Plastic and Reconstructive Surgery

The Division of Plastic and Reconstructive Surgery at Montefiore provides patients with a full complement of cosmetic and reconstructive options, including non-traditional techniques and procedures that have been developed and used in our Department.

Pioneers of New Procedures

Among some of the newer developments are the body-contouring procedures for post-gastric bypass patients with radical weight loss. A staged approach has been used to trim away massive amounts of excess skin – first in a complicated, mid-body lift (circumferential abdominoplasty), and subsequently in further body contouring procedures. These include trimming underarm "bat wings" (brachioplasty), as well as breast, thigh, face, neck, and back lifts. There is a remarkably low incidence of complications; operating time has been reduced; and scarring has been minimized.

In addition to the expected and usual facial and breast plastic surgery, our Division has pioneered such advances as the "weave lift," a procedure developed to re-suspend and reshape sagging facial structures along specific anatomic lines. Careful placement of sutures provides lateral brow elevation, mid-face elevation, lower face suspension, and neck suspension. The average weave lift requires only about 60 minutes; general anesthesia is not required; and maintenance of results has been demonstrated up to 2 years postoperatively. Other developments have included the transfer of dermafat to correct facial wasting in HIV/AIDS patients, and the use of irradiated cartilage for sophisticated nasal plastic surgery.

Advancements in Replantation and Reconstructive Surgery

In the early 1970's, we were the first EMS-designated replant center in New York City and led the advancement of microvascular surgery in the area. Our center continues to treat approximately 40 to 50 patients a year who have sustained limb-threatening injuries; they come from as close as New York City and as far as the Upper Hudson Valley, Connecticut, and Western Massachusetts. While most amputations are of the fingers, at least two a year are of the forearm or higher.

In addition to trauma microvascular surgery, our surgeons are involved with reconstructive microsurgery. We work closely with surgeons from other specialties in order to provide immediate reconstruction after tumor resection for various cancers, such as head and neck cancers, breast cancer, and soft-tissue sarcomas. Large complex wounds and ulcerating irradiated wounds occasionally require bringing into a poorly healing area, tissue with its own blood supply that needs to be "plugged in" to vessels close by. Because of the small diameter of these vessels, the anastomosis is performed with the use of an operating microscope with thread as thin as a strand of human hair.

History of Innovation

In the area of peripheral nerve surgery, our division has a long history of innovation, and that tradition continues today with an active research laboratory. Our researchers are currently investigating modalities to increase or accelerate tissue growth and healing. Clinically, our surgeons have the specialized expertise and training in peripheral nerve and microsurgery to release, repair, and/or graft peripheral nerves as large as 10 millimeters or as small as digital nerves of two millimeters in diameter. Our center is one of a few institutions in the country where cutting-edge nerve-transfer procedures are performed for patients with paralyzed limbs. This requires taking healthy, undamaged nerves and splicing a portion of the healthy nerve into damaged non-functioning nerves without compromising or reducing the function of the uninjured nerve. For patients who have nerve injuries at the level of the spinal roots or at multiple levels, this is often the only option to reanimate the paralyzed extremity.

Our surgeons' activities in the craniofacial area continue with the correction of birth defects including lip and palate clefting. The recent successful separation of twin boys conjoined at the head drew an enormous amount of media coverage, and members of the team have been consulted internationally for their help in other cases of this nature. Working with the center of the craniofacial defects, the surgical and sociological problems engendered in these defects are treated holistically.