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'''Surgical oncology''' is the branch of [[surgery]] which focuses on the surgical management of malignant neoplasms ([[cancer]]).
'''Plastic surgery''' is a general term for operative manual and instrumental treatment which is performed for functional or [[aesthetic]] reasons. The word "plastic" derives from the Greek ''plastikos'' meaning to mold or to shape; its use here is not connected with modern [[plastics]].
Whether surgical oncology constitutes a medical specialty ''per se'' is the topic of a heated debate. Today, some would agree that it is simply impossible for any one surgeon to be competent in the surgical management of ''all'' malignant disease. However, there are currently 14 surgical oncology fellowship training programs in the United States that have been approved by the Society of Surgical Oncology. While many general surgeons are actively involved in treating patients with malignant neoplasms, the designation of "surgical oncologist" is generally reserved for those surgeons who have completed one of the approved fellowship programs. However, this is a matter of semantics, as many surgeons who are thoroughly involved in treating cancer patients may consider themselves to be surgical oncologists.
The principal areas of plastic surgery include two broad fields.
* Reconstructive surgery, including [[microsurgery]], focuses on undoing or masking the destructive effects of [[Physical trauma|trauma]], surgery or [[disease]]. Reconstructive surgery may include closing defects using skin grafts or with local, regional or distant flaps—that is, by moving tissue from other parts of the body.
* Cosmetic (or aesthetic) surgery is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons (for example, [[breast reduction]] when [[orthopedics|orthopedic]] problems are present).
Most often, ''surgical oncologist'' refers to a general surgical oncologist (cf. [[General Surgery]]), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients.
==History==
The history of cosmetic surgery reaches back to the ancient world. Physicians in [[ancient India]] including the great Indian surgeon [[Susrutha]] were utilizing [[skin graft]]s for reconstructive work as early as the [[8th century BC]]. His work ''Sushruta Samhita'' describes [[rhinoplasty]] and [[otoplasty]]. This knowledge of plastic surgery existed in [[India]] up to the late 18th century as can be seen from the reports published in ''Gentleman's Magazine'' (October 1794). [http://vigyanprasar.com/dream/jan2000/article2.htm] [http://members.ozemail.com.au/~oknoses/Overview.html]
The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of [[clinical trials]], that outcomes in surgical cancer care are positively associated to surgeon volume -- i.e. the more [[cancer]] cases a surgeon treats, the more proficient he becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted -- even as common sense -- that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of cancer resections such as [[pancreaticoduodenectomy]] (Whipple procedure) for pancreatic cancer, and [[gastrectomy]] with extended (D2) [[lymphadenectomy]] for gastric cancer.
The [[Ancient Rome|Romans]] were able to perform simple techniques such as repairing damaged ears from around the [[1st century BC]]. In mid-[[15th century]] Europe, [[Heinrich von Pfolspeundt]] described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the [[19th century|19th]] and [[20th century|20th centuries]] that such surgeries became commonplace.
The [[United States|U.S.'s]] first plastic surgeon was [[John Peter Mettauer|Dr. John Peter Mettauer]]. He performed the first [[cleft|cleft palate]] operation in [[1827]] with instruments that he designed himself. The New Zealander [[Harold Gillies|Sir Harold Gillies]] developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in [[World War I]], he is considered to be the father of modern plastic surgery. His work was expanded upon during [[World War II]] by one of his former students and cousin, [[Archibald McIndoe]], who pioneered treatments for [[Royal Air Force|RAF]] aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the [[Guinea Pig Club]].
*[http://www.esso-surgeonline.be European Society of Surgical Oncology]
* [http://www. plasticsurgerysurgonc.org / The American Society of PlasticSurgical SurgeonsOncology] ▼
==Reconstructive surgery==
Common reconstructive surgeries are: [[breast reconstruction]] for women who have had a [[mastectomy]], [[cleft|cleft lip and palate surgery]], [[contracture]] surgery for [[burn]] survivors, and closing skin and [[mucosa]] defects after removal of tumors in the head and neck region. [[Sex reassignment surgery]] for [[transsexual]] people is another example of reconstructive surgery.
Plastic surgeons have developed the use of [[microsurgery]] to transfer tissue for coverage of a defect when no local tissue is available. Tissue "flaps" comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.
There is a definite gray area between reconstructive and cosmetic surgery. Many of the techniques of cosmetic surgery are utilized in reconstructive surgery to improve [[cosmesis]].
==Cosmetic surgery==
Cosmetic surgery is a very popular avenue for personal enhancement, as demonstrated by the 11.9 million cosmetic procedures performed in the U.S. alone in [[2004]]. As for any operation, cosmetic procedures involve risk, and should therefore not be undertaken lightly. Within the US, critics of plastic surgery note that it is legal for any [[Physician|doctor]], regardless of speciality, to perform "cosmetic surgery", but not "plastic surgery". It is thus important to distinguish the terms "plastic surgery" and "cosmetic surgery": Plastic Surgery is recognized by the [[American Board of Medical Specialties]] (the only official entity overseeing physician certification in the United States) as the subspecialty dedicated to the surgical repair of defects of form or function -- this includes cosmetic (or aesthetic) surgery, as well as reconstructive surgery. The term "cosmetic surgery" however, simply refers to surgery that is designed to improve cosmetics, or appearance. (One could argue that reconstructive surgery always has some cosmetic aspect to it, because form and function are often both important in plastic surgery repairs.) Thus there is no real art of "cosmetic surgery": it is a catch-all commercial phrase that laypeople understand easily and non-plastic surgeons eagerly use because they are not allowed to use the term "plastic surgery".
