Mr Adam Bialostocki
Cosmetic and Reconstructive Plastic Surgeon
MBChB FRACS (Plastics)

RECONSTRUCTIVE SURGERY

Reconstructive Surgery is surgery performed to improve and restore functionality of abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumours or diseases.

Breast Reconstruction

There are many techniques available for reconstruction of breast defects after surgery for breast cancer. The art is to choose the right technique for an individual woman, taking into account lifestyle, post-operative support and expectations. While an immediate breast reconstruction is ideal, not all breast cancer patients can have an immediate reconstruction because of the type of cancer, and because of the additional treatments that may be recommended such as chemotherapy and radiotherapy. A delayed breast reconstruction can be undertaken any time after the mastectomy and adjuvant therapy is completed, from a few months later to many years. Usually a complete reconstruction will involve more than 1 operation to achieve an aesthetic breast shape with a nipple reconstruction.

Nipple Tattooing (Nipple-areolar micropigmentation)

Nipple tattooing is the final stage in the process of breast reconstruction, following mastectomy. This completes the process of recreating the most natural looking breasts and allows a woman to feel as much like herself as she did prior to her mastectomy.

During this procedure, permanent pigment is tattooed into the skin to create the natural colour of the nipple-areolar complex. This offers a more realistic appearance following mastectomy surgery. The pigment is designed to be permanent, although some fading of it is expected over time and may require additional topping up. The staff at Bay Plastic Surgery have been trained in blending the right pigment colours, to achieve an areola colour which best matches the individual person and their skin tone. The pigments themselves are made from purified ingredients which meet FDC (food drug and cosmetic) standards in the USA and are hypoallergenic.

Both nipple creation and nipple tattooing are performed on site at Bay Plastic Surgery under local anaesthetic, with minimal discomfort and downtime. Nipple tattooing is offered to women about 3 months after nipple creation surgery. Our specialist nurses will discuss colouring, the process and will also provide photos which other women who have undergone the procedure have kindly allowed us to share. The procedure is performed in pleasant surroundings, and takes from 1½ - 3 hours, depending on whether one or both sides are tattooed. Patients are able to go home immediately afterwards.

Follow up appointments are also a vital part of the process to assure the very best outcome possible, since some women will require a touch up session after 3 – 12 months.

Skin Cancer Reconstruction

Once a skin cancer has been surgically removed, it is important to repair the hole immediately and skilfully to avoid unnecessary disfigurement. All surgery leaves scars, and these scars can take up to 12 months to fully mature. Factors that will influence the scarring include smoking and genetic make-up. Considerable training and skill are also required to plan and perform surgery in such a way that the inevitable scar is as inconspicuous as possible. The simplest repairs can involve a straight-line scar, but even these can be disfiguring if it is puckered, placed in the wrong direction or has train-track marks. More complex repairs involving a skin flap (moving local tissues to fill the hole) or skin grafts (borrowing skin from another part of your body and placing it into the hole) are best left to Specialist Surgeons with qualifications in Reconstructive techniques. Please visit the website for the New Zealand Association of Plastic Surgeons at www.plasticsurgery.org.nz for further information.

Hand Surgery

The delicate and intricate nature of the structures of the hand are a specialised area that plastic surgeons have broad experience in dealing with. A wide range of problems can occur in the hand and wrist. These may be due to disease, trauma, malformations or previous surgery. In many cases, surgery may be the recommended treatment because it can relieve pain and improve function. Many disorders of the hand and wrist can be treated by surgery.

Hand and wrist surgery can be performed under general anaesthesia or local anaesthesia, depending on the particular treatment. Mr Bialostocki operates from his rooms at Bay Plastic Surgery for procedures performed under local anaesthesia and for cases where a general anaesthetic is required, at Grace Hospital in Tauranga.

While there are common conditions involving the hand, there are always a larger number of patients seeking revision or optimisation of previous hand injuries which require individualised treatment plans. The decision to have surgery should only be made after discussion with your plastic surgeon. We welcome your enquiry and advise a consultation with Mr Bialostocki to discuss your specific condition and proposed treatment options, the benefits and risks of surgery.

