Reconstructive Procedures offered by Dr. Tumi
Click on the procedure to view more information.
Hand Surgery
Breast Surgery
Head & Neck
Other parts of the body
HAND SURGERY
In Canada, most of the hand surgery and medical management of hand health problems is performed by plastic surgeons.
Hand health problems include most of the problems for which people go to Emergency Departments. This includes infection, animal bites, burns, wounds of any kind, broken bones or any other problems seen daily in any Emergency Department. The more simple hand problems are managed by the Emergency room physicians. The more complex hand problems are generally referred to plastic surgeons.
Most broken bones of the hand heal with casting for a period of 2-4 weeks. However, some fractures will require surgery to better align the broken fragments. This is especially true if the break occurs into a joint where arthritis is more likely to occur if the broken fragments are not properly lined up.
When nerves in the hand are cut accidentally they are repaired by plastic surgeons. Fingers or thumbs are numb after nerve injuries. If a successful nerve repair operation is possible some of the feeling does return to the involved finger or thumb tip several weeks or months after the operation. Patients are usually out of work 2-3 weeks with these injuries, but they must be careful to protect the numb parts until sensation returns.
Tendons are the cords underneath the skin responsible for finger and thumb movement. When severed, these need to be repaired with surgery in order to regain normal finger function. Tendon injuries usually result in several weeks of absence from work.
Carpal Tunnel Syndrome is a very common hand problem affecting up to 3% of Canadians. With this condition, there is usually numbness of the thumb, index, long finger and half of the ring finger. The numbness often begins in the night and may respond to splinting the wrist straight while sleeping. However, it may progress to daytime numbness and sometimes associated pain. Carpal Tunnel Syndrome is explained by a lack of room for the median nerve in the carpal tunnel of the hand. Surgery has a greater than 90% success rate for this problem and usually requires a 4-8 week absence from work.
Trigger finger is another hand problem where the finger becomes stuck as it flexes into the palm. The other hand is usually used to pull the finger out straight; this is accompanied by "popping" and pain.
Trigger finger is caused by a tendon whose bulge becomes too big to smoothly traverse within its tunnel. Trigger finger is curable with an operation under local anesthesia to release the tunnel and allow smooth tendon gliding.
Dupuytren's contracture of the hand is a frequently inherited problem which results in the gradual bending of the ring, small or other fingers into the palm with the inability to get it out straight no matter how hard you try. It is caused by deposition of tissues in the hand that cause contracture. Surgery involves removing these contractile tissues. Although it does not cure this disease, relief and improved function with the ability to straighten the fingers often lasts many years after the operation .
For further information about hand surgery please click here: ASPS
Breast Reduction
If you find that your breasts are very large and heavy, and that they create
discomfort to your shoulders, back and neck, you may be a candidate for a breast
reduction.
While a breast reduction can be performed in
the teenage years, it is recommended that
the procedure be undertaken only when
breast development is completed and when
sufficient maturity has been attained to
understand all of the issues involved.
Childbirth and breast-feeding can also have
a significant effect on the size and shape of
your breasts. Though some women decide
to have breast reduction before having
children, you should discuss plans to breast-feed with your plastic surgeon, as this may
not be possible after breast reduction.
In assessing you as a candidate for breast reduction, your doctor will carefully
check the size and shape of your breasts, the quality of your skin and the
placement of the nipples and areolas. If you are overweight, your plastic surgeon
may suggest that you lose weight before having surgery.
There are variations to the incisions used for
breast reduction. Dr. Tumi usually uses a vertical incision technique.
After excess skin and breast tissue is removed, the
nipple and areola are moved to a higher
position. Skin that was located above the
nipple pre-surgery is pulled down. Together
these two maneuvers give a new shape to
the breast.
Liposuction may also be employed to improve the contour of the breast.
Because the nipples and areolas remain
attached to the breast tissue, sensation
in this area is preserved most of the time but
numbness can occur after breast reduction.
Some of the possible complications of this
surgery include bleeding, scarring, nipple necrosis, asymmetry, infection and
reactions to anesthesia. The breasts may not
be exactly the same or nipple height may
vary after surgery.
Several days after surgery you will be able to
move about comfortably. You may be
asked to wear a support bra for a few weeks,
until swelling and discoloration diminish. Incisions will be red at first and normally stay this way for several months following surgery. After breast reduction surgery, it is usually possible to return to work within a month of surgery.
For further information about breast reduction, please visit ASPS and www.plasticsurgery.ca
BREAST RECONSTRUCTION
Mastectomy is a traumatic experience for
any woman. Breast reconstruction is an
alternative for women of any age providing
your health is good enough for you to
tolerate a general anesthetic.
There are two basic ways of reconstructing a
breast or both breasts - prosthetic implants or
using your own tissue. Your surgeon will
discuss with you the risks and benefits of
implants versus using your own tissue to
reconstruct your breast(s).
Prosthetic implants usually consist of silicone
shell implants enclosing saline (salt water)
or silicone. Dr. Tumi prefers to use silicone implants. The implants are usually placed underneath
the muscle of the chest wall. Although
implant surgery is usually more simple and shorter
than using your own tissue, the complication
rate of implant surgery and the need to
operate again at a later date is higher with
implants. Implants have a higher rate of complications
if you have had radiation to the chest skin.
Implants placed under the skin are more
convenient than prostheses placed in your
brassiere. However, the body's reaction to
these can be a capsule or envelope
surrounding the implant making the breast
hard and tender. In addition, implants do not
have the same natural feel as would transplanting your own tissue.
After mastectomy, the skin envelope may not
be large enough to allow for an implant and
skin expansion may be required before the "permanent" implant is inserted. Tissue
expansion is done by inserting an expandable
silicone "balloon" which is inflated with salt
water weekly by your surgeon. When enough
skin is available the implant can be inserted.