The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.
* [[Abdominoplasty]] (or "tummy tuck"): reshaping and firming of the [[abdomen]]
* [[Abdominal etching]] (or "ab etching": Specialized and trademarked liposuction surgery for male and female patients that affords six-pack abs or a flat, athletic, or countoured stomach.
* [[Blepharoplasty]] (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including [[Asian blepharoplasty]]
* [[breast implant|Augmentation Mammaplasty]] (or "breast enlargement" or "boob job"): Augmentation of the [[breast]]s. This can involve either saline or silicone gel prosthetics.
* [[Buttock Augmentation]] (or "butt augmentation" or "butt implants"): Enhancement of the [[buttock]]s. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
* [[Chemical peel]]: Removal of [[acne]] scars and sagging skin—not technically surgery and can be performed by a [[cosmetologist]]. Chemical peels commonly involve Phenol, TCA, or Glycolic acid as the active agent. Phenol peels, while the most effective, require cardiac monitoring and require longer recovery periods, thus diminishing their current popularity.
* [[Mastopexy]] (or "breast lift"): Raising of sagging breasts
* [[Labiaplasty]]: Surgical reduction and reshaping of the labia
* [[Rhinoplasty]] (or "nose job"): Reshaping of the [[nose]]
* [[Otoplasty]] (or ear surgery): Reshaping of the [[ear]]
* [[Rhytidectomy]] (or "face lift"): Removal of wrinkles and signs of aging from the face
* [[Liposuction|Suction-Assisted Lipectomy]] (or ''liposuction''): Removal of fat from the body
* [[Chin augmentation]]: Augmentation of the [[chin]] with an implant (e.g. silicone) or by [[sliding genioplasty]] of the jawbone.
* [[Cheek augmentation]]
* [[Collagen]], [[fat]], and other tissue filler injections (eg [[hyaluronic acid]])
* [[Mesotherapy]] : An alternative to liposuction where fluids are injected to break down and dissolve the fat (still a speculative treatment).
==Related disciplines==
Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the [[American Board of Plastic Surgery]] includes mastery of the following as well:
* [[Craniofacial surgery]] mostly revolves around the treatment of pediatric congenital anomalies, such as cleft lip and palate, craniosynostosis, and other disturbances in facial growth and development. Because these children have multiple issues, they are often taken care of in an interdisciplinary approach which include oral surgeons, otolaryngologists, speech therapists, occupational therapists, geneticists.
* [[Hand surgery]] is a field that has some overlap with [[general surgery|general surgeons]] and [[orthopedic surgery|orthopedic surgeons]] (see [[Hand surgeon]]). Plastic surgeons receive full training in hand surgery, with some trainees deciding even to do an additional full-year hand [[fellowship]] afterwards (this fellowship can also be pursued by general surgeons and orthopedic surgeons). In particular, plastic surgeons receive training in [[microvascular surgery]], which is needed to replant an amputated hand or digit. Many hand operations (such as reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects) are performed by plastic surgeons.
* [[Maxillofacial surgery]] is surgery of the "maxilla" (which means [[jaw]]) and face, and is an important aspect of plastic surgery. This field grew from contributions by both the plastic surgeons and oral surgeons. Examples of repairs here would be traumatic [[fractures]] of the jaw and face (such as from fights or vehicle accidents), tumors of the jaw and face.
== Addiction to cosmetic surgery ==
Some people appear to become addicted to cosmetic surgery, possibly because of [[body dysmorphic disorder]]. Sufficient amounts of repeated cosmetic surgery can lead to irreversible damage to the normal body structure. However, due to the high cost of repeated cosmetic surgery, this disorder is generally one limited to the [[wealth]]y. However, others have been known to take out loans for repeat procedures.
==See also==
* [[microsurgery]]
* [[breast reconstruction]], [[Breast reduction]], [[Breast implant]], [[Breast lift]]
* [[Operation Good Samaritan]][http://www.opgoodsam.org]
* [[Operation Smile]]
* [[Body modification]]
* [[Botox]]
* ''[[Dr. 90210]]''
* ''[[Extreme Makeover]]''
* ''[[Nip/Tuck]]''
===Plastic surgeons===
* [[Harry J. Buncke]]
* [[Wallace Chang]]
* [[Harold Gillies]]
* [[G. Patrick Maxwell]]
* [[Archibald McIndoe]]
* [[Joseph Murray]]
* [[Ivo Pitanguy]]
▲* [http://www.plasticsurgery.org/ The American Society of Plastic Surgeons]
* [http://www.surgery.org The American Society for Aesthetic Plastic Surgery]
* [http://www.abplsurg.org/ The American Board of Plastic Surgery]
* [http://www.emedicine.com/plastic/topic433.htm Emedicine's History of Plastic Surgery entry]
[[Category:Plastic surgery| Plastic surgeryOncology]]
[[Category: HumanSurgical appearanceoncology|*]] ▼[[Category:Surgical specialties]]
▲[[Category:Human appearance]]
[[de:PlastischeCancer Chirurgiesurgery]]
[[essl:CirugíaOnkološka plásticakirurgija]]
[[eu:Kirurgia plastiko]]
[[fr:Chirurgie plastique]]
[[he:ניתוח פלסטי]]
[[ja:形成外科学]]
[[pt:Cirurgia Plástica]]
[[sr:Пластична хирургија]]
[[sv:Plastikkirurgi]]
[[zh:整容]]
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