Common reasons for hand surgery include:
Ganglions
Carpal Tunnel Syndrome
Other types of nerve compression eg Ulnar nerve around the wrist and elbow
Dupuytren’s Contractures
Scar release
Tendon reconstructions
Nail abnormalities
Bone re-alignment

What anaesthetic is used?
The common Local Anesthetics are Lignocaine & Marcain. A mixture of the two is usually used to provide rapid onset with long duration. Added adrenaline helps to reduce bleeding.

Will it hurt?
There are two aspects to this: the fine needle gives a brief sharp prick, but the anaesthetic itself does sting for a few seconds. The injection will remove sensations of pain, but, it is normal to sometimes feel some sensations of ‘pushing, pulling & tugging’ during the procedure, as the nerves for those sensations take longer to block. 

Shave Excision

Only the top of the lesion or mole is removed, and the remaining raw area is left to heal. These wounds are dressed with antibiotic ointment for 5-7 days until it dries & flakes off.

Using this technique, the scar can be very good, but the lesion may re-grow in time, so it is not used for skin cancers.

Excision & Direct Closure

The entire lesion is removed with a safety margin of normal skin. The wound is stitched closed. On occasion, these are stitched closed with hidden dissolving sutures. Otherwise, a non-dissolving suture is used which requires removal.

Excision direct closure

Excision & Skin Graft

A skin graft is a thin shaving of skin from a donor site (such as thigh), which is transferred to cover the wound.
To heal, grafts depend on in-growth of blood supply. Infection, bleeding and movement reduce the chance of graft ‘take’.
These dressings must be kept dry & are first changed at 5-7 days.

Excision skin graft

Excision & Flap Repair

Tissue adjacent to the defect is moved to close the wound.
Planning of these repairs can be complex, requiring in-depth knowledge of the underlying anatomy to take into account blood vessels and nerves.
The defect created by moving this flap is closed directly with sutures.

Excision flap repair

Procedure Information

  • Please do not wear make-up on the day of your facial surgery.
  • During the procedure an electric machine is used to cauterize any small bleeding points in your wound. In order for this to work, an “earthing’ plate is placed on your bare skin. This can be initially quite cold!
  • You may have some pain after your operation. In the majority of cases this is minor & is dealt with very well by taking Paracetamol only.
  • The body part operated on will need to be elevated. This will encourage swelling to subside quicker & reduce the chance of bleeding. It will also reduce the pain you may experience post-operatively.
  • For some operations, an antibiotic to reduce the chance of infection will be prescribed. This does not reduce the chance to 0%. Infections may make the resulting scar less aesthetic than planned.
  • You will be given written instructions on how to look after your wound after the operation. In general, they need to be kept dry.
  • No dressing is water-proof.
  • If you are taking blood thinners regularly, you may re-start them 2 days after your operation, but please discuss this at your initial consultation.
  • Your surgery is likely to leave a scar. Scars may take up to 9 months to mature / fade. This time can be reduced by taping the scar with Micropore tape or massage of the scars. A small group of patients will have a genetic pre-disposition for forming thickened, red & itchy scars called Keloids.
  • The results of any tissue sent to the laboratory should be available in approx. 7-10 days and the practice nurse will phone you with the results. There is a 1 in 20 chance that something further may need to be done based on those results. (e.g. further investigation, treatment or surgery)
  • Smoking has a detrimental effect on healing tissue: It will make infection more likely, will make the scars less cosmetically-appealing than planned & will increase the chance of skin dying on flaps & grafts. Ideally, you should stop 8 weeks pre-operatively.
  • If your surgery is on your head & neck or lower legs, you should arrange a driver to pick you up.

No guarantee can be given as to the histological result issued from the laboratory. Lesions thought to be cancers, could ultimately be reported as benign. A biopsy for lesions that appear indeterminate may be offered.

CoolSculpting®

Visit our site www.coolsculptingdavinciclinic.co.nz for full information about this fantastic procedure.