Using your own tissue is called autologous
reconstruction. Autologous reconstruction
involves transferring soft tissues (skin, fat)
from other areas of the body. Because of the
frequent excess tissues and because of the
convenient anatomy skin from the lower belly
is often a preferred area for harvesting
autologous tissues for breast reconstruction
(TRAM flap reconstruction). Less commonly,
other areas can also be harvested, i.e.
buttock, thigh or back. Complications of using your own tissue
include the small chance that the transplanted tissue does not survive. There are other complications associated with the four hour surgery including
hernia if the tissue is taken from the abdomen.
It is important to understand that a "normal" breast will never be obtained with a
breast reconstruction operation and realistic expectations are in order. However,
patient satisfaction is generally high.
Please also see the ASPS site, www.breastreconstruction.ca and www.plasticsurgery.ca for further information about breast reconstruction.
POST TRAUMATIC RHINOPLASTY
While there is no upper age limit for having rhinoplasty patients may be advised
to wait until they are 16 (when the nose is fully developed) before considering
undergoing rhinoplasty.
Sometimes breathing problems related to
the internal nasal structures can be
corrected at the same time as nose
reshaping. It is important to have a clear
idea of how you would like your nose to look
as well as to know there are some
limitations to aesthetic nasal surgery.
Your plastic surgeon may ask whether you
have difficulty breathing through your nose,
suffer from allergies or use nasal spray
excessively.
In evaluating you for rhinoplasty, your plastic surgeon will examine your nose both
internally and externally. Skin quality as well as the size and shape of your nose
must be carefully studied. Sometimes, chin augmentation may be suggested so
that a more harmonious facial balance can be achieved.
With rhinoplasty, work is done on the
cartilage and bone that form the structure of
your nose. Certain bones may
need to be altered in order to make your
nose look narrower and straighter.
If your nose needs to be augmented, this
can be accomplished using cartilage from
your nose or cartilage from another part of
the body. The skin and soft tissues will
re-position themselves over the new form of
your nose. In most cases, incisions will be placed
inside your nose so they will not be visible.
If the base of the nose is narrowed or the
nostrils reduced, small pieces of skin below
the nostrils will be removed.
When external incisions are recommended
they are placed in well hidden areas like the
crease where the nose and cheek join or
where the nose and the lip join. Skin numbness after rhinoplasty may occur but is usually temporary.
Occasionally, extra surgery may be necessary to refine the result. Bruising is mostly gone after a week and you can use concealing makeup if you
wish. Swelling, however, can last a number of weeks or months though residual
swelling usually affects just the nasal tip.
For further information about rhinoplasty, please visit ASPS or www.plasticsurgery.ca
BURNS OR SKIN CANCEr defect reconstruction
More than one in four fair skinned Canadians who are currently alive will get a skin
cancer in their lifetime. Plastic surgeons are involved in removing a large share of
these as most of them occur on the "sun belt" of the face which includes the
nose, cheeks, temples and ears. Almost all skin cancers are caused
by sunburns. Aging Canadians should also not burn as the damage caused by
ultraviolet light is not as well reversed by DNA repair enzymes as you age. In
other words, the older you are when you get sunburn, the more likely you are to
get a skin cancer from the sunburn. This is why no one should sunburn anymore.
The longer you wait to have a skin cancer removed, the bigger it gets, and the
more complicated the reconstruction becomes to make the patient look as close
to normal as possible. This is why it is best treated early while it is still small.
Basal cell skin cancer is the most common kind of skin
cancer. It is usually a smooth
pink or red flat or lumpy area. Basal skin cancer does not go away but gradually gets larger and larger. These
cancers generally do not know how to spread elsewhere (metastasize). They
therefore do not generally get into the blood and do not spread to the lungs, liver
or brain as do many cancers such as breast or bowel cancer. Basal cell skin cancer generally never kills
people unless you refuse to do something about it and you let it grow out of
control, as it will not stop growing. The cure rate with removing these surgically is
over 95%. Those who are not cured simply have not had all of the cancer cells
removed and will require additional surgery to remove the leftover cancer for cure.
Squamous cell skin cancer is very much the same as basal
cell skin cancer in appearance
except the red areas tend to
have hard rough spots on
them and bleed more easily.
Squamous cell skin cancers also have a slightly higher risk of metastasizing than
basal cell skin cancers. However, the risk of metastasis and death is usually less
than 5% if the squamous cell skin cancer is in a sun induced area (i.e. not on the
genitals, inside the mouth or in the anal areas). Squamous cell skin cancers on
the hand, the lip and the ear do have a higher risk of metastasis than sun induced
squamous cell skin cancers on the rest of the face and body.
Malignant melanoma occurs in 1% of fair skinned Canadians. This kind of cancer
does know how to metastasize and result in death. However, if you catch it early
and have it removed, the cure rate is high.
There are three things that make
melanoma obvious, as this is
not a subtle skin cancer in most
instances:
- Melanoma is usually black or has black in it and arises from moles 1/3 of the
time
- Melanoma tends to grow quickly and will often double in size over weeks
- Melanoma tends to have an unusual or irregular shape as opposed to benign moles which are usually round or
oval
If you have a thin melanoma (<1mm thick) your plastic surgeon will usually
recommend a 1cm excision of normal looking skin around the tumour followed by
no further treatment. If you have an intermediate thickness melanoma (1-4mm
thick) you will usually have 2cm of normal looking skin removed from either side
of the tumour followed by a sentinel (first relay) lymph node dissection.
Dr. Tumi will discuss the details of this with you. For further information about skin cancer treatment, please visit ASPS and www.plasticsurgery.ca
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