Plastic and reconstructive surgery

Plastic surgery is about the restoration of form and function. It has been a hugely innovative speciality over the last six decades. My predecessors have brought the world craniofacial surgery, tissue expansion, microsurgical free tissue transfer, breast reconstruction, smile surgery, ear reconstruction and vaginal reconstruction to name but a few procedures. It’s a speciality defined by concepts. We look at a problem such as a wound and decide which reconstructive technique to apply. Often a surgeon might apply a number of techniques but careful consideration of what might achieve the best functional outcome, aesthetic outcome or, indeed, the safest outcome allows the surgeon to select which is appropriate for the patient. Our tools include grafts, local flaps, microsurgical free tissue transfer, tissue expansion and prosthetics. Who knows, in the future face transplantation may become routine but for the moment most surgeons maintain a healthy scepticism in the face of the complications from immunosuppressive therapy.

Getting into plastic and reconstructive surgery

Anatomy is the key if you are an undergraduate considering a career in plastic surgery. When a surgeon is carefully performing a dissection of the face a ‘Janet and John’ anatomical knowledge will not wash. Time spent learning anatomy will be repaid a hundredfold in your future career. Early exposure to specialities such as dermatology and intensive care would also be valuable. Plastic and reconstructive surgeons work closely with a vast array of other surgical specialities, but experience in breast surgery, otolaryngology, neurosurgery, orthopaedics, vascular surgery and paediatric surgery would all be beneficial. In an ideal world you should also gain experience that relates to your future area of sub-speciality interest in plastic surgery. As a specialty trainee you will need to master the art of meticulous dissection, master the anatomical details of a wide variety of flaps, become proficient in microsurgery, pass some fairly arduous exams and become skilled at assessing patients’ requirements and expectations. A large dose of determination goes a long way.

Top tips for those considering plastic and reconstructive surgery

When applying for training positions, be original and think outside the box. Do something different with your time that will grab the attention of a tired consultant ploughing through 100 CVs at midnight, for example, working in a far flung place cleaning hospitals and witnessing medical care in a different context. It is never too early to publish in the medical literature and it is never too early to go to the plastic surgery theatre, scrub in and help the consultant when his or her trainees have all gone off on an away day. If all you want is to be rich then take up plumbing or start your own business. However, if you want a rewarding career helping people with disfigurement, traumatic disability or pressure sores after spinal injury then plastic surgery may be for you.

Ken Stewart MBChB, MD, FRCS Ed (Plast) is a consultant plastic and reconstructive surgeon at NHS Royal Hospital for Sick Children, Edinburgh. He is also self-employed in private practice at BUPA Murrayfield, Edinburgh.