*This article is brought to you by APRASSA: The Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa*
Find a plastic surgeon www.aprassa.co.za | +27 (0)11 784 4537
Both the plastic and reconstructive surgery fields hail from ancient roots, with reconstructive surgery techniques (including nose surgery), being carried out in 800 BC, India. In fact, its complex surgical techniques are documented in the book, Sushruta Samhita.3
Meanwhile, modern plastic surgery made its most significant advances in the last century, largely as a result of the two world wars. Pioneering plastic surgeons, Sir Harold Gillies, and Sir Archibald McIndoe innovated many techniques whilst treating soldiers – particularly airman who had burns after being shot down.
This led to the formation of the “Guinea Pig” club, which was founded by the airmen who had been operated on. This club was the first patient support group for burn disfigurements,5 with its members continuing to meet annually until 2007.
However, prior to World War II, plastic surgery did not exist as a specific surgical speciality, neither were there any recognised or registered plastic surgeons around during this era. It was only after the war that training programs were started across the globe.
Then, in the early 1940s, one Major Jack Penn and one Lieutenant Colonel Norman Petersen were sent by the South African army to England, with the orders to work under Sir Harold Gillies and St Archibald MacIndoe in the burns and plastic surgery unit at East Grinstead. These two men ultimately came to be the first South African plastic surgeons.7
History in the making
And so, upon their return to South Africa, Jack Penn set up the Brenthurst Military hospital for plastic surgery in Johannesburg, whilst Norman Petersen created a similar unit at the Springfield Military hospital in Durban. This is where they remained to treat and operate on thousands of injured and burnt military servicemen. After the war, the training of plastic surgeons began at UCT in 1945, and at Wits in 1948 thereafter, with other university units starting in the 1950s.
This was followed by the creation of the Association of Plastic Surgeons of Southern Africa in 1956.
As for Jack Penn, he not only travelled annually to Japan to assist with the reconstruction of patients post WWII, but also found the time to become a founding member of the Japanese Association of Plastic Surgeons. What’s more, he published a journal entitled The Brenthurst Papers, which may have been the first journal devoted entirely to plastic and reconstructive surgery in the English language.6
A rose by any other name… Plastic surgery vs reconstructive surgery vs aesthetic or cosmetic surgery. How do they differ from each other?
- Plastic surgery is defined as the surgical speciality concerned with improving both the aesthetic appearance and functionality of a patient’s body, thus encompassing both cosmetic and reconstructive surgery.
- Reconstructive surgery entails the rebuilding of missing or damaged body parts to improve the appearance and physical function. Reconstructive procedures include a broad range of surgeries that are used to treat injuries or deformities caused by trauma, birth defects, or medical conditions such as cancer and infection.
- Aesthetic or cosmetic surgery involves procedures which are performed to enhance the cosmetic appearance of the patient by adjusting and reshaping the tissues to create a form closer to an “ideal”, with the end goal being the enhancement of one’s physical appearance.
So, taking into account the abovementioned facts on the origins and back history of these surgical fields, it’s evidently clear that both reconstructive and aesthetic components are intimately intertwined – with training in plastic surgery requiring mastery of both components.
In almost every procedure we undertake, both elements will be present – since a decent reconstruction must not only restore function – but has to look acceptable as well. Similarly, most cosmetic surgery techniques were born from understanding the principles learnt through the development of reconstructive procedures.
A symbiotic union
The fusion of cosmetic and reconstructive surgical procedures has resulted in many successful outcomes. Take cleft lip and palate surgeries, for instance: these procedures correct the child’s appearance, as well as their ability to feed and speak normally.
Another excellent example of this synthesis at work is the combined procedure of tummy tuck, liposuction and breast reconstruction. Below is a simplified step-by-step guide on how this works:
- Microsurgery allows the transfer of tissue block with a blood and nerve supply.
- Should there be some mastectomy defects, the lower abdominal skin and fat may be transferred to the chest to form a “breast”.
- The donor site is then closed as a tummy tuck.
- Contouring of the new breast and abdomen is then done at a later stage, along with liposuction and fat grafting.
The best conclusion comes from 16th-century Italian surgeon, Gaspare Tagliacozzi, whose 1597 text has become synonymous with plastic surgery. He wrote: “We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.”4
2.) “Plastic”. Etymonline. https://www.etymonline.com/word/plastic
APRASSA is the Association of Plastic Reconstructive and Aesthetic Plastic Surgery of Southern Africa.
To find an APRASSA member plastic surgeon please go to www.aprassa.co.za or call +27 11 784 4537).
Written by Dr Isabel Do Vale and Dr Marshall Murdoch
Dr Isabel Do Vale
MBChB (Wits), FC Plast Surg (SA)
- Practises at www.plasticsurgeon-johannesburg.co.za
- Executive committee member of APRASSA (The Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa) www.aprassa.co.za
- Member of ISAPS (International Society of Aesthetic Plastic Surgery) www.isaps.org
- Currently holds a consultant teaching post at Charlotte Maxeke Johannesburg Academic Hospital, and practises at Netcare Linksfield Hospital
Dr Marshall Murdoch
BSc, MB BCh, FC PlastSurg (SA)
- Plastic & Reconstructive Surgeon www.drmjmurdoch.co.za
- Special interests in aesthetics, oncoplastic reconstructive surgery and microsurgery
- Executive committee member of ISAPS and APRASSA www.aprassa.co.za
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Isabel Do Vale and Dr Marshall Murdoch and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Autumn Edition (Mar – Jun 2022: Issue 40).
A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skincare, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).
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