor site will fade.

Tissue expansion

This allows the body to generate skin by stretching tissue next to the wound. Surgeons insert an expander under the repair area, which fills with water. This causes the skin to stretch. Tissue expansion allows the match to be of the same color, sensation, and texture. Skin stays connected to the original blood and nerve supply, reducing the risk of tissue loss. Scars are less noticeable than those in flaps or grafts.  An expander causes a temporary bulge in the skin. Some patients find this undesirable.

Advanced wound care: Flap surgery and microsurgery

Advances in technology allow surgeons to help more with disfigurement and severe injury. These procedures can take hours. Surgeons might need operating microscopes, but the advantages are many. Surgeons can keep the blood supply intact.

About Wilmington Health’s Cosmetic and Reconstructive Surgery

Dr. Ljung graduated from the School of Medicine at East Carolina University. He also completed his internship and residency there. He performed his fellowship at the Health Sciences Center in the Department of Plastic Surgery at the University of Virginia.

He is a member of the following:

  • American College of Surgeons
  • American Society of Aesthetic Plastic Surgery
  • American Society of Plastic Surgeons
  • American Board of Plastic Surgery

Dr. Ljung travels with a team to Mexico to perform cleft palate surgeries on children in rural communities.

Visit the Reconstructive Surgery page to learn